Abstract：
Primary thyroid cancer metastasizing to the spine portends poor survival and low quality of life. Current management strategies continue to evolve. This single-institution retrospective study analyzes outcomes after spinal stereotactic radiosurgery for patients with spinal metastases from thyroid cancer.
Nineteen patients (median age: 64.5 years) were treated with stereotactic radiosurgery (SRS) for spinal primary thyroid metastases (40 metastases, 47 vertebral levels) between 2003 and 2023. Nineteen (47.5%) lesions had epidural involvement and 20 (50%) lesions were classified as potentially unstable or unstable via the Spinal Instability Neoplastic Score. The median tumor volume per lesion was 33 cc (range: 1.5-153). The median single fraction prescription dose was 20 Gy (range: 12-23.5).
The median follow-up period was 15 months (range: 2-40). Five (12.8%) lesions locally progressed at a median of 9 months (range: 4-26) after SRS. The 1-, 2-, and 3-year local tumor control rates per lesion were 90.4%, 83.5%, and 75.9%, respectively. On univariate analysis, age at SRS >70 years (P = 0.05, hazard ratio: 6.86, 95% confidence interval: 1.01-46.7) was significantly correlated with lower rates of local tumor control. The median overall survival was 35 months (range: 2-141). The 1-, 2-, and 3-year overall survival rates were 73.7%, 50.4%, and 43.2%, respectively. For 33 lesions initially associated with pain, patients reported pain improvement (22 lesions, 66.7%), stability (10 lesions, 30.3%), and worsening (1 lesion, 3.0%) after SRS. One patient developed dysphagia 4 months after SRS treatment.
SRS can be utilized as an effective and safe primary and adjuvant treatment option for primary thyroid metastases to the spine.
Nineteen patients (median age: 64.5 years) were treated with stereotactic radiosurgery (SRS) for spinal primary thyroid metastases (40 metastases, 47 vertebral levels) between 2003 and 2023. Nineteen (47.5%) lesions had epidural involvement and 20 (50%) lesions were classified as potentially unstable or unstable via the Spinal Instability Neoplastic Score. The median tumor volume per lesion was 33 cc (range: 1.5-153). The median single fraction prescription dose was 20 Gy (range: 12-23.5).
The median follow-up period was 15 months (range: 2-40). Five (12.8%) lesions locally progressed at a median of 9 months (range: 4-26) after SRS. The 1-, 2-, and 3-year local tumor control rates per lesion were 90.4%, 83.5%, and 75.9%, respectively. On univariate analysis, age at SRS >70 years (P = 0.05, hazard ratio: 6.86, 95% confidence interval: 1.01-46.7) was significantly correlated with lower rates of local tumor control. The median overall survival was 35 months (range: 2-141). The 1-, 2-, and 3-year overall survival rates were 73.7%, 50.4%, and 43.2%, respectively. For 33 lesions initially associated with pain, patients reported pain improvement (22 lesions, 66.7%), stability (10 lesions, 30.3%), and worsening (1 lesion, 3.0%) after SRS. One patient developed dysphagia 4 months after SRS treatment.
SRS can be utilized as an effective and safe primary and adjuvant treatment option for primary thyroid metastases to the spine.
摘要：
目的：原发性甲状腺癌向脊柱转移预示着患者生存率和生活质量低下。当前的管理策略继续发展。这项单机构回顾性研究分析了患有甲状腺癌脊柱转移的患者的脊柱立体定向放射外科手术后的结果。
方法：19例患者（中位年龄：64.5岁）接受立体定向放射外科（SRS）治疗脊柱原发性甲状腺转移瘤（40例转移瘤，47个椎骨水平）在2003年至2023年之间。根据脊髓不稳定肿瘤评分，有19例（47.5％）病变硬膜外受累，有20例（50％）病变被分类为潜在不稳定或不稳定。每个病灶的中位肿瘤体积为33cc(范围:1.5-153)。单次处方剂量中位数为20Gy（范围：12-23.5）。
结果：中位随访期为15个月（范围：2-40）。5个（12.8%）病变在SRS后的中位9个月（范围：4-26）局部进展。1-,2-,每个病灶3年局部肿瘤控制率为90.4%，83.5%,75.9%,分别。在单变量分析中，SRS>70岁时(P=0.05,风险比:6.86,95%置信区间:1.01-46.7)的年龄与较低的局部肿瘤控制率显著相关.中位总生存期为35个月（范围：2-141）。1-,2-,3年总生存率为73.7%,50.4%,和43.2%，分别。对于最初与疼痛相关的33个病变，患者报告疼痛改善(22个病变，66.7%），稳定性（10个病变，30.3%），并恶化（1个病变，3.0%)SRS后。一名患者在SRS治疗后4个月出现吞咽困难。
结论：SRS可作为原发性甲状腺转移到脊柱的有效和安全的主要和辅助治疗选择。
方法：19例患者（中位年龄：64.5岁）接受立体定向放射外科（SRS）治疗脊柱原发性甲状腺转移瘤（40例转移瘤，47个椎骨水平）在2003年至2023年之间。根据脊髓不稳定肿瘤评分，有19例（47.5％）病变硬膜外受累，有20例（50％）病变被分类为潜在不稳定或不稳定。每个病灶的中位肿瘤体积为33cc(范围:1.5-153)。单次处方剂量中位数为20Gy（范围：12-23.5）。
结果：中位随访期为15个月（范围：2-40）。5个（12.8%）病变在SRS后的中位9个月（范围：4-26）局部进展。1-,2-,每个病灶3年局部肿瘤控制率为90.4%，83.5%,75.9%,分别。在单变量分析中，SRS>70岁时(P=0.05,风险比:6.86,95%置信区间:1.01-46.7)的年龄与较低的局部肿瘤控制率显著相关.中位总生存期为35个月（范围：2-141）。1-,2-,3年总生存率为73.7%,50.4%,和43.2%，分别。对于最初与疼痛相关的33个病变，患者报告疼痛改善(22个病变，66.7%），稳定性（10个病变，30.3%），并恶化（1个病变，3.0%)SRS后。一名患者在SRS治疗后4个月出现吞咽困难。
结论：SRS可作为原发性甲状腺转移到脊柱的有效和安全的主要和辅助治疗选择。
