Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors
Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors
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DOI：
10.3171/2016.11.focus16348
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发表时间：
2017-03-01
影响因子：
4.1
通讯作者：
Bilsky, Mark H.
中科院分区：
文献类型：
--
作者：
Stubblefield, Michael D.;Ibanez, Katarzyna;Bilsky, Mark H.
目的 本研究的目的是确定脊柱高剂量（1800-2600 cGy）单次立体定向放射外科（SF-SRS）治疗导致周围神经系统（PNS）损伤的百分比。 方法 所有在 2004 年 1 月至 2013 年 5 月期间因原发性或转移性脊柱肿瘤接受 SF-SRS 治疗并转至康复医学服务进行评估和治疗的患者回顾性地确定了神经肌肉、肌肉骨骼或功能损伤或疼痛。 结果 447 名患者接受了 557 次 SF-SRS 治疗，导致 13 名患者出现 14 处 PNS 损伤。所有损伤均由以 2400 cGy 的能量传递到颈椎或腰骶椎的 SF-SRS 造成。 SF-SRS 治疗导致 PNS 损伤的总体百分比为 2.5%，当胸椎被排除在分析之外时，该比例增加至 4.5%。 SF-SRS 后到症状出现的中位时间为 10 个月（范围 4-32 个月）。 14 例中有 12 例（86%）神经丛（颈、臂和/或腰骶）受到临床和/或电生理学影响，14 例中有 2 例（14%）神经根受到影响，14 例中有 6 例（43%）神经根受到影响。所有患者都经历了疼痛，并且大多数（93%）出现虚弱。 14% 的周围神经系统损伤为 CTCAE 1 级，64% 为 2 级，21% 为 3 级。未检测到 SF-SRS 剂量与 PNS 损伤之间的剂量关系。 结论 对脊柱进行单次 SRS 可能导致 PNS 损伤，对功能和生活质量产生重大影响。
OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury.METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified.RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4-32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected.CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.