Departments of Radiation Oncology.
Neurological Surgery, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, OH.
Am J Clin Oncol. 2024 Jun 1;47(6):289-290. doi: 10.1097/COC.0000000000001091. Epub 2024 Feb 19.
Spinal metastases are common in metastatic cancer, affecting around 40% of patients. The primary treatment involves radiation therapy, transitioning from conventional external beam radiation therapy (EBRT) to stereotactic body radiation therapy (SBRT) for its superior, durable response. While spine SBRT has gained popularity in the United States, Level I evidence supporting it over EBRT is limited to a Canadian trial using a 2-fraction SBRT regimen. We present our findings from one of the earliest US experiences of 2-fraction spine SBRT for spinal metastases.
A retrospective analysis of patients with metastatic spine cancer receiving 2-fraction spine SBRT at a single center was conducted. Patients received treatment based on Level 1 evidence (24 Gy in 2 fractions). Follow-up records were assessed for local control outcomes and toxicity.
Twenty patients since August 2022 have been treated with 2-fraction spine SBRT. Most patients were treated at 1 (45%) or 2 (40%) spinal levels, with the thoracic (55%) and lumbar (50%) spine being the most common locations. Common primary sites included the lung (30%), breast (20%), esophagus (15%), and prostate (10%). The rate of local control was 100%, while the rate of vertebral compression fracture was 15%. No esophageal or bowel toxicity occurred, and no fractures required intervention.
These findings suggest that 2-fraction spine SBRT is safe and effective, consistent with existing Level I evidence. Our local control rate exceeding 95% aligns with the literature, indicating the feasibility and achievability of implementing this approach in the United States over a short period of time.
脊柱转移瘤在转移性癌症中很常见，影响约 40%的患者。主要治疗方法包括放射治疗，从传统的外照射放疗（EBRT）过渡到立体定向体放射治疗（SBRT），因为它具有更好、更持久的疗效。虽然脊柱 SBRT 在美国已得到广泛应用，但支持 SBRT 优于 EBRT 的一级证据仅限于一项使用 2 分次 SBRT 方案的加拿大试验。我们报告了我们在美国最早的 2 分次脊柱 SBRT 治疗脊柱转移瘤经验之一的结果。
对一家中心接受 2 分次脊柱 SBRT 治疗的转移性脊柱癌患者进行回顾性分析。患者根据一级证据（24 Gy 分 2 次）接受治疗。评估随访记录以了解局部控制结果和毒性。
自 2022 年 8 月以来，有 20 例患者接受了 2 分次脊柱 SBRT 治疗。大多数患者接受了 1 （45%）或 2 （40%）个脊柱水平的治疗，最常见的部位是胸椎（55%）和腰椎（50%）。常见的原发部位包括肺（30%）、乳腺（20%）、食管（15%）和前列腺（10%）。局部控制率为 100%，而椎体压缩性骨折率为 15%。没有发生食管或肠道毒性，也没有骨折需要干预。
这些发现表明，2 分次脊柱 SBRT 是安全有效的，与现有的一级证据一致。我们的局部控制率超过 95%，与文献一致，表明在美国短时间内实施这种方法是可行和可实现的。
