Hypofractionated Stereotactic Body Radiotherapy in Spinal Metastasis - With or Without Epidural Extension
Hypofractionated Stereotactic Body Radiotherapy in Spinal Metastasis - With or Without Epidural Extension
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DOI：
10.1016/j.clon.2015.01.035
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发表时间：
2015-06-01
影响因子：
3.4
通讯作者：
Singh, H. M.
中科院分区：
文献类型：
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作者：
Anand, A. K.;Venkadamanickam, G.;Singh, H. M.
目标：目的探讨立体定向放射治疗（SBRT）治疗脊柱转移瘤的临床疗效及硬膜外恶性压迫（MEC）的影响。20例患者（38.4%）检测到MEC，并单独勾画。对受累椎体（计划靶体积）规定的中位剂量为24戈伊（范围24 - 27戈伊），中位剂量为3次（范围1 - 3）。未累及的元素分三次给予21戈伊。在59处病变（77.6%）中，治疗了整个椎体，在17处病变（22.4%）中，仅治疗了前部结构。所有患者均在Novalis Tx直线加速器和ExacTrac系统上接受了图像引导下的容积调制式弧形治疗。剂量和临床结果进行了比较，在患者或没有MEC。结果：在中位随访8.48个月（范围3 - 40个月），1年的局部控制和总生存率分别为94和68%。在有或无硬膜外延伸的患者中，肿瘤体积（GTV; 95%）的中位剂量分别为23.48戈伊（范围13.70 - 25.75）和22.99戈伊（范围13.55 - 26.84），脊髓Dmax的中位剂量分别为17.36戈伊（范围8.47 - 21.63）和15.71戈伊（范围8.39 - 23.33）。硬膜外GTV中位数（D95%）为21.16戈伊（范围15.43 - 23.92）。90%的MEC患者和93.75%的无MEC患者（P = NS）的疼痛完全缓解，60%的患者在两组patients.Conclusion中神经功能改善，这是可行的，提供高剂量的辐射（类似于90%的处方剂量）的硬膜外组件与体积调制弧治疗SBRT和图像引导。在伴有或不伴有MEC的脊柱转移瘤患者中，它产生了较高的疼痛控制率和局部控制率。(C)2015年皇家放射科医师学院。由爱思唯尔有限公司出版。保留所有权利。
Aims: To evaluate clinical outcome and the effect of malignant epidural compression (MEC) in the treatment of spine metastasis with stereotactic body radiotherapy (SBRT).Materials and methods: Seventy-six lesions in 52 patients with spinal metastasis received SBRT during the period July 2010 to December 2012. MEC was detected in 20 patients (38.4%) and was separately contoured. The median dose prescribed to involved vertebra (planning target volume) was 24 Gy (range 24-27 Gy) in a median of three fractions (range 1-3). Uninvolved elements were prescribed 21 Gy in three fractions. In 59 lesions (77.6%), the entire vertebra was treated and in 17 lesions (22.4%) only the anterior elements were treated. All patients were treated with volumetric modulated arc therapy with image guidance on a Novalis Tx linear accelerator with the ExacTrac system. Dosimetric and clinical outcomes were compared in patients with or without MEC.Results: At a median follow-up of 8.48 months (range 3-40 months), 1 year local control and overall survival was 94 and 68%, respectively. In patients with or without epidural extension, the median dose to the gross tumour volume (GTV; 95%) was 23.48 Gy (range 13.70-25.75) and 22.99 Gy (range 13.55-26.84), the median spinal cord Dmax was 17.36 Gy (range 8.47-21.63) and 15.71 Gy (range 8.39-23.33). The median GTV epidural (D95%) was 21.16 Gy (range 15.43-23.92). Complete pain relief was seen in 90% of patients with MEC and 93.75% without MEC (P = NS) and neurological improvement was seen in 60% of patients in both groups of patients.Conclusion: It is feasible to deliver a high dose of radiation (similar to 90% of the prescription dose) to the epidural component with volumetric modulated arc therapy SBRT and image guidance. It yielded high rates of pain control and local control in patients with spine metastases with or without MEC. (C) 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.