Florez Marcus A, De Brian, Cavazos Adriana, Farooqi Ahsan, Beckham Thomas H, Wang Chenyang, Yeboa Debra N, Bishop Andrew J, McAleer Mary F, Briere Tina, Amini Behrang, Li Jing, Tatsui Claudio E, Rhines Laurence D, Ghia Amol J
Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas.
Pract Radiat Oncol. 2023 Jan-Feb;13(1):e7-e13. doi: 10.1016/j.prro.2022.08.010. Epub 2022 Oct 24.
Intensity modulated radiation therapy (RT) for spine metastases using a simultaneous integrated boost (SSIB) was shown as an alternative to the treatment of select osseous metastases that are not amenable to spine stereotactic radiosurgery. We sought to update our clinical experience using SSIB in patients for whom dose escalation was warranted but spine stereotactic radiosurgery was not feasible.
A total of 58 patients with 63 spinal metastatic sites treated with SSIB between 2012 and 2021 were retrospectively reviewed. The gross tumor volume and clinical target volume were prescribed 40 and 30 Gy in 10 fractions, respectively.
The median follow-up time was 31 months. Of 79% of patients who reported pain before RT with SSIB, 82% reported an improvement following treatment. Patient-reported pain scores on a 10-point scale revealed a significant decrease in pain at 1, 3, 6, and 12 months after SSIB (P < .0001). Additionally, there were limited toxicities; only 1 patient suffered grade 3 toxicity (pain) following RT. There were no reports of radiation-induced myelopathy at last follow-up, and 8 patients (13%) experienced a vertebral column fracture post-treatment. Local control was 88% (95% confidence interval [CI], 80%-98%) and 74% (95% CI, 59%-91%) at 1 and 2 years, respectively. Overall survival was 64% (95% CI, 53%-78%) and 45% (95% CI, 34%-61%) at 1 and 2 years, respectively. The median overall survival was 18 months (95% CI, 13-27 months). Multivariable analysis using patient, tumor, and dosimetric characteristics revealed that a higher Karnofsky performance status before RT (hazard ratio, 0.44, 0.22-0.89; P = .02) was associated with longer survival.
These data demonstrate excellent pain relief and local control with limited acute toxicities following treatment with RT using SSIB to 40 Gy. Collectively, our data suggest that dose escalation to spine metastases using SSIB can be safe and efficacious for patients, especially those with radioresistant disease. Further investigation is warranted to validate these findings.
对于不适合脊柱立体定向放射外科治疗的特定骨转移瘤，使用同步整合加量（SSIB）的强度调制放射治疗（RT）已被证明是一种替代治疗方法。我们试图更新我们在那些有必要进行剂量递增但脊柱立体定向放射外科不可行的患者中使用SSIB的临床经验。
回顾性分析了2012年至2021年间接受SSIB治疗的58例患者的63个脊柱转移部位。大体肿瘤体积和临床靶体积分别给予40 Gy分10次和30 Gy分10次照射。
中位随访时间为31个月。在接受SSIB放疗前报告有疼痛的患者中，79%的患者在治疗后疼痛有所改善，报告疼痛改善的患者比例为82%。患者报告的10分制疼痛评分显示，SSIB治疗后1、3、6和12个月疼痛显著减轻（P <.0001）。此外，毒性反应有限；放疗后只有1例患者出现3级毒性反应（疼痛）。在最后一次随访时，没有放射诱发脊髓病的报告，8例患者（13%）在治疗后发生了脊柱骨折。1年和2年时的局部控制率分别为88%（95%置信区间[CI]，80%-98%）和74%（95% CI，59%-91%）。1年和2年时的总生存率分别为64%（95% CI，53%-78%）和45%（95% CI，34%-6１%）。中位总生存期为18个月（95% CI，13 - 27个月）。使用患者、肿瘤和剂量学特征进行的多变量分析显示，放疗前较高的卡氏功能状态（风险比，0.44，0.22 - 0.89；P = 0.02）与更长的生存期相关。
这些数据表明，使用SSIB将放疗剂量增至40 Gy后，能有效缓解疼痛并实现局部控制，且急性毒性反应有限。总体而言，我们的数据表明，对于患者，尤其是那些患有放射抗拒性疾病的患者，使用SSIB对脊柱转移瘤进行剂量递增可能是安全有效的。有必要进行进一步研究以验证这些发现。
