Gasho Jordan O, de Reus Daniel, Pierik Robert-Jan, Amelink Jantijn, Schwab Joseph H, Tobert Daniel G
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Orthopedic Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, Netherlands.
Global Spine J. 2025 May 22:21925682251345753. doi: 10.1177/21925682251345753.
Study DesignRetrospective cohort.ObjectivesWith rising cancer rates and survival, effective palliative treatments are crucial. For decades, conventional external beam RT (cEBRT) has been the standard for palliation but is dose-limited. The efficacy of postoperative radiotherapy for spinal metastases with stereotactic body radiation therapy (SBRT) in direct comparison to cEBRT remains understudied. We aim to compare clinical outcomes after treatment with cEBRT or SBRT for patients with spinal metastases.MethodsEligible patients included those who received palliative RT with cEBRT or SBRT between January 2017 and December 2022 at Massachusetts General Hospital. A matched cohort of 204 patients was created using propensity score matching. Reoperation, overall survival (OS), and postoperative complications were evaluated. Multivariable logistic regression was used to adjust for residual bias after propensity score matching.Results81 patients treated with cEBRT were matched with 123 patients treated with SBRT. Reoperation rate was 13.2%, with no significant difference between the cEBRT and SBRT groups (12.4% vs 13.8%, = 0.76). Median OS was 15.9 months (IQR, 6.7-40.6 months). Kaplan-Meier analysis revealed no significant association between type of radiotherapy and either reoperation or OS ( = 0.40 and = 0.56, respectively). When comparing reoperation by radiation modality, multivariable logistic regression analysis showed no significant difference.ConclusionWe observed that SBRT does not reduce rates of reoperation or complications, nor does it improve overall survival. These findings suggest that conventional radiotherapy remains a viable postoperative treatment for spinal metastases, especially when SBRT is not available or feasible, or when cost is a significant concern.
研究设计
回顾性队列研究。
目的
随着癌症发病率和生存率的上升，有效的姑息治疗至关重要。几十年来，传统外照射放疗（cEBRT）一直是姑息治疗的标准方法，但存在剂量限制。与cEBRT直接比较，立体定向体部放疗（SBRT）用于脊柱转移瘤术后放疗的疗效仍未得到充分研究。我们旨在比较cEBRT或SBRT治疗脊柱转移瘤患者后的临床结局。
方法
符合条件的患者包括2017年1月至2022年12月在麻省总医院接受cEBRT或SBRT姑息性放疗的患者。使用倾向评分匹配创建了一个由204名患者组成的匹配队列。评估再次手术、总生存期（OS）和术后并发症。采用多变量逻辑回归来调整倾向评分匹配后的残余偏倚。
结果
81例接受cEBRT治疗的患者与123例接受SBRT治疗的患者相匹配。再次手术率为13.2%，cEBRT组和SBRT组之间无显著差异（12.4%对13.8%，P = 0.76）。中位OS为15.9个月（四分位间距，6.7 - 40.6个月）。Kaplan-Meier分析显示，放疗类型与再次手术或OS之间均无显著关联（分别为P = 0.40和P = 0.56）。在按放疗方式比较再次手术时，多变量逻辑回归分析显示无显著差异。
结论
我们观察到SBRT并未降低再次手术率或并发症发生率，也未改善总生存期。这些发现表明，传统放疗仍然是脊柱转移瘤可行的术后治疗方法，特别是在无法获得或不可行SBRT时，或者当成本是一个重要问题时。
