Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the do...Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord.The purpose of this study was to evaluate the safety and efficacy of CyberKnife（R） radiation therapy for spinal metastases.Methods Seventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed.Thirteen tumors in 12 patients had received prior radiation.Patients were followed clinically and radiographically for at least 12 months or until death.In all patients,the spinal cord and thecal sac were contoured for dose-volume constraints,and maximum doses to 0.1,0.5,1,2,and 5-ml volumes were analyzed.Results Using the CyberKnife System,20-48 Gy in one to five fractions for unirradiated patients,and 21-38 Gy in one to five fractions for the previously irradiatied patients,were delivered.Median 2-Gy normalized Biological Equvaient Dose （nBED） of unirradiated targets and irradiated targets were 49.6 Gy10/2 （range,31.25-74.8 Gy10/2） and 46.9 Gy10/2 （range,29.8-66 Gy10/2）,respectively.With a median follow-up of 9.4 months （range,2.5-45 months）,twenty-nine patients （46.7％） were alive,whereas the others died of progressive disease.Fifty-six patients （93.3％） reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up,17 patients （28.3％） reported some degree of pain relief after first fraction of the treatment course.Two patients experienced local recurrence at fifth and ninth months postradiotherapy.Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 （range,8.3-154.5Gy2/2） and 83.5 Gy2/2 （range,10.5-180.5 Gy2/2）,respectively.Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 （range,17.7-140 Gy2/2） and 70.5 Gy2/2 （range,21.7-141.3 Gy2/展开更多
随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通...随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通过外照射的方式聚焦到肿瘤部位,达到消灭肿瘤的目的。目前越来越多SBRT技术用于脊柱转移瘤的治疗。为更好地治疗脊柱转移瘤,NOMS(neurologic,oncologic,mechanical,and systemic)决策框架的概念被引入临床实践中,它将立体定向放射治疗、分离手术、脊柱的稳定和常规分割放疗联合起来,为脊柱转移瘤提供最佳治疗策略。脊柱转移瘤SBRT,局控率高,副作用小,但是需要注意危及器官剂量的限制。该文对NOMS中关于脊柱转移瘤SBRT的一些建议进行解读,为临床肿瘤放射医师提供参考。展开更多
基金This study was supported by grants from the National Natural Science Foundation of China （No. 81302003） and Tianjin Science and Technology Foundation （No. 2012KZ065）.
文摘Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord.The purpose of this study was to evaluate the safety and efficacy of CyberKnife（R） radiation therapy for spinal metastases.Methods Seventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed.Thirteen tumors in 12 patients had received prior radiation.Patients were followed clinically and radiographically for at least 12 months or until death.In all patients,the spinal cord and thecal sac were contoured for dose-volume constraints,and maximum doses to 0.1,0.5,1,2,and 5-ml volumes were analyzed.Results Using the CyberKnife System,20-48 Gy in one to five fractions for unirradiated patients,and 21-38 Gy in one to five fractions for the previously irradiatied patients,were delivered.Median 2-Gy normalized Biological Equvaient Dose （nBED） of unirradiated targets and irradiated targets were 49.6 Gy10/2 （range,31.25-74.8 Gy10/2） and 46.9 Gy10/2 （range,29.8-66 Gy10/2）,respectively.With a median follow-up of 9.4 months （range,2.5-45 months）,twenty-nine patients （46.7％） were alive,whereas the others died of progressive disease.Fifty-six patients （93.3％） reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up,17 patients （28.3％） reported some degree of pain relief after first fraction of the treatment course.Two patients experienced local recurrence at fifth and ninth months postradiotherapy.Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 （range,8.3-154.5Gy2/2） and 83.5 Gy2/2 （range,10.5-180.5 Gy2/2）,respectively.Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 （range,17.7-140 Gy2/2） and 70.5 Gy2/2 （range,21.7-141.3 Gy2/
文摘随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通过外照射的方式聚焦到肿瘤部位,达到消灭肿瘤的目的。目前越来越多SBRT技术用于脊柱转移瘤的治疗。为更好地治疗脊柱转移瘤,NOMS(neurologic,oncologic,mechanical,and systemic)决策框架的概念被引入临床实践中,它将立体定向放射治疗、分离手术、脊柱的稳定和常规分割放疗联合起来,为脊柱转移瘤提供最佳治疗策略。脊柱转移瘤SBRT,局控率高,副作用小,但是需要注意危及器官剂量的限制。该文对NOMS中关于脊柱转移瘤SBRT的一些建议进行解读,为临床肿瘤放射医师提供参考。
