Kann Michael R, Adida Samuel, Taori Suchet, Bhatia Shovan, Rajan Akshath, Bayley James C, Zinn Pascal O, Burton Steven A, Flickinger John C, Sefcik Roberta K, Gerszten Peter C
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Neurooncol. 2025 Sep 11. doi: 10.1007/s11060-025-05221-8.
Lung cancer spinal metastases may present with intractable pain and neurological deficits. This study is one of the largest to examine outcomes following stereotactic radiosurgery (SRS) in this patient population.
A single institution retrospectively collected database of patients with lung cancer spinal metastases treated with SRS between 2003-2023 was analyzed. The primary outcome was local control (LC). Secondary outcomes included pain response, overall survival (OS), and radiation-induced toxicity. The median single-fraction dose was 16 Gy (range: 12-20). Multi-fractionated treatments utilized doses of 18-30 Gy in 2-5 fractions.
One hundred twenty-two patients with 167 lesions met inclusion criteria. Prior to radiosurgery, 21 lesions (13%) underwent open resection and 131 lesions (78%) received external beam radiation therapy. Median follow-up was 4 months (range: 1-133). Fifteen lesions (9%) locally recurred 5 months (range: 1-10) after treatment. Six-month and 1-year LC rates were 88% and 75%, respectively. Patient-reported pain predominantly improved or remained stable (67%) after treatment; worsened pain was associated with inferior LC (p < 0.01, HR: 22.7, 95% CI: 2.5-207.1) and development of radiation-induced vertebral compression fractures (VCFs) (p < 0.01, OR: 34.2, 95% CI: 3.0-392.4). Six-month and 1-year OS rates were 45% and 23%, respectively. Low functional status (Karnofsky Performance Score ≤ 70) was associated with inferior LC (p = 0.03, HR: 3.7, 95% CI: 1.1-12.1) and OS (p = 0.03, HR: 1.8, 95% CI: 1.1-2.9). Thirty-one radiation-induced toxicities (19%), including 13 VCFs (8%), were observed.
Radiosurgery provides LC and pain palliation with minimal rates of toxicity in a challenging patient population with lung cancer spinal metastases.
肺癌脊柱转移可能会出现顽固性疼痛和神经功能缺损。本研究是针对该患者群体立体定向放射治疗（SRS）后疗效进行研究的最大规模研究之一。
对一家机构在2003年至2023年间接受SRS治疗的肺癌脊柱转移患者的回顾性收集数据库进行分析。主要结局是局部控制（LC）。次要结局包括疼痛反应、总生存期（OS）和放射诱导毒性。单次分割剂量中位数为16 Gy（范围：12 - 20）。多次分割治疗采用18 - 30 Gy分2 - 5次给予。
122例患者的167个病灶符合纳入标准。在放射治疗前，21个病灶（13%）接受了开放切除术，131个病灶（78%）接受了外照射放疗。中位随访时间为4个月（范围：1 - 133个月）。15个病灶（9%）在治疗后5个月（范围：1 - 10个月）出现局部复发。6个月和1年的LC率分别为88%和75%。患者报告的疼痛在治疗后主要改善或保持稳定（67%）；疼痛加重与LC较差（p < 0.01，HR：22.7，95% CI：2.5 - 207.1）和放射诱导的椎体压缩骨折（VCF）发生相关（p < 0.01，OR：34.2，95% CI：3.0 - 392.4）。6个月和1年的OS率分别为45%和23%。低功能状态（卡诺夫斯基表现评分≤70）与较差的LC（p = 0.03，HR：3.7，95% CI：1.1 - 12.1）和OS（p = 0.03，HR：1.8，95% CI：1.1 - 2.9）相关。观察到31例放射诱导毒性（19%），包括13例VCF（8%）。
在具有挑战性的肺癌脊柱转移患者群体中，放射治疗提供了局部控制和疼痛缓解，且毒性发生率最低。
