Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Radiation Oncology and Amsterdam Cancer Center, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands.
Semin Radiat Oncol. 2023 Apr;33(2):159-171. doi: 10.1016/j.semradonc.2022.11.006.
Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients with painful vertebral metastases, metastatic spinal cord compression, oligometastatic disease and in a reirradiation situation. Outcomes after dose-intensified SBRT are compared with results of conventional radiotherapy and patient selection criteria will be discussed. Though rates of severe toxicity after spinal SBRT are low, strategies to minimize the risk of vertebral compression fracture, radiation induced myelopathy, plexopathy and myositis are summarized, to optimize the use of SBRT in multidisciplinary management of vertebral metastases.
生物癌症特征、靶向全身治疗和多模式治疗策略的进展已经将脊柱转移放疗的目标从短期缓解转变为长期症状控制和并发症预防。本文概述了脊柱立体定向体部放疗（SBRT）的方法学以及 SBRT 在伴有疼痛性椎体转移、转移性脊髓压迫、寡转移疾病和再放疗情况下的癌症患者中的临床结果。剂量递增 SBRT 的结果与常规放疗的结果进行了比较，并讨论了患者选择标准。尽管脊柱 SBRT 后严重毒性的发生率较低，但为了优化 SBRT 在脊柱转移多学科管理中的应用，总结了降低椎体压缩骨折、放射性脊髓病、丛病和肌炎风险的策略。
