单次和多次分割脊柱立体定向体部放射治疗与放射性脊髓病风险
Single and Multifraction Spine Stereotactic Body Radiation Therapy and the Risk of Radiation Induced Myelopathy.
作者信息
Lucido J John, Mullikin Trey C, Abraha Feven, Harmsen W Scott, Vaishnav Birjoo D, Brinkmann Debra H, Kowalchuk Roman O, Marion Joseph T, Johnson-Tesch Benjamin A, El Sherif Omar, Brown Paul D, Rose Peter S, Owen Dawn, Morris Jonathan M, Waddle Mark R, Siontis Brittany L, Stish Bradley J, Pafundi Deanna H, Laack Nadia N, Olivier Kenneth R, Park Sean S, Merrell Kenneth W
机构信息
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Department of Radiation Oncology, Duke University, Durham, North Carolina.
出版信息
Adv Radiat Oncol. 2022 Aug 13;7(6):101047. doi: 10.1016/j.adro.2022.101047. eCollection 2022 Nov-Dec.
PURPOSE
This study reports on the risk of radiation-induced myelitis (RM) of the spinal cord from a large single-institutional experience with 1 to 5 fraction stereotactic body radiation therapy (SBRT) to the spine.
METHODS AND MATERIALS
A retrospective review of patients who received spine SBRT to a radiation naïve level at or above the conus medullaris between 2007 and 2019 was performed. Local failure determination was based on SPIne response assessment in Neuro-Oncology criteria. RM was defined as neurologic symptoms consistent with the segment of cord irradiated in the absence of neoplastic disease recurrence and graded by Common Toxicity Criteria for Adverse Events, version 4.0. Rates of adverse events were estimated and dose-volume statistics from delivered treatment plans were extracted for the planning target volumes and spinal cord.
RESULTS
A total of 353 lesions in 277 patients were identified that met the specified criteria, for which 270, 70, and 13 lesions received 1-, 3-, and 5-fraction treatments, respectively, with a median follow-up of 46 months (95% confidence interval [CI], 41-52 months) for all surviving patients. The median overall survival was 33.0 months (95% CI, 29-43). The median D0.03cc to the spinal cord was 11.7 Gy (interquartile range [IQR], 10.5-12.4), 16.7 Gy (IQR, 12.8-20.6), and 26.0 Gy (IQR, 24.1-28.1), for 1-, 3-, 5-fractions. Using an a/b = 2Gy for the spinal cord, the median single-fraction equivalent-dose (SFED) was 11.7 Gy (IQR, 10.2-12.5 Gy) and the normalized biological equivalent dose (nBED) was 19.9 Gy (IQR, 15.4-22.8 Gy). One patient experienced grade 2 RM after a single-fraction treatment. The cumulative probability of RM was 0.3% (95% CI, 0%-2%).
CONCLUSIONS
Spine SBRT is safe while limiting the spinal cord (as defined on treatment planning magnetic resonance imaging or computed tomography myelogram) D0.03cc to less than 14 Gy, 21.9 Gy, and 30 Gy, for 1, 3, and 5-fractions, consistent with standard guidelines.
目的
本研究报告了在一家大型单机构中，对脊柱进行1至5次分割的立体定向体部放射治疗（SBRT）后发生放射性脊髓炎（RM）的风险。
方法和材料
对2007年至2019年间接受脊柱SBRT治疗、脊髓圆锥水平及以上初次接受放疗的患者进行回顾性研究。局部失败的判定基于神经肿瘤学标准中的脊柱反应评估。RM被定义为在无肿瘤疾病复发的情况下，出现与照射脊髓节段相符的神经症状，并根据不良事件通用毒性标准4.0版进行分级。估计不良事件发生率，并从已实施的治疗计划中提取计划靶体积和脊髓的剂量体积统计数据。
结果
共识别出277例患者的353个符合特定标准的病变，其中270个、70个和13个病变分别接受了1次、3次和5次分割治疗，所有存活患者的中位随访时间为46个月（95%置信区间[CI]，41 - 52个月）。中位总生存期为33.0个月（95% CI，29 - 43）。脊髓的中位D0.03cc分别为1次分割11.7 Gy（四分位间距[IQR]，10.5 - 12.4）、3次分割16.7 Gy（IQR，12.8 - 20.6）和5次分割26.0 Gy（IQR，24.1 - 28.1）。使用脊髓的a/b = 2Gy，中位单次分割等效剂量（SFED）为11.7 Gy（IQR，10.2 - 12.5 Gy），归一化生物等效剂量（nBED）为19.9 Gy（IQR，15.4 - 22.8 Gy）。1例患者在单次分割治疗后出现2级RM。RM的累积概率为0.3%（95% CI，0% - 2%）。
结论
脊柱SBRT是安全的，将脊髓（根据治疗计划磁共振成像或计算机断层脊髓造影定义）的D0.03cc限制在1次分割小于14 Gy、3次分割小于21.9 Gy和5次分割小于30 Gy，符合标准指南。
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