Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases
Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases
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DOI：
10.1007/s00066-014-0706-1
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发表时间：
2014-11-01
影响因子：
3.1
通讯作者：
Guckenberger, Matthias
中科院分区：
文献类型：
--
作者：
Mantel, Frederick;Glatz, Stefan;Guckenberger, Matthias
尽管转移状态，但预期寿命较长的患者可能受益于脊髓转移的长期局部控制。剂量强化放疗（RT）被认为能更好地控制肿瘤生长，从而提供更长的疼痛缓解。这项单机构研究报告了基于身体状况、转移程度、组织学和转移时间的预期寿命较好的脊柱转移患者的分割立体定向全身放射治疗（SBRT）。2004年至2010年间，32例患者（中位年龄55岁，男性占61%，Karnofsky评分中位数85）的36个治疗点接受了分式SBRT治疗。中位治疗剂量为60 Gy（范围，48.5-65 Gy），中位数分为20组（范围，17-33）；脊髓计划风险体积（PRV-SC）的中位最大剂量为46.6 Gy。所有在放疗前有疼痛的患者在治疗后均报告疼痛缓解；中位随访20.3个月后，61%的治疗部位无痛，另外25%伴有轻度疼痛。在86%的治疗中，患者在最后一次临床随访时没有神经系统症状。11例患者出现急性1级毒性反应（CTCAE 3.0）。没有患者出现脊髓病。12个月和24个月后，放射学控制的局部进展自由度分别为92%和84%。中位总生存期（OS）为19.6个月。尽管存在转移性疾病，但患者的选择导致了长期的生存期，并且剂量强化的分割SBRT治疗脊柱转移是安全的，并且实现了长期的局部肿瘤控制和疼痛缓解。
Patients with long life expectancy despite metastatic status might benefit from long-term local control of spinal metastases. Dose-intensified radiotherapy (RT) is believed to control tumor growth better and thus offers longer pain relief. This single-institution study reports on fractionated stereotactic body radiation therapy (SBRT) for spinal metastases in patients with good life expectancy based on performance status, extent of metastases, histology, and time to metastasis.Between 2004 and 2010, 36 treatment sites in 32 patients (median age 55 years; male 61 %; median Karnofsky performance score 85) were treated with fractionated SBRT. The median treatment dose was 60 Gy (range, 48.5-65 Gy) given in a median of 20 fractions (range, 17-33); the median maximum dose to the planning risk volume for the spinal cord (PRV-SC) was 46.6 Gy.All patients suffering from pain prior to RT reported pain relief after treatment; after a median follow-up of 20.3 months, 61 % of treatment sites were pain-free, another 25 % associated with mild pain. In 86 % of treatments, patients were free from neurological symptoms at the time of the last clinical follow-up. Acute grade 1 toxicities (CTCAE 3.0) were observed in 11 patients. Myelopathy did not occur in any patient. Radiologically controlled freedom from local progression was 92 and 84 % after 12 and 24 months, respectively. Median overall survival (OS) was 19.6 months.Patient selection resulted in long OS despite metastatic disease, and dose-intensified fractionated SBRT for spinal metastases was safe and achieved long-term local tumor control and palliation of pain.