Department of Radiotherapy and CyberKnife Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China.
Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China.
Cancer Sci. 2022 Dec;113(12):4277-4288. doi: 10.1111/cas.15559. Epub 2022 Sep 16.
Owing to the complex anatomical structure and biomechanics, the current standard palliative treatments for cervical spinal metastases are associated with a high risk of recurrence and complications. Stereotactic body radiotherapy (SBRT) can provide radical dose to tumors while protecting normal organs to the maximum extent. However, the efficacy and safety of SBRT for cervical spinal metastases is not well characterized. Data from 71 patients with cervical spine metastases who were treated with SBRT using CyberKnife between 2006 and 2021 were obtained from our prospectively maintained database. Primary endpoint was pain response at 12 weeks following SBRT completion; secondary endpoints included local control (LC), overall survival (OS), and adverse events. Standard-risk patients were planned to receive 30 Gy (range 21-36) with median fractions of 3 (range 1-3) and high-risk patients 35 Gy (range 24-50) with median fractions of 5 (range 4-5) according to the spinal cord and esophagus dose constraints. The median follow-up time was 17.07 months (range 3.1-118.9). After 12 weeks of SBRT completion, 54 (98.2%) of 55 patients with baseline pain achieved pain response and 46 (83.6%) achieved complete pain response. LC rates were 93.1% and 90% at 1 year and 2 year, respectively. The 1-year and 2-year OS rates were 66.2% and 37.4%, respectively. Eight patients experienced grades 1-4 adverse events (six vertebral compression fracture [VCF], five of them had VCF before SBRT; and two hemiparesis). No grade 5 adverse events were observed. Therefore, risk-adapted SBRT for cervical spine metastases achieved high pain control and LC rates with acceptable adverse events.
由于颈椎解剖结构复杂，生物力学特性特殊，目前针对颈椎转移瘤的标准姑息性治疗方法存在较高的局部复发和并发症风险。立体定向放疗（SBRT）可在最大程度保护正常器官的前提下，为肿瘤提供根治性剂量。然而，SBRT 治疗颈椎转移瘤的疗效和安全性尚未得到充分证实。我们从前瞻性维护的数据库中获取了 2006 年至 2021 年间使用 CyberKnife 行 SBRT 治疗的 71 例颈椎转移瘤患者的数据。主要终点为 SBRT 治疗结束后 12 周的疼痛缓解情况；次要终点包括局部控制率（LC）、总生存率（OS）和不良事件。根据脊髓和食管剂量限制，标准风险患者计划接受 30Gy（范围 21-36），中位数分割次数为 3（范围 1-3）；高风险患者计划接受 35Gy（范围 24-50），中位数分割次数为 5（范围 4-5）。中位随访时间为 17.07 个月（范围 3.1-118.9）。SBRT 治疗结束后 12 周，55 例基线疼痛患者中有 54 例（98.2%）达到疼痛缓解，46 例（83.6%）达到完全疼痛缓解。1 年和 2 年时的 LC 率分别为 93.1%和 90%。1 年和 2 年 OS 率分别为 66.2%和 37.4%。8 例患者发生 1-4 级不良事件（6 例椎体压缩性骨折[VCF]，其中 5 例在 SBRT 前已发生 VCF；2 例偏瘫）。未观察到 5 级不良事件。因此，颈椎转移瘤的风险适应性 SBRT 可实现较高的疼痛控制和 LC 率，并具有可接受的不良事件。
