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A Phase 2 Study of Post-Operative Stereotactic Body Radiation Therapy (SBRT) for Solid Tumor Spine Metastases.

实体瘤脊柱转移瘤术后立体定向放射治疗 (SBRT) 的 2 期研究。

  • 影响因子:3.70
  • DOI:10.1016/j.ijrobp.2019.10.011
  • 作者列表:"Redmond KJ","Sciubba D","Khan M","Gui C","Lo SL","Gokaslan ZL","Leaf B","Kleinberg L","Grimm J","Ye X","Lim M
  • 发表时间:2020-02-01
Abstract

PURPOSE:In patients with spinal instability, cord compression, or neurologic deficits, the standard of care is surgery followed by radiation therapy (RT). Recurrence rates after conventional RT remain high. The purpose of this study is to prospectively examine the efficacy of postoperative stereotactic body RT (SBRT) in patients who have undergone surgical intervention for spine metastases. We hypothesize that postoperative SBRT to the spine would be associated with higher local control than historical rates after conventional RT. METHODS AND MATERIALS:Thirty-five adult patients with a Karnofsky Performance Status score ≥40 and spine metastases from solid tumors with no prior overlapping RT and target volumes ≤3 consecutive vertebral levels were enrolled. Thirty-three patients were treated. Two patients underwent treatment to 2 target volumes for a total of 35 target volumes. All patients received SBRT 30 Gy in 5 fractions. Patients were followed with neurological examinations and computed tomography and/or magnetic resonance imaging every 3 months. Neurologic function was assessed at the same time points using the American Spinal Injury Association (ASIA) impairment score. Pain was rated according to the 10-point visual analogue scale and MD Anderson Cancer Center brief pain index. Toxicity was recorded according to National Cancer Institute Common Toxicity Criteria for Adverse Events Version 4. The primary objective was the rate of radiographic local recurrence at 12 months after completion of SBRT. RESULTS:Patient characteristics were as follows: 34.3% had radioresistant primaries; 71.4% were ASIA E and the remainder ASIA D; and the median baseline Karnofsky Performance Status score was 70 (range, 50-100). Radiographic and symptomatic local control at 1 year were 90% (95% confidence interval, 76%-98%). The median time to recurrence in these 3 patients was 3.5 months (range, 3.4-5.8 months), all had radiosensitive tumors, and all recurrences were epidural. No patients experienced wound dehiscence, hardware failure, or spinal cord myelopathy. The median time to return to systemic therapy was 0.5 months (range, 0-9.4 months). CONCLUSIONS:This prospective study of postoperative spine SBRT demonstrates excellent local control with low toxicity. These data suggest superior rates of local control compared with conventional RT; however, a formal comparative study is warranted.

摘要

目的: 对于脊柱不稳、脊髓压迫或神经功能缺损的患者,标准的治疗是手术,然后进行放射治疗 (RT)。常规RT后复发率仍然很高。本研究的目的是前瞻性地检查术后立体定向体部RT (SBRT) 对接受手术治疗的脊柱转移瘤患者的疗效。我们假设脊柱术后SBRT与传统RT后的历史发生率相比,局部控制率更高。 方法和材料: 入组 35 例Karnofsky性能状态评分 ≥ 40 分的成人患者,以及既往无重叠RT且靶体积 ≤ 3 个连续椎体水平的实体瘤脊柱转移患者。治疗了 33 例患者。2 例患者接受治疗至 2 个靶体积,共 35 个靶体积。所有患者均接受SBRT 30 Gy,分 5 次。每 3 个月对患者进行神经系统检查和计算机断层扫描和/或磁共振成像随访。使用美国脊髓损伤协会 (ASIA) 损伤评分在同一时间点评估神经功能。根据 10 分视觉模拟量表和MD安德森癌症中心简明疼痛指数对疼痛进行评级。毒性根据美国国家癌症研究所不良事件常见毒性标准第 4 版记录。主要目标是SBRT完成后 12 个月的影像学局部复发率。 结果: 患者特征如下: 34.3% 有放射抗拒初级; 71.4% 为ASIA E,其余为ASIA D; 中位基线Karnofsky性能状态评分为 70 (范围,50-100)。1 年时影像学和症状性局部对照为 90% (95% 置信区间,76%-98%)。这 3 例患者的中位复发时间为 3.5 个月 (范围为 3.4-5.8 个月),均为放射敏感肿瘤,所有复发均为硬膜外复发。没有患者出现伤口裂开、硬件故障或脊髓病。恢复全身治疗的中位时间为 0.5 个月 (范围为 0-9.4 个月)。 结论: 这项脊柱术后SBRT的前瞻性研究显示了良好的局部控制和低毒性。这些数据表明,与传统RT相比,局部控制率更高; 然而,需要进行正式的比较研究。

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DOI:10.1259/bjr.20180883
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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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