School of Medicine, University of Pittsburgh Medical Center, Pennsylvania, Pennsylvania, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pennsylvania, USA.
World Neurosurg. 2024 May;185:e653-e661. doi: 10.1016/j.wneu.2024.02.102. Epub 2024 Feb 25.
Primary thyroid cancer metastasizing to the spine portends poor survival and low quality of life. Current management strategies continue to evolve. This single-institution retrospective study analyzes outcomes after spinal stereotactic radiosurgery for patients with spinal metastases from thyroid cancer.
Nineteen patients (median age: 64.5 years) were treated with stereotactic radiosurgery (SRS) for spinal primary thyroid metastases (40 metastases, 47 vertebral levels) between 2003 and 2023. Nineteen (47.5%) lesions had epidural involvement and 20 (50%) lesions were classified as potentially unstable or unstable via the Spinal Instability Neoplastic Score. The median tumor volume per lesion was 33 cc (range: 1.5-153). The median single fraction prescription dose was 20 Gy (range: 12-23.5).
The median follow-up period was 15 months (range: 2-40). Five (12.8%) lesions locally progressed at a median of 9 months (range: 4-26) after SRS. The 1-, 2-, and 3-year local tumor control rates per lesion were 90.4%, 83.5%, and 75.9%, respectively. On univariate analysis, age at SRS >70 years (P = 0.05, hazard ratio: 6.86, 95% confidence interval: 1.01-46.7) was significantly correlated with lower rates of local tumor control. The median overall survival was 35 months (range: 2-141). The 1-, 2-, and 3-year overall survival rates were 73.7%, 50.4%, and 43.2%, respectively. For 33 lesions initially associated with pain, patients reported pain improvement (22 lesions, 66.7%), stability (10 lesions, 30.3%), and worsening (1 lesion, 3.0%) after SRS. One patient developed dysphagia 4 months after SRS treatment.
SRS can be utilized as an effective and safe primary and adjuvant treatment option for primary thyroid metastases to the spine.
原发于甲状腺的癌症转移至脊柱预示着生存率低和生活质量差。目前的治疗策略仍在不断发展。本单中心回顾性研究分析了接受脊柱立体定向放射外科治疗的甲状腺癌脊柱转移患者的结局。
2003 年至 2023 年，共 19 例患者（中位年龄：64.5 岁）因脊柱原发性甲状腺转移（40 个转移灶，47 个椎体水平）接受了立体定向放射外科治疗（SRS）。19 个（47.5%）病灶有硬膜外受累，20 个（50%）病灶通过脊柱不稳性肿瘤评分（Spinal Instability Neoplastic Score）被归类为潜在不稳定或不稳定。每个病灶的中位肿瘤体积为 33cc（范围：1.5-153）。单次分割处方剂量的中位数为 20Gy（范围：12-23.5）。
中位随访时间为 15 个月（范围：2-40）。SRS 后 9 个月（范围：4-26）中位时间，5 个（12.8%）病灶局部进展。每个病灶的 1 年、2 年和 3 年局部肿瘤控制率分别为 90.4%、83.5%和 75.9%。单因素分析显示，SRS 时年龄>70 岁（P=0.05，风险比：6.86，95%置信区间：1.01-46.7）与局部肿瘤控制率较低显著相关。中位总生存期为 35 个月（范围：2-141）。1 年、2 年和 3 年的总生存率分别为 73.7%、50.4%和 43.2%。在 33 个最初与疼痛相关的病灶中，患者报告 SRS 后疼痛改善（22 个病灶，66.7%）、稳定（10 个病灶，30.3%）和恶化（1 个病灶，3.0%）。1 例患者在 SRS 治疗后 4 个月出现吞咽困难。
SRS 可作为治疗脊柱原发性甲状腺转移的有效、安全的一线和辅助治疗选择。
