Abstract：
OBJECTIVE: Recent progress in diagnostics and treatment of metastatic cancer patients have improved survival substantially. These developments also affect local therapies, with treatment aims shifting from short-term palliation to long-term symptom or disease control. There is consequently a need to better define the value of stereotactic body radiotherapy (SBRT) for the treatment of spinal metastases.
METHODS: This ESTRO clinical practice guideline is based on a systematic literature review conducted according to PRISMA standards, which formed the basis for answering four key questions about the indication and practice of SBRT for spine metastases.
RESULTS: The analysis of the key questions based on current evidence yielded 22 recommendations and 5 statements with varying levels of endorsement, all achieving a consensus among experts of at least 75%. In the majority, the level of evidence supporting the recommendations and statements was moderate or expert opinion, only, indicating that spine SBRT is still an evolving field of clinical research. Recommendations were established concerning the selection of appropriate patients with painful spine metastases and oligometastatic disease. Recommendations about the practice of spinal SBRT covered technical planning aspects including dose and fractionation, patient positioning, immobilization and image-guided SBRT delivery. Finally, recommendations were developed regarding quality assurance protocols, including description of potential SBRT-related toxicity and risk mitigation strategies.
CONCLUSIONS: This ESTRO clinical practice guideline provides evidence-based recommendations and statements regarding the selection of patients with spinal metastases for SBRT and its safe implementation and practice. Enrollment of patients into well-designed prospective clinical trials addressing clinically relevant questions is considered important.
METHODS: This ESTRO clinical practice guideline is based on a systematic literature review conducted according to PRISMA standards, which formed the basis for answering four key questions about the indication and practice of SBRT for spine metastases.
RESULTS: The analysis of the key questions based on current evidence yielded 22 recommendations and 5 statements with varying levels of endorsement, all achieving a consensus among experts of at least 75%. In the majority, the level of evidence supporting the recommendations and statements was moderate or expert opinion, only, indicating that spine SBRT is still an evolving field of clinical research. Recommendations were established concerning the selection of appropriate patients with painful spine metastases and oligometastatic disease. Recommendations about the practice of spinal SBRT covered technical planning aspects including dose and fractionation, patient positioning, immobilization and image-guided SBRT delivery. Finally, recommendations were developed regarding quality assurance protocols, including description of potential SBRT-related toxicity and risk mitigation strategies.
CONCLUSIONS: This ESTRO clinical practice guideline provides evidence-based recommendations and statements regarding the selection of patients with spinal metastases for SBRT and its safe implementation and practice. Enrollment of patients into well-designed prospective clinical trials addressing clinically relevant questions is considered important.
摘要：
目的：转移性癌症诊断和治疗的最新进展显著提高了患者的生存率。这些发展也影响当地的治疗，治疗的目的是从短期缓解转向长期症状或疾病控制。因此,需要更好地定义立体定向身体放射疗法(SBRT)用于治疗脊柱转移瘤的价值。
方法：本ESTRO临床实践指南基于根据PRISMA标准进行的系统文献综述，这为回答有关SBRT治疗脊柱转移瘤的适应症和实践的四个关键问题奠定了基础。
结果：基于当前证据对关键问题的分析得出了22条建议和5条不同程度的认可声明，至少75%的专家达成共识。在大多数情况下,支持建议和声明的证据水平是中等或专家意见，只有,这表明脊柱SBRT仍然是一个不断发展的临床研究领域。建立了有关选择适当的脊柱疼痛转移和寡转移疾病患者的建议。关于脊柱SBRT实践的建议涵盖了技术规划方面，包括剂量和分割，患者定位,固定和图像引导SBRT交付。最后,提出了关于质量保证协议的建议，包括潜在的SBRT相关毒性和风险缓解策略的描述。
结论：本ESTRO临床实践指南提供了关于选择脊柱转移患者进行SBRT及其安全实施和实践的循证建议和声明。将患者纳入精心设计的解决临床相关问题的前瞻性临床试验被认为是重要的。
方法：本ESTRO临床实践指南基于根据PRISMA标准进行的系统文献综述，这为回答有关SBRT治疗脊柱转移瘤的适应症和实践的四个关键问题奠定了基础。
结果：基于当前证据对关键问题的分析得出了22条建议和5条不同程度的认可声明，至少75%的专家达成共识。在大多数情况下,支持建议和声明的证据水平是中等或专家意见，只有,这表明脊柱SBRT仍然是一个不断发展的临床研究领域。建立了有关选择适当的脊柱疼痛转移和寡转移疾病患者的建议。关于脊柱SBRT实践的建议涵盖了技术规划方面，包括剂量和分割，患者定位,固定和图像引导SBRT交付。最后,提出了关于质量保证协议的建议，包括潜在的SBRT相关毒性和风险缓解策略的描述。
结论：本ESTRO临床实践指南提供了关于选择脊柱转移患者进行SBRT及其安全实施和实践的循证建议和声明。将患者纳入精心设计的解决临床相关问题的前瞻性临床试验被认为是重要的。
