Abstract：
OBJECTIVE: Advances in characterizing cancer biology and the growing availability of novel targeted agents and immune therapeutics have significantly changed the prognosis of many patients with metastatic disease. Palliative radiotherapy needs to adapt to these developments. In this study, we summarize the available evidence for stereotactic body radiotherapy (SBRT) in the treatment of spinal metastases.
METHODS: A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I2-test, assuming substantial and considerable as I2 > 50 % and I2 > 75 %, respectively. A p-value < 0.05 was considered statistically significant.
RESULTS: A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I2 = 93 %, I2 = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0-2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I2 = 92 %, I2 = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization.
CONCLUSIONS: Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.
METHODS: A systematic review and meta-analysis was performed using PRISMA methodology, including publications from January 2005 to September 2021, with the exception of the randomized phase III trial RTOG-0631 which was added in April 2023. Re-irradiation was excluded. For meta-analysis, a random-effects model was used to pool the data. Heterogeneity was assessed with the I2-test, assuming substantial and considerable as I2 > 50 % and I2 > 75 %, respectively. A p-value < 0.05 was considered statistically significant.
RESULTS: A total of 69 studies assessing the outcomes of 7236 metastases in 5736 patients were analyzed. SBRT for spine metastases showed high efficacy, with a pooled overall pain response rate of 83 % (95 % confidence interval [CI] 68 %-94 %), pooled complete pain response of 36 % (95 % CI: 20 %-53 %), and 1-year local control rate of 94 % (95 % CI: 86 %-99 %), although with high levels of heterogeneity among studies (I2 = 93 %, I2 = 86 %, and 86 %, respectively). Furthermore, SBRT was safe, with a pooled vertebral fracture rate of 9 % (95 % CI: 4 %-16 %), pooled radiation induced myelopathy rate of 0 % (95 % CI 0-2 %), and pooled pain flare rate of 6 % (95 % CI: 3 %-17 %), although with mixed levels of heterogeneity among the studies (I2 = 92 %, I2 = 0 %, and 95 %, respectively). Only 1.7 % of vertebral fractures required surgical stabilization.
CONCLUSIONS: Spine SBRT is characterized by a favorable efficacy and safety profile, providing durable results for pain control and disease control, which is particularly relevant for oligometastatic patients.
摘要：
目的：癌症生物学特征的进展以及新型靶向药物和免疫治疗的日益普及，已经显著改变了许多转移性疾病患者的预后。姑息性放射治疗需要适应这些发展。在这项研究中,我们总结了立体定向放疗（SBRT）治疗脊柱转移瘤的现有证据。
方法：使用PRISMA方法进行了系统评价和荟萃分析，包括2005年1月至2021年9月的出版物,但2023年4月增加的随机III期试验RTOG-0631除外.排除再照射。对于荟萃分析，使用随机效应模型来汇集数据.异质性用I2检验评估，假设I2>50%和I2>75%，分别。P值<0.05被认为是统计学上显著的。
结果：总共分析了69项研究，评估了5736例患者中7236例转移的结果。SBRT对脊柱转移瘤有较高的疗效，合并的总体疼痛反应率为83%（95%置信区间[CI]68%-94%），合并的完全疼痛反应为36%（95%CI：20%-53%），1年局部控制率为94%（95%CI：86%-99%），尽管研究之间存在高度异质性(I2=93%，I2=86%，86%,分别)。此外，SBRT是安全的,合并椎体骨折率为9%(95%CI：4%-16%，合并辐射诱导的脊髓病发生率为0%（95%CI0-2%），合并疼痛发作率为6%(95%CI:3%-17%)，尽管研究中异质性水平参差不齐(I2=92%，I2=0%，95%,分别)。只有1.7％的椎骨骨折需要手术稳定。
结论：脊柱SBRT具有良好的疗效和安全性，为疼痛控制和疾病控制提供持久的结果，这与寡转移患者特别相关。
方法：使用PRISMA方法进行了系统评价和荟萃分析，包括2005年1月至2021年9月的出版物,但2023年4月增加的随机III期试验RTOG-0631除外.排除再照射。对于荟萃分析，使用随机效应模型来汇集数据.异质性用I2检验评估，假设I2>50%和I2>75%，分别。P值<0.05被认为是统计学上显著的。
结果：总共分析了69项研究，评估了5736例患者中7236例转移的结果。SBRT对脊柱转移瘤有较高的疗效，合并的总体疼痛反应率为83%（95%置信区间[CI]68%-94%），合并的完全疼痛反应为36%（95%CI：20%-53%），1年局部控制率为94%（95%CI：86%-99%），尽管研究之间存在高度异质性(I2=93%，I2=86%，86%,分别)。此外，SBRT是安全的,合并椎体骨折率为9%(95%CI：4%-16%，合并辐射诱导的脊髓病发生率为0%（95%CI0-2%），合并疼痛发作率为6%(95%CI:3%-17%)，尽管研究中异质性水平参差不齐(I2=92%，I2=0%，95%,分别)。只有1.7％的椎骨骨折需要手术稳定。
结论：脊柱SBRT具有良好的疗效和安全性，为疼痛控制和疾病控制提供持久的结果，这与寡转移患者特别相关。
