Shanker Mihir D, Cavazos Adriana P, Li Jing, Beckham Thomas H, Yeboa Debra N, Wang Chenyang, McAleer Mary Frances, Briere Tina Marie, Amini Behrang, Tatsui Claudio E, North Robert Y, Alvarez-Breckenridge Christopher A, Cezayirli Phillip Cem, Rhines Laurence D, Ghia Amol J, Bishop Andrew J
The University of Texas MD Anderson Cancer Centre, United States; The University of Queensland, Brisbane, Australia.
The University of Texas MD Anderson Cancer Centre, United States.
Radiother Oncol. 2024 Apr;193:110119. doi: 10.1016/j.radonc.2024.110119. Epub 2024 Feb 3.
Sarcoma spinal metastases (SSM) are particularly difficult to manage given their poor response rates to chemotherapy and inherent radioresistance. We evaluated outcomes in a cohort of patients with SSM uniformly treated using single-fraction simultaneous-integrated-boost (SIB) spine stereotactic radiosurgery (SSRS).
A retrospective review was conducted at a single tertiary institution treated with SSRS for SSM between April 2007-April 2023. 16-24 Gy was delivered to the GTV and 16 Gy uniformly to the CTV. Kaplan-Meier analysis was conducted to assess time to progression of disease (PD) with proportionate hazards modelling used to determine hazard ratios (HR) and respective 95 % confidence intervals (CI).
70 patients with 100 lesions underwent SSRS for SSM. Median follow-up was 19.3 months (IQR 7.7-27.8). Median age was 55 years (IQR42-63). Median GTV and CTVs were 14.5 cm (IQR 5-32) and 52.7 cm (IQR 29.5-87.5) respectively. Median GTV prescription dose and biologically equivalent dose (BED) [α/β = 10] was 24 Gy and 81.6 Gy respectively. 85 lesions received 24 Gy to the GTV. 27 % of patients had Bilsky 1b or greater disease. 16 of 100 lesions recurred representing a crude local failure rate of 16 % with a median time to failure of 10.4 months (IQR 5.7-18) in cases which failed locally. 1-year actuarial local control (LC) was 89 %. Median overall survival (OS) was 15.3 months (IQR 7.7-25) from SSRS. Every 1 Gy increase in GTV absolute minimum dose (DMin) across the range (5.8-25 Gy) was associated with a reduced risk of local failure (HR = 0.871 [95 % CI 0.782-0.97], p = 0.009). 9 % of patients developed vertebral compression fractures at a median of 13 months post SSRS (IQR 7-25).
This study represents one of the most homogenously treated and the largest cohorts of patients with SSM treated with single-fraction SSRS. Despite inherent radioresistance, SSRS confers durable and high rates of local control in SSM without unexpected long-term toxicity rates.
肉瘤脊柱转移瘤（SSM）因其对化疗反应率低和固有的放射抵抗性而特别难以治疗。我们评估了一组使用单次分割同步整合加量（SIB）脊柱立体定向放射外科（SSRS）进行统一治疗的SSM患者的治疗结果。
在一家单一的三级医疗机构进行回顾性研究，该机构在2007年4月至2023年4月期间对SSM患者进行了SSRS治疗。向大体肿瘤体积（GTV）给予16 - 24 Gy的剂量，并向临床靶体积（CTV）均匀给予16 Gy的剂量。采用Kaplan-Meier分析评估疾病进展时间（PD），并使用比例风险模型确定风险比（HR）和各自的95%置信区间（CI）。
70例患者的100个病灶接受了SSM的SSRS治疗。中位随访时间为19.3个月（四分位间距7.7 - 27.8）。中位年龄为55岁（四分位间距42 - 63）。GTV和CTV的中位体积分别为14.5 cm（四分位间距5 - 32）和52.7 cm（四分位间距29.5 - 87.5）。GTV处方剂量和生物等效剂量（BED）[α/β = 10]的中位值分别为24 Gy和81.6 Gy。85个病灶的GTV接受了24 Gy的剂量。27%的患者患有Bilsky 1b级或更高级别的疾病。100个病灶中有16个复发，粗局部失败率为16%，局部失败的病例中位失败时间为10.4个月（四分位间距5.7 - 18）。1年精算局部控制率（LC）为89%。从SSRS开始计算的中位总生存期（OS）为15.3个月（四分位间距7.7 - 25）。在整个范围（5.8 - 25 Gy）内，GTV绝对最小剂量（DMin）每增加1 Gy，局部失败风险降低（HR = 0.871 [95% CI 0.782 - 0.97]，p = 0.009）。9%的患者在SSRS后中位13个月（四分位间距7 - 25）出现椎体压缩性骨折。
本研究代表了接受单次分割SSRS治疗的SSM患者中治疗最均匀且规模最大的队列之一。尽管存在固有的放射抵抗性，但SSRS在SSM中能提供持久且高的局部控制率，且无意外的长期毒性发生率。
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