Andrade-Almeida Romulo A, Call-Orellana Francisco, Zuluaga-Garcia Juan P, Ramirez-Ferrer Esteban, Kimchi Gil, De Brian S, Guimaraes Alexandre B, Alvarez-Breckenridge Christopher A, Li Jing, Ghia Amol J, Rhines Laurence, Tom Martin C, Wang Chenyang, Beckham Thomas H, Amini Behrang, North Robert Y, Tatsui Claudio E
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of CNS Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Adv Radiat Oncol. 2025 Jun 10;10(7):101806. doi: 10.1016/j.adro.2025.101806. eCollection 2025 Jul.
Carbon fiber-reinforced polyetheretherketone (CFRP) spinal implants are gaining popularity in the surgical management of spinal metastasis because of their physical and radiographic properties, which facilitate adjuvant radiation planning and tumor surveillance. Their impact on clinical outcomes is still under investigation. We evaluated the role of hardware material (CFRP vs titanium) in local control and hardware durability in metastatic cases receiving decompressive surgery and adjuvant spinal stereotactic radiosurgery (SSRS).
This single-institution, retrospective cohort study was approved by the local institutional review board. Patients who underwent decompressive surgery with posterior segmental instrumentation followed by treatment with SSRS for metastatic spine disease were included. Exclusion criteria were as follows: (1) cervical implants, (2) mixed-type hardware, (3) SSRS greater than 60 days after surgery, and (4) less than 3 months magnetic resonance imaging follow-up. Only tumor progression occurring inside or at the margins of the irradiated field was considered.
Eighty-three spinal segments (55 titanium, 28 CFRP; from 82 patients) were evaluated. Except for the number of radiation fractions, proportion of single-fraction 24 Gy cases, and radiation equivalent dose in 2-Gy fractions, no significant differences were found between groups. The median follow-up time was 14.5 months (range, 3.0-70.4 months). Sixteen local progressions were identified, with 15 in the titanium group ( = .009). Using death as a competing factor, local progression-free survival was longer in the CFRP group (HR, 0.127; 95% CI, 0.017-0.945; = .044). The median time to progression was 9.27 months (IQR, 4.5-15.65 months). Higher equivalent dose in 2-Gy fractions was the only variable associated with local tumor control in both univariate and multivariate analyses ( = .025 and = .019, respectively). The titanium cohort experienced 4 hardware adverse events, whereas the CFRP group had 2 adverse events ( > .05).
CFRP implants were associated with lower rates of local progression in crude analyses, but did not reach statistical significance in multivariable models. No differences in hardware durability were identified.
碳纤维增强聚醚醚酮（CFRP）脊柱植入物因其物理和影像学特性，在脊柱转移瘤的手术治疗中越来越受欢迎，这些特性有助于辅助放疗计划制定和肿瘤监测。其对临床结果的影响仍在研究中。我们评估了硬件材料（CFRP与钛）在接受减压手术和辅助脊柱立体定向放射外科（SSRS）的转移瘤病例中的局部控制作用和硬件耐用性。
这项单机构回顾性队列研究经当地机构审查委员会批准。纳入接受后路节段性器械减压手术并随后接受SSRS治疗转移性脊柱疾病的患者。排除标准如下：（1）颈椎植入物；（2）混合型硬件；（3）手术后超过60天进行SSRS；（4）磁共振成像随访少于3个月。仅考虑在照射野内或边缘发生的肿瘤进展。
评估了83个脊柱节段（55个钛制，28个CFRP制；来自82名患者）。除了放射分次次数、单次24 Gy病例的比例以及2 Gy分次的放射等效剂量外，两组之间未发现显著差异。中位随访时间为14.5个月（范围3.0 - 70.4个月）。确定了16例局部进展，其中钛制组15例（P = 0.009）。以死亡作为竞争因素，CFRP组的局部无进展生存期更长（HR，0.127；95% CI，0.017 - 0.945；P = 0.044）。进展的中位时间为9.27个月（IQR，4.5 - 15.65个月）。在单因素和多因素分析中，2 Gy分次中较高的等效剂量是与局部肿瘤控制相关的唯一变量（分别为P = 0.02 和P = 0.019）。钛制队列发生4例硬件不良事件，而CFRP组有2例不良事件（P > 0.05）。
在粗分析中，CFRP植入物与较低的局部进展率相关，但在多变量模型中未达到统计学意义。未发现硬件耐用性方面的差异。
