Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy
Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy
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DOI：
10.1093/neuonc/not101
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发表时间：
2013-10-01
期刊：
影响因子：
15.9
通讯作者：
Sahgal, Arjun
中科院分区：
文献类型：
--
作者：
Al-Omair, Ameen;Masucci, Laura;Sahgal, Arjun
背景脊柱立体定向放射治疗（SBRT）越来越多地应用于脊柱转移瘤术后患者。我们的目的是确定局部控制（LC）和生存的临床和剂量学预测。从我们的前瞻性数据库中确定了2008年10月至2012年2月期间接受术后SBRT治疗的80例患者，并对其进行了回顾性分析。中位随访时间为8.3个月。3 - 5例（44%）患者接受18-26戈伊分1或2次治疗，45例（56%）患者接受18-40戈伊分3-5次治疗。观察到21例局部失败（26%），1年LC和总生存率（OS）分别为84%和64%。最常见的失败部位是硬膜外腔（15/21，71%）。多变量比例风险分析确定SBRT后全身治疗是OS的唯一显著预测因素（P = 0.02），18-26戈伊/1或2次治疗（P = 0.02）和术后硬膜外疾病等级为0或1（0，无硬膜外疾病; 1，仅压迫硬脑膜的硬膜外疾病，P = 0.003）是LC的显著预测因素。仅对术前有高度硬膜外疾病（脊髓畸形）的患者（n = 48/80）进行亚组分析，结果显示手术分级为0/1 vs 2时，LC发生率显著增加（P = 0.0009）。术后SBRT的总剂量范围为18 - 26戈伊，分1-2次输送，预测上级LC，术后硬膜外分级也是如此。
Background. Spine stereotactic body radiotherapy (SBRT) is increasingly being applied to the postoperative spine metastases patient. Our aim was to identify clinical and dosimetric predictors of local control (LC) and survival.Methods. Eighty patients treated between October 2008 and February 2012 with postoperative SBRT were identified from our prospective database and retrospectively reviewed.Results. The median follow-up was 8.3 months. Thirty-five patients (44%) were treated with 18-26 Gy in 1 or 2 fractions, and 45 patients (56%) with 18-40 Gy in 3-5 fractions. Twenty-one local failures (26%) were observed, and the 1-year LC and overall survival (OS) rates were 84% and 64%, respectively. The most common site of failure was within the epidural space (15/21, 71%). Multivariate proportional hazards analysis identified systemic therapy post-SBRT as the only significant predictor of OS (P = .02) and treatment with 18-26 Gy/1 or 2 fractions (P = .02) and a postoperative epidural disease grade of 0 or 1 (0, no epidural disease; 1, epidural disease that compresses dura only, P = .003) as significant predictors of LC. Subset analysis for only those patients (n = 48/80) with high-grade preoperative epidural disease (cord deformed) indicated significantly greater LC rates when surgically downgraded to 0/1 vs 2 (P = .0009).Conclusions. Postoperative SBRT with high total doses ranging from 18 to 26 Gy delivered in 1-2 fractions predicted superior LC, as did postoperative epidural grade.