摘要
目的评估立体定向放疗(stereotactic body radiotherapy,SBRT)技术用于脊柱转移瘤再程放疗的有效性和安全性。方法回顾性分析2019年至2020年间接受再程放疗的脊柱转移瘤患者数据,其中脊柱再程放疗等剂量线与初次放疗时相互重叠。共纳入42例患者,共计42个靶病灶。初次放疗时脊髓的平均剂量为30 Gy。SBRT进行脊柱再程放疗应用适形调强放疗(intensity modulated radiation therapy,IMRT)技术。所有患者的计划靶区均接受了25 Gy/5次的分割模式。观察总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)、症状缓解和不良事件(adverse event,AE)发生情况。结果40例疼痛患者中,60%(24例)在再程放疗后获得了疼痛缓解。15例有神经功能障碍的患者中,53%(8例)获得了神经功能改善。再程放疗耐受性良好,未出现4级或5级不良反应。2例患者出现≥2级的不良事件,包括1例3级疼痛和1例3级脊柱骨折。没有患者出现放射性脊髓损伤。PFS和OS的中位时间分别为10个月和18个月。1年和2年PFS分别为67%和23%,1年和2年的总生存率分别为80%和45%。结论对脊柱转移瘤进行SBRT再程放疗可有效缓解疼痛和改善神经功能,具有较好的总生存期和无进展生存期,且不良反应发生率低,值得推广。
Objective This study was aimed at assessing the feasibility and toxicity of using stereotactic body radiation therapy(SBRT)for reirradiation of spinal metastatic tumors.Methods We conducted a retrospective review,from our institutional database,of the data of patients who received reirradiation,with overlap of some prescribed isodose lines to the vertebra from the initial radiation therapy,between 2019 and 2020.We identified 42 patients with spinal metastatic tumors,totaling up to 42 target lesions.The median dose to spinal cord at the initial radiation therapy was 30 Gy.SBRT based on the intensity-modulated radiation therapy(IMRT)technique was used for reirradiation to spare the spinal cord.All patients received a prescription dose of 25 Gy in 5 fractions to the planning target volume(PTV).Overall survival(OS),progression-free survival(PFS),remission and adverse events(AE)were observed.Results Among the 40 cases who had pain,pain relief was obtained in 24(60%)after reirradiation.Neurologic improvement was obtained in 8 of 15 cases(53%).Reirradiation was well-tolerated,with only 2 patients experiencing adverse events≥grade 2 in severity,including 1 patient with grade 3 pain,and another patient with grade 3 spinal fracture.None of the patients developed radiation myelopathy.The median time for PFS and OS was 10 months and 18 months,respectively.1-year and 2-year PFS were 67% and 23%,respectively,and 1-year and 2-year overall survival rates were 80% and 45%,respectively.Conclusion SBRT reradiotherapy for spinal metastases can effectively relieve pain and improve nerve function,with better OS and PFS,and tolerable toxicity,which is worth popularizing.
作者
张建鑫
ZHANG Jianxin(Department of Oncology,Shanting District People's Hospital,Zaozhuang 277200,Shandong,P.R.China)
出处
《滨州医学院学报》
2025年第4期384-388,共5页
Journal of Binzhou Medical University
关键词
脊柱转移瘤
再程放疗
立体定向放疗
spinal metastasis
reirradiation
stereotactic body radiation therapy
