Abstract：
OBJECTIVE: This study aimed to assess the results of primary stereotactic body radiotherapy (SBRT) for spinal bone metastases (SBM) originating from lung adenocarcinoma (ADC). We considered the revised Tokuhashi score (rTS), Spinal Instability Neoplastic Score (SINS), and genetic characteristics.
METHODS: We examined adult patients with lung ADC who underwent primary SBRT (using the CyberKnife System) for SBM between March 2012 and January 2023.
RESULTS: We analyzed data from 99 patients, covering 152 SBM across 194 vertebrae. The overall local control (LC) rate was 77.6% for SBM from lung ADC, with a LC rate of 90.7% at 1 year. The median period for local progression (LP) occurrence was recorded at 10.0 (3-52) months. Additionally, Asian patients demonstrated higher LC rates than White patients. Utilizing the rTS and SINS as predictive tools, we revealed that a poor survival prognosis and an unstable spinal structure were associated with increased rates of LP. Furthermore, the presence of osteolytic bone destructions and pain complaints were significantly correlated with the occurrence of LP. In the cohort of this study, 108 SBM underwent analysis to determine the expression levels of programmed cell death ligand 1 (PD-L1). Additionally, within this group, 60 showed mutations in the epidermal growth factor receptor (EGFR) alongside PD-L1 expression. Nevertheless, these genetic differences did not result in statistically significant differences in the LC rate.
CONCLUSIONS: The one-year LC rate for primary SBRT targeting SBM from lung ADC stood at 90.7%, particularly with the use of the CyberKnife System. Patients achieving LC exhibited significantly longer survival times compared to those with LP.
METHODS: We examined adult patients with lung ADC who underwent primary SBRT (using the CyberKnife System) for SBM between March 2012 and January 2023.
RESULTS: We analyzed data from 99 patients, covering 152 SBM across 194 vertebrae. The overall local control (LC) rate was 77.6% for SBM from lung ADC, with a LC rate of 90.7% at 1 year. The median period for local progression (LP) occurrence was recorded at 10.0 (3-52) months. Additionally, Asian patients demonstrated higher LC rates than White patients. Utilizing the rTS and SINS as predictive tools, we revealed that a poor survival prognosis and an unstable spinal structure were associated with increased rates of LP. Furthermore, the presence of osteolytic bone destructions and pain complaints were significantly correlated with the occurrence of LP. In the cohort of this study, 108 SBM underwent analysis to determine the expression levels of programmed cell death ligand 1 (PD-L1). Additionally, within this group, 60 showed mutations in the epidermal growth factor receptor (EGFR) alongside PD-L1 expression. Nevertheless, these genetic differences did not result in statistically significant differences in the LC rate.
CONCLUSIONS: The one-year LC rate for primary SBRT targeting SBM from lung ADC stood at 90.7%, particularly with the use of the CyberKnife System. Patients achieving LC exhibited significantly longer survival times compared to those with LP.
摘要：
目的：本研究旨在评估原发性立体定向放疗（SBRT）治疗源自肺腺癌（ADC）的脊柱骨转移瘤（SBM）的结果。我们考虑了修改后的德桥得分(rTS)，脊髓不稳定肿瘤评分(SINS),和遗传特征。
方法：我们检查了2012年3月至2023年1月期间接受原发性SBRT（使用Cyberknife系统）的肺ADC成年患者。
结果：我们分析了99例患者的数据，覆盖152SBM跨越194椎骨。来自肺ADC的SBM的总体局部控制率(LC)为77.6%,1年的LC率为90.7%。在10.0（3-52）个月时记录局部进展（LP）发生率的中位数。此外,亚洲患者的LC率高于白人患者。利用rTS和SINS作为预测工具，我们发现生存预后差和脊柱结构不稳定与LP发生率升高相关.此外，溶骨性骨破坏和疼痛投诉的存在与LP的发生显着相关。在这项研究的队列中，108对SBM进行分析以确定程序性细胞死亡配体1(PD-L1)的表达水平。此外,在这个群体中，图60显示表皮生长因子受体(EGFR)中伴随PD-L1表达的突变。然而，这些遗传差异未导致LC率的统计学显著差异.
结论：针对来自肺ADC的SBM的原发性SBRT的一年LC率为90.7%，特别是使用射波刀系统。与具有LP的患者相比,实现LC的患者表现出显著更长的存活时间。
方法：我们检查了2012年3月至2023年1月期间接受原发性SBRT（使用Cyberknife系统）的肺ADC成年患者。
结果：我们分析了99例患者的数据，覆盖152SBM跨越194椎骨。来自肺ADC的SBM的总体局部控制率(LC)为77.6%,1年的LC率为90.7%。在10.0（3-52）个月时记录局部进展（LP）发生率的中位数。此外,亚洲患者的LC率高于白人患者。利用rTS和SINS作为预测工具，我们发现生存预后差和脊柱结构不稳定与LP发生率升高相关.此外，溶骨性骨破坏和疼痛投诉的存在与LP的发生显着相关。在这项研究的队列中，108对SBM进行分析以确定程序性细胞死亡配体1(PD-L1)的表达水平。此外,在这个群体中，图60显示表皮生长因子受体(EGFR)中伴随PD-L1表达的突变。然而，这些遗传差异未导致LC率的统计学显著差异.
结论：针对来自肺ADC的SBM的原发性SBRT的一年LC率为90.7%，特别是使用射波刀系统。与具有LP的患者相比,实现LC的患者表现出显著更长的存活时间。
