Risk-adapted stereotactic body radiotherapy for patients with cervical spinal metastases.
Risk-adapted stereotactic body radiotherapy for patients with cervical spinal metastases.
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颈椎转移瘤患者的风险适应性立体定向放疗
作者：
由于颈椎转移瘤具有复杂的解剖结构和生物力学特点，目前标准的姑息治疗具有较高的复发风险和并发症。立体定向全身放射治疗(SBRT)可以在最大限度地保护正常器官的同时，为肿瘤提供根治性剂量。然而，SBRT治疗颈椎转移瘤的有效性和安全性尚未得到很好的研究。2006年至2021年间，71名颈椎转移瘤患者采用CyberKnife进行了SBRT治疗，数据来自我们前瞻性维护的数据库。主要终点是SBRT完成后12 周的疼痛反应；次要终点包括局部控制(LC)、总存活率(OS)和不良事件。根据脊髓和食道的剂量限制，标准风险患者计划接受30 Gy21~36次，中位剂量为3次(1~3次)，高危患者35 Gy24~50次，中位数5次(4~5次)。中位随访时间为17.07 个月(3.1~118.9个月)。完成 治疗12周后，55例基础疼痛患者中54例(98.2%)疼痛缓解，46例(83.6%)疼痛完全缓解。1年LC率为93.1%，2年LC率为90%。1年OS率为66.2%，2年OS率为37.4%。8例患者发生1-4级不良事件(6例椎体压缩骨折，其中5例在SBRT前有椎体压缩骨折；2例偏瘫)。未观察到5级不良事件。因此，风险适应的SBRT治疗颈椎转移瘤获得了高的疼痛控制率和LC率，且不良反应可接受。风险适应的SBRT治疗颈椎转移瘤获得了高的疼痛控制率和LC率，且不良反应可接受。未观察到5级不良事件。重要的是，无论是否累及脊髓，这些结果都具有可比性。
Owing to the complex anatomical structure and biomechanics, the current standard palliative treatments for cervical spinal metastases are associated with a high risk of recurrence and complications. Stereotactic body radiotherapy (SBRT) can provide radical dose to tumors while protecting normal organs to the maximum extent. However, the efficacy and safety of SBRT for cervical spinal metastases is not well characterized. Data from 71 patients with cervical spine metastases who were treated with SBRT using CyberKnife between 2006 and 2021 were obtained from our prospectively maintained database. Primary endpoint was pain response at 12 weeks following SBRT completion; secondary endpoints included local control (LC), overall survival (OS), and adverse events. Standard‐risk patients were planned to receive 30 Gy (range 21–36) with median fractions of 3 (range 1–3) and high‐risk patients 35 Gy (range 24–50) with median fractions of 5 (range 4–5) according to the spinal cord and esophagus dose constraints. The median follow‐up time was 17.07 months (range 3.1–118.9). After 12 weeks of SBRT completion, 54 (98.2%) of 55 patients with baseline pain achieved pain response and 46 (83.6%) achieved complete pain response. LC rates were 93.1% and 90% at 1 year and 2 year, respectively. The 1‐year and 2‐year OS rates were 66.2% and 37.4%, respectively. Eight patients experienced grades 1–4 adverse events (six vertebral compression fracture [VCF], five of them had VCF before SBRT; and two hemiparesis). No grade 5 adverse events were observed. Therefore, risk‐adapted SBRT for cervical spine metastases achieved high pain control and LC rates with acceptable adverse events. Risk‐adapted SBRT for cervical spine metastases achieved high pain control and LC rates with acceptable adverse events. No grade 5 adverse events were observed. Importantly, these results were comparable regardless of spinal cord involvement.
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DOI：
10.3171/2012.11.spine12111
发表时间：
2013-03
期刊：
Journal of neurosurgery. Spine
影响因子：
--
作者：
Laufer I;Iorgulescu JB;Chapman T;Lis E;Shi W;Zhang Z;Cox BW;Yamada Y;Bilsky MH
通讯作者：
Bilsky MH
影响因子：
3.4
作者：
Anand, A. K.;Venkadamanickam, G.;Singh, H. M.
通讯作者：
Singh, H. M.
影响因子：
4.5
作者：
Quraishi, Nasir A.;Arealis, George;Boszczyk, Bronek M.
通讯作者：
Boszczyk, Bronek M.
DOI：
10.1016/s0140-6736(17)33326-3
发表时间：
2018-03-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
Allemani C;Matsuda T;Di Carlo V;Harewood R;Matz M;Nikšić M;Bonaventure A;Valkov M;Johnson CJ;Estève J;Ogunbiyi OJ;Azevedo E Silva G;Chen WQ;Eser S;Engholm G;Stiller CA;Monnereau A;Woods RR;Visser O;Lim GH;Aitken J;Weir HK;Coleman MP;CONCORD Working Group
通讯作者：
CONCORD Working Group
影响因子：
15.9
作者：
Al-Omair, Ameen;Masucci, Laura;Sahgal, Arjun
通讯作者：
Sahgal, Arjun