■我们旨在回顾性评估椎体压缩性骨折(VCF)的发生率,检查与VCF潜在相关的临床病理因素,并评估接受立体定向放疗(SBRT)治疗脊柱转移瘤(spMets)的患者的治疗反应。
■我们在基线和后续评估时确定了78例125spMets患者。患者接受16或18Gy的SBRT剂量。排除预先存在VCF和同时存在局部进展的患者。脊柱不稳定性肿瘤评分(SINS)用于spMets分类。根据实体瘤正电子发射断层扫描反应标准(PERCIST)和Genant评分评估对SBRT和VCF的反应,分别。Kaplan-Meier分析用于评估疾病的局部控制和椎体压缩性骨折无生存(FFS)。
■我们用SBRT治疗了103例单spMets和11例双spMets。在第一次和最后一次PET/CT报告中,有3.2%和8.2%的病例报告了进展性疾病,分别。其余患者的治疗反应分布为:30.6%的患者完全缓解,47.1%的患者有部分反应,在第一次PET/CT中,22.3%的患者病情稳定;62.3%的患者完全缓解,16.7%的患者有部分反应,在最后一次监测时,21%的患者病情稳定。在15例(12%)中观察到局部故障。SINS中位数为5(范围:1-13);我们队列中的大多数患者(70.4%)根据SINS被分类为稳定的,5例(4%)患者在SBRT后的中位时间为16个月(范围:2-22个月)出现3级VCF,和60%的VCF发生在SBRT后至少12个月的间隔后。没有双膦酸盐的使用与VCF显着相关(r=-0.204;p=0.022)。FFS中位数为21个月。单变量分析表明,女性性别(p<0.001),使用双膦酸盐(p=0.005),>6个月的双膦酸盐使用(p=0.002),最低的椎体塌陷评分(p=0.023)与较高的FFS相关。女性(p=0.007),>6个月的双膦酸盐使用(p=0.018),最低椎体塌陷评分(p=0.044)保持独立的显著性。
■这项研究表明,剂量为16-18Gy的脊柱SBRT有望以可接受的VCF率对疾病进行良好的局部控制。最低椎体塌陷评分,女性性别,>6个月的双膦酸盐使用与较长的FFS显著相关。
UNASSIGNED: We aimed to retrospectively assess the incidence of vertebral compression fractures (VCF), examine clinicopathologic factors potentially associated with VCF, and evaluate treatment response in patients who received stereotactic body radiotherapy (SBRT) for spine metastases (spMets).
UNASSIGNED: We identified 78 patients with 125 spMets at baseline and subsequent assessments. Patients received SBRT doses of 16 or 18 Gy. Patients with pre-existing VCF and co-existing local progression were excluded. Spine instability neoplastic score (SINS) was used for spMets categorization. Response to SBRT and VCF were assessed according to the Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) and Genant scores, respectively. Kaplan-Meier analyses were used to assess local control of disease and vertebral compression fracture-free survival (FFS).
UNASSIGNED: We treated 103 cases with single spMets and 11 cases involving double spMets with SBRT. Progressive disease was reported in 3.2% and 8.2% of the cases in the first and last PET/CT reports, respectively. The distribution of treatment response in the remaining patients was: complete response in 30.6% of patients, partial response in 47.1% of patients, and stable disease in 22.3% of patients in the first PET/CT; complete response in 62.3% of patients, partial response in 16.7% of patients, and stable disease in 21% of patients at the last monitoring. Local failures were observed in 15 (12%) of cases. Median SINS was 5 (range: 1-13); majority of patients in our cohort (70.4%) were categorized as stable according to SINS, five (4%) patients had Grade 3 VCF at a median time of 16 months after SBRT (range: 2-22 months), and 60% of VCF occurred after an interval of at least 12 months after SBRT. No bisphosphonate usage was significantly associated with VCF (r = -0.204; p = 0.022). Median FFS was 21 months. Univariate analyses indicated that female gender (p < 0.001), bisphosphonate use (p = 0.005), >6 months of bisphosphonates use (p = 0.002), and the lowest vertebral body collapse score (p = 0.023) were associated with higher FFS. Female gender (p = 0.007), >6 months of bisphosphonates usage (p = 0.018), and the lowest vertebral body collapse score (p = 0.044) retained independent significance.
UNASSIGNED: This study demonstrated that spine SBRT with doses of 16-18 Gy promises good local control of disease with acceptable VCF rates. Lowest vertebral body collapse score, female gender, and >6 months of bisphosphonate use were significantly associated with longer FFS.