Abstract：
OBJECTIVE: Breast cancer that metastasizes to the spine is associated with low quality of life and poor survival. Radiosurgery has an increasing role in this patient population. This single-institution (2003-2023) study analyzes clinical outcomes and prognostic factors for patients who underwent spinal stereotactic radiosurgery (SSRS) for metastatic breast cancer.
METHODS: Ninety patients (155 unique breast cancer spinal metastases) were treated with SSRS. The median age was 57 years (range: 35-88), and the median KPS was 80 (range: 40-100). Forty-two (27%) lesions were managed surgically prior to radiosurgery. At SSRS, 75 (48%) lesions impinged or compressed the spinal cord per the epidural spinal cord scale (ESCC). Seventy-nine (51%) lesions were categorized as potentially unstable or unstable by the Spinal Instability Neoplastic Score (SINS).
RESULTS: The median follow-up was 15 months (range: 1-183). The median single-session tumor volume was 25.4 cc (range: 2-197), and the median single-fraction prescription dose was 17 Gy (range: 12-25). Seven (5%) lesions locally progressed. The 1-, 2-, and 5-year local control rates were 98%, 97%, and 92%, respectively. The median overall survival (OS) for the cohort was 32 months (range: 2-183). The 1-, 2-, and 5-year OS rates were 72%, 53%, and 30%, respectively. On univariate analysis, KPS ≥ 80 (p = 0.009, HR: 0.51, 95% CI: 0.31-0.84) was associated with improved OS. Patient-reported pain improved (68%), remained stable (29%), or worsened (3%) following radiosurgery. Fifteen (10%) radiation-induced toxicities were reported.
CONCLUSIONS: Spinal radiosurgery is a safe and highly effective long-term treatment modality for metastases to the spine that originate from breast cancer.
METHODS: Ninety patients (155 unique breast cancer spinal metastases) were treated with SSRS. The median age was 57 years (range: 35-88), and the median KPS was 80 (range: 40-100). Forty-two (27%) lesions were managed surgically prior to radiosurgery. At SSRS, 75 (48%) lesions impinged or compressed the spinal cord per the epidural spinal cord scale (ESCC). Seventy-nine (51%) lesions were categorized as potentially unstable or unstable by the Spinal Instability Neoplastic Score (SINS).
RESULTS: The median follow-up was 15 months (range: 1-183). The median single-session tumor volume was 25.4 cc (range: 2-197), and the median single-fraction prescription dose was 17 Gy (range: 12-25). Seven (5%) lesions locally progressed. The 1-, 2-, and 5-year local control rates were 98%, 97%, and 92%, respectively. The median overall survival (OS) for the cohort was 32 months (range: 2-183). The 1-, 2-, and 5-year OS rates were 72%, 53%, and 30%, respectively. On univariate analysis, KPS ≥ 80 (p = 0.009, HR: 0.51, 95% CI: 0.31-0.84) was associated with improved OS. Patient-reported pain improved (68%), remained stable (29%), or worsened (3%) following radiosurgery. Fifteen (10%) radiation-induced toxicities were reported.
CONCLUSIONS: Spinal radiosurgery is a safe and highly effective long-term treatment modality for metastases to the spine that originate from breast cancer.
摘要：
目的：转移到脊柱的乳腺癌与低生活质量和低生存率相关。放射外科在该患者人群中的作用越来越大。这项单机构（2003-2023年）研究分析了接受脊柱立体定向放射外科（SSRS）治疗转移性乳腺癌的患者的临床结果和预后因素。
方法：90例患者（155例独特的乳腺癌脊柱转移）接受SSRS治疗。中位年龄为57岁（范围：35-88），KPS中位数为80（范围：40-100）。在放射外科手术之前，对42个（27％）病变进行了手术处理。在SSRS,根据硬膜外脊髓量表（ESCC），75（48％）个病变撞击或压迫了脊髓。根据脊柱不稳定肿瘤评分（SINS），将79个（51％）病变归类为潜在不稳定或不稳定。
结果：中位随访时间为15个月（范围：1-183）。单次肿瘤体积中位数为25.4cc（范围：2-197），单份处方剂量中位数为17Gy（范围：12-25）。七个（5％）病变局部进展。1-,2-,5年局部控制率为98%，97%,92%,分别。该队列的中位总生存期（OS）为32个月（范围：2-183）。1-,2-,5年OS率为72%，53%,30%,分别。在单变量分析中，KPS≥80（p=0.009，HR：0.51，95%CI：0.31-0.84）与OS改善相关。患者报告的疼痛有所改善（68％），保持稳定（29%），或放射外科手术后恶化（3％）。报告了15（10％）辐射诱导的毒性。
结论：脊柱放射外科治疗源自乳腺癌的脊柱转移瘤是一种安全有效的长期治疗方法。
方法：90例患者（155例独特的乳腺癌脊柱转移）接受SSRS治疗。中位年龄为57岁（范围：35-88），KPS中位数为80（范围：40-100）。在放射外科手术之前，对42个（27％）病变进行了手术处理。在SSRS,根据硬膜外脊髓量表（ESCC），75（48％）个病变撞击或压迫了脊髓。根据脊柱不稳定肿瘤评分（SINS），将79个（51％）病变归类为潜在不稳定或不稳定。
结果：中位随访时间为15个月（范围：1-183）。单次肿瘤体积中位数为25.4cc（范围：2-197），单份处方剂量中位数为17Gy（范围：12-25）。七个（5％）病变局部进展。1-,2-,5年局部控制率为98%，97%,92%,分别。该队列的中位总生存期（OS）为32个月（范围：2-183）。1-,2-,5年OS率为72%，53%,30%,分别。在单变量分析中，KPS≥80（p=0.009，HR：0.51，95%CI：0.31-0.84）与OS改善相关。患者报告的疼痛有所改善（68％），保持稳定（29%），或放射外科手术后恶化（3％）。报告了15（10％）辐射诱导的毒性。
结论：脊柱放射外科治疗源自乳腺癌的脊柱转移瘤是一种安全有效的长期治疗方法。
