■立体定向消融放疗(SABR)普遍用于治疗骨转移。尽管它的功效,不良事件,包括椎体压缩骨折(VCF),经常被观察到。这里,我们调查了SABR后肝细胞癌寡转移椎体骨转移的VCF风险。
■回顾性分析了2009年至2019年间在三个机构治疗的84例144个转移性骨病变患者。主要终点是VCF发展,新的或预先存在的VCF的进展。使用脊柱不稳定肿瘤评分(SINS)评估VCF。
■在144个脊柱节段中,26(18%)具有预先存在的VCF,90(63%)具有软组织延伸。中位生物有效剂量(BED)为76.8Gy。在118例VCF初治患者中,有14例(12%)出现了VCF,在26例已有VCF的患者中,有20例进展。VCF发展的中位时间为6个月(范围,1-12个月)。SINSI级12个月时VCF的累积发生率,II和III为0%,26%和83%,分别(p<0.001)。VCF发展的重要因素是预先存在的VCF,软组织延伸,高床,单变量分析中的SINS类,以及多变量分析中预先存在的VCF。在犯罪的六个组成部分中,疼痛,骨病变类型,脊柱对齐,椎体塌陷,和后外侧受累被确定为VCF发展的预测因子。
■SABR用于HCC的寡转移椎体病变,导致新的VCF发展和预先存在的VCF进展的发生率很高。预先存在的VCF是VCF开发的重要风险因素,这需要在病人护理中特别注意。患有III级SINS的患者应考虑手术治疗,而不是前期SABR。
UNASSIGNED: Stereotactic ablative radiotherapy (SABR) is popularly used to treat bone metastasis. Despite its efficacy, adverse events, including vertebral compression fracture (VCF), are frequently observed. Here, we investigated VCF risk after SABR for oligometastatic vertebral bone metastasis from hepatocellular carcinoma.
UNASSIGNED: A total of 84 patients with 144 metastatic bone lesions treated at three institutions between 2009 and 2019 were retrospectively reviewed. The primary endpoint was VCF development, either new or progression of a pre-existing VCF. VCFs were assessed using the spinal instability neoplastic score (SINS).
UNASSIGNED: Among 144 spinal segments, 26 (18%) had pre-existing VCF and 90 (63%) had soft tissue extension. The median biologically effective dose (BED) was 76.8 Gy. VCF developed in 14 (12%) of 118 VCF-naïve patients and progressed in 20 of the 26 with pre-existing VCF. The median time to VCF development was 6 months (range, 1-12 months). The cumulative incidence of VCF at 12 months with SINS class I, II and III was 0%, 26% and 83%, respectively (p < 0.001). Significant factors for VCF development were pre-existing VCF, soft tissue extension, high BED, and SINS class in univariate analysis, and pre-existing VCF in multivariate analysis. Of the six components of SINS, pain, type of bone lesion, spine alignment, vertebral body collapse, and posterolateral involvement were identified as predictors of VCF development.
UNASSIGNED: SABR for oligometastatic vertebral bone lesions from HCC resulted in a substantial rate of new VCF development and pre-existing VCF progression. Pre-existing VCF was significant risk factor for VCF development, which require special attention in patient care. Patients with SINS class III should be considered surgical treatment rather than upfront SABR.