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Efficacy and toxicity of re-irradiation spine stereotactic body radiotherapy with respect to irradiation dose history.

根据照射剂量史,再照射脊柱立体定向体放疗的疗效和毒性。

  • 影响因子:2.04
  • DOI:10.1093/jjco/hyaa178
  • 作者列表:"Ito K","Ogawa H","Nakajima Y
  • 发表时间:2021-02-08
Abstract

OBJECTIVE:We aimed to clarify the outcomes of re-irradiation stereotactic body radiotherapy for spinal metastases with a uniform dose fractionation schedule at our institution. METHODS:Data of patients treated with re-irradiation stereotactic body radiotherapy for spinal metastases (September 2013-March 2020) were retrospectively reviewed. The prescribed dose was 24 Gy in two fractions. The spinal cord dose constraint and dose for previously irradiated cases ≥50 Gy in 25 fractions were 12.2 Gy (maximum dose) and 11 Gy, respectively. The endpoints were pain control, local failure and adverse effects. Pain status was measured on a scale of 0-10 using the patients' self-reports and pain response was defined using international consensus criteria. Local failure was defined as tumor progression on imaging evaluations. RESULTS:We assessed 133 lesions in 123 patients, where 70 (52.6%) had three or more spinal levels treated, 58 (43.6%) had previous irradiation doses of 40 Gy or more and 53 (39.8%) had the targets compressing the cord. The median follow-up was 12 months and the 3-, 6- and 12-month pain response rate was 75, 64 and 59%, respectively. The 1-year local failure rate was 25.8%. Previous irradiation dose was not correlated with local failure rate (P = 0.13). Radiation-induced myelopathy, radiculopathy and vertebral compression fractures were observed in 4 (3.0%), 2 (1.5%) and 17 (13.8%) lesions, respectively. A trend towards an association between any toxicity and previous irradiation dose was not observed. CONCLUSIONS:Re-irradiation spine stereotactic body radiotherapy achieved good local control and pain control, with reduced risk of radiation myelopathy.

摘要

目的: 我们旨在阐明我们机构采用均匀剂量分割方案对脊柱转移瘤进行再照射立体定向放疗的结果。 方法: 回顾性分析2013年9月至2020年3月行立体定向放疗的脊柱转移瘤患者的临床资料。处方剂量为24 gy,分为两部分。在25个分数中,既往照射 ≥ 50 Gy的病例的脊髓剂量约束和剂量分别为12.2 Gy (最大剂量) 和11 Gy。终点为疼痛控制、局部失败和不良反应。使用患者的自我报告以0-10的等级测量疼痛状态,并使用国际共识标准定义疼痛反应。局部失败定义为影像学评价的肿瘤进展。 结果: 我们评估了133例患者的123个病灶,其中70例 (52.6%) 接受了3个或更多脊柱水平的治疗,58例 (43.6%) 既往照射剂量 ≥ 40 gy,53例 (39.8%) 目标压迫脊髓。中位随访12个月,3、6和12个月疼痛反应率分别为75、64和59%。1年局部失败率为25.8%。既往照射剂量与局部失败率无相关性 (P = 0.13)。放射性脊髓病、神经根病和椎体压缩性骨折分别为4例 (3.0%) 、2例 (1.5%) 和17例 (13.8%)。未观察到任何毒性与先前照射剂量之间的关联的趋势。 结论: 再照射脊柱立体定向放射治疗取得了良好的局部控制和疼痛控制,降低了放射性脊髓病的风险。

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