Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Cancer Med. 2023 Jun;12(12):13279-13289. doi: 10.1002/cam4.6019. Epub 2023 May 10.
To evaluate the impact of radiosensitivity on outcomes of spinal metastases treated with stereotactic body radiotherapy (SBRT) and identify the correlated prognostic factors.
The authors retrospectively reviewed the records of all patients who underwent SBRT with no prior radiation for spinal metastases between October 2015 and October 2020 at Sun Yat-sen University Cancer Center. On the basis of radiosensitivity, patients were divided into two groups-radiosensitive and radioresistant. The endpoints included local control (LC), overall survival (OS), pain relief, and time to pain relief.
A total of 259 (82.5%) patients with 451 lesions were assessable with a median follow-up time of 10.53 months. The 1-, 2-, and 3-year OS rates were 59%, 52%, and 44%, respectively. The median survival was 33.17 months. Higher Karnofsky Performance Scale score and shorter time to diagnosis of spinal metastases from primary cancer at consult predicted for better OS (p = 0.02 and p < 0.001, respectively). The presence of other metastases (p = 0.04) and pain at enrollment assessed by the Brief Pain Inventory predicted for worse OS (p = 0.01). The 6-, 12-, and 24-month LC rates were 88%, 86%, and 82%, respectively. Younger age was identified for better LC and pain relief (p < 0.001 and p = 0.04, respectively). There was no variable independently associated with time to pain relief. As for toxicity, no Grade ≥3 toxicity was observed.
Regardless of radiosensitivity, SBRT is feasible and appears to be an effective treatment paradigm for patients with spinal metastases, with limited accepted toxicities.
评估立体定向体部放疗（SBRT）治疗脊柱转移瘤的放射敏感性对结局的影响，并确定相关的预后因素。
作者回顾性分析了 2015 年 10 月至 2020 年 10 月中山大学肿瘤防治中心接受 SBRT 治疗且无既往放疗的脊柱转移瘤患者的病历。根据放射敏感性，将患者分为两组：敏感组和耐放射组。终点包括局部控制（LC）、总生存（OS）、疼痛缓解和疼痛缓解时间。
共 259 例（82.5%）患者的 451 处病变可评估，中位随访时间为 10.53 个月。1、2、3 年 OS 率分别为 59%、52%和 44%。中位生存时间为 33.17 个月。更高的 Karnofsky 表现量表评分和从原发性癌症确诊到脊柱转移的时间更短与更好的 OS 相关（p=0.02 和 p<0.001）。其他转移的存在（p=0.04）和登记时简明疼痛量表评估的疼痛与更差的 OS 相关（p=0.01）。6、12 和 24 个月的 LC 率分别为 88%、86%和 82%。年龄较小与更好的 LC 和疼痛缓解相关（p<0.001 和 p=0.04）。没有一个变量与疼痛缓解时间独立相关。至于毒性，没有观察到≥3 级毒性。
无论放射敏感性如何，SBRT 对脊柱转移瘤患者都是可行的，且似乎是一种有效的治疗模式，毒性有限。
