McVeigh Luke G, Linzey Joseph R, Strong Michael J, Duquette Elizabeth, Evans Joseph R, Szerlip Nicholas J, Jackson William C
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
Neurooncol Adv. 2024 Feb 13;6(Suppl 3):iii28-iii47. doi: 10.1093/noajnl/vdad175. eCollection 2024 Oct.
Advances in local and systemic therapies continue to improve overall survival for patients with cancer, increasing the incidence of spine metastases. Up to 15% of patients with solid tumors develop spinal metastases. Spinal metastases can be particularly devastating for quality of life given the potential pain, neurological deficits from spinal cord compression or cauda equina syndrome, spinal instability, and pathological fractures that may result. Stereotactic body radiotherapy (SBRT) with or without adding less invasive surgical techniques for stabilization or separation has gained favor. SBRT uses smaller, more precise treatment volumes, allowing for higher doses per fracture, thus increasing ablative abilities.
We conducted a systematic review using MEDLINE, Embase (Elsevier), and Web of Science to identify all articles investigating the effectiveness of SBRT in providing local disease control, pain control, and relief of spinal cord compression for patients with metastatic disease of the spine.
The review yielded 84 articles that met inclusion criteria. The evidence indicates SBRT provides excellent local control and pain control for patients with spine metastesis, and this remains true for patients with spinal cord compression managed with surgical separation followed by postoperative spine SBRT.
While not all patients are appropriate candidates for SBRT, carefully considering appropriate frameworks that consider the patient's overall prognosis can guide a multidisciplinary team toward the patients who will benefit the most from this treatment modality.
局部和全身治疗方法的进展持续改善癌症患者的总生存率，导致脊柱转移瘤的发病率上升。高达15%的实体瘤患者会发生脊柱转移。脊柱转移瘤对生活质量可能造成特别严重的影响，因为可能会导致疼痛、脊髓压迫或马尾综合征引起的神经功能缺损、脊柱不稳定以及病理性骨折。立体定向体部放疗（SBRT）联合或不联合采用侵入性较小的手术技术进行稳定或减压已受到青睐。SBRT使用更小、更精确的治疗体积，允许每次分割给予更高剂量，从而提高消融能力。
我们使用MEDLINE、Embase（爱思唯尔）和科学引文索引进行了一项系统评价，以识别所有研究SBRT对脊柱转移性疾病患者进行局部疾病控制、疼痛控制和缓解脊髓压迫有效性的文章。
该评价纳入了84篇符合纳入标准的文章。证据表明，SBRT为脊柱转移瘤患者提供了出色的局部控制和疼痛控制，对于通过手术减压后再行术后脊柱SBRT治疗的脊髓压迫患者也是如此。
虽然并非所有患者都适合接受SBRT治疗，但仔细考虑适当的框架，综合考虑患者的总体预后，可指导多学科团队找到最能从这种治疗方式中获益的患者。
