Chen Dingbang, Yu Wenlong, Yin Mengchen, Zhang Luosheng, Gao Xin, Li Lin, Huang Quan, Xiao Jianru
Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Military Medical University, Shanghai, China.
Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Neurosurg Rev. 2025 May 26;48(1):446. doi: 10.1007/s10143-025-03617-8.
This review systematically reviewed the current guidelines related to radiotherapy for spinal metastases, summarized the relevant recommendations, and assessed the quality of their supporting evidence. The guidelines on radiotherapy for spinal metastases were searched by the keyword "guidelines" and "spinal metastasis". The most updated guidelines on radiotherapy for spinal metastasis were selected based on pre-defined inclusion and exclusion criteria. AGREE II was used to evaluate the quality of these guidelines. In addition, the related recommendations were extracted, and their quality was assessed using an evidence-grading scale. Nine guidelines established between 2013 and 2024 were included in this study. Three of the guidelines had an applicability rating of less than 50%. The difference in scores was the largest in rigor of development (range 48.50-88.03%). A total of 44 recommendations based on indications, re-irradiation, radiation dose and regimen, and emergency radiotherapy, were extracted and evaluated for SM. In conclusion, this study summarizes nine guidelines on radiotherapy for SM and provides useful information for improving treatment outcomes in patients with SM. All nine guidelines scored low in terms of adaptability, and most recommendations were based on a moderate-to-high LOE. The timing of re-radiotherapy varies across guidelines and fractionated radiotherapy regimens are available for specific SM patients. SBRT is more suitable than RBRT for patients with oligo-metastases, but more high-quality evidence is needed to confirm the more advantages of SBRT compared with conventional radiotherapy.
本综述系统回顾了当前与脊柱转移瘤放疗相关的指南，总结了相关建议，并评估了其支持证据的质量。通过关键词“指南”和“脊柱转移瘤”检索脊柱转移瘤放疗指南。根据预先定义的纳入和排除标准，选择了关于脊柱转移瘤放疗的最新指南。采用AGREE II评估这些指南的质量。此外，提取了相关建议，并使用证据分级量表评估其质量。本研究纳入了2013年至2024年间制定的9项指南。其中3项指南的适用性评级低于50%。在制定的严谨性方面得分差异最大（范围为48.50%-88.03%）。共提取了44条基于适应症、再照射、放射剂量和方案以及急诊放疗的建议，并对脊柱转移瘤进行了评估。总之，本研究总结了9项关于脊柱转移瘤放疗的指南，为改善脊柱转移瘤患者的治疗效果提供了有用信息。所有9项指南在适应性方面得分较低，大多数建议基于中到高的证据水平。再放疗的时机因指南而异，特定的脊柱转移瘤患者可采用分割放疗方案。对于寡转移患者，立体定向体部放疗比常规分割放疗更合适，但需要更多高质量证据来证实立体定向体部放疗与传统放疗相比的更多优势。
