Diabetes increases the risk of serious adverse events after re-irradiation of the spine
Diabetes increases the risk of serious adverse events after re-irradiation of the spine
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DOI：
10.1016/j.radonc.2019.04.002
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发表时间：
2019-07-01
影响因子：
5.7
通讯作者：
Engelholm, Svend Aage
中科院分区：
文献类型：
--
作者：
Suppli, Morten Hiul;Af Rosenschold, Per Munck;Engelholm, Svend Aage
简介：在这项研究中，我们调查了一个大型队列的放射诱导的严重不良事件的脊柱转移癌姑息性放疗（RT）的连续复治患者。方法和材料：从2010年到2014年，2387例患者在我们的机构接受了转移性脊髓压迫的姑息性脊柱放疗。对患者进行了既往RT检查，220例患者接受了脊柱再照射。临床和治疗数据来自患者记录和RT计划系统。结果如下：患者患有乳腺癌、前列腺癌、肺癌、血液病或其他癌症的转移性疾病（分别为22.7%、21.8%、21.4%、3.2%和30.9%）。中位随访时间为99天。中位累积EQD 2为57.6 Gy 2;范围：20.0-90.0戈伊。在14名患者中观察到与再照射相关的脊柱事件; 6名患者被诊断为放射性脊髓病（RIM），9名患者被诊断为放射性椎体骨折（RIF）。在多变量分析中，糖尿病与毒性风险增加相关（HR = 7.9; P = 0.003）。结论：在我们的再照射患者队列中，RIM和RIF的发生率（分别为220例患者中的6例和9例）较低。糖尿病患者发生不良事件的风险较高，在脊柱再次照射前应予以考虑。(C)2019爱思唯尔B. V.保留所有权利。放射治疗及肿瘤
Introduction: In this study we investigate the risk of radiation-induced serious adverse event of the spine in a large cohort of consecutive retreated patients with palliative radiotherapy (RT) for metastatic cancer in the spine. Methods and materials: From 2010 to 2014, 2387 patients received spinal irradiation with a palliative intent for metastatic spinal cord compression at our institution. The patients were reviewed for prior RT and 220 patients had received re-irradiation of the spine. Clinical and treatment data were obtained from the patients' records and the RT planning system. Results: Patients had metastatic disease from breast, prostate, lung, hematological or other cancers (22.7%, 21.8%, 21.4%, 3.2% and 30.9%, respectively). Median follow-up was 99 days. Median cumulative EQD2 was 57.6 Gy2; range: 20.0-90.0 Gy. Spinal events related to re-irradiation were observed in fourteen patients; six patients were diagnosed with radiation-induced myelopathy (RIM) and nine patients with radiation-induced vertebral fracture (RIF). In a multivariate analysis, diabetes was related to increased risk of toxicity (HR = 7.9; P = 0.003). Conclusion: The incidence of RIM and RIF (6 and 9 out of 220 patients, respectively) was low in our cohort of re-irradiated patients. Patients with diabetes had a higher risk of adverse events which should be considered before re-irradiation of the spine. (C) 2019 Elsevier B.V. All rights reserved. Radiotherapy and Oncology