医学
核医学
置信区间
累积发病率
放射治疗
入射(几何)
质子疗法
放射外科
放射科
内科学
队列
物理
光学
作者
Roman O. Kowalchuk,T.C. Mullikin,Grant M. Spears,Benjamin A. Johnson‐Tesch,Peter S. Rose,Brittany L. Siontis,Dong Kun Kim,Brian A. Costello,Jonathan M. Morris,Robert W. Gao,Satomi Shiraishi,J. John Lucido,Kenneth R. Olivier,Dawn Owen,Bradley J. Stish,Mark R. Waddle,Nadia N. Laack,Sean S. Park,Paul D. Brown,Kenneth W. Merrell
标识
DOI:10.1016/j.radonc.2024.110260
摘要
Objectives Metastasis-directed stereotactic body radiation therapy (SBRT) has demonstrated robust clinical benefits in carefully selected patients, improving local control and even overall survival (OS). We assess a large database to determine clinical and dosimetric predictors of local failure after spine SBRT. Methods Spine SBRT treatments with imaging follow-up were identified. Patients were treated with a simultaneous integrated boost technique using 1 or 3 fractions, delivering 20–24 Gy in 1 fraction to the gross tumor volume (GTV) and 16 Gy to the low dose volume (or 27–36 Gy and 21–24 Gy for 3 fraction treatments). Exclusions included: lack of imaging follow-up, proton therapy, and benign primary histologies. Results 522 eligible spine SBRT treatments (68 % single fraction) were identified in 377 unique patients. Patients had a median OS of 43.7 months (95 % confidence interval: 34.3–54.4). The cumulative incidence of local failure was 10.5 % (7.4–13.4) at 1 year and 16.3 % (12.6–19.9) at 2 years. Local control was maximized at 15.3 Gy minimum dose for single-fraction treatment (HR = 0.31, 95 % CI: 0.17 – 0.56, p < 0.0001) and confirmed via multivariable analyses. Cumulative incidence of local failure was 6.1 % (2.6–9.4) vs. 14.2 % (8.3–19.8) at 1 year using this cut-off, with comparable findings for minimum 14 Gy. Additionally, epidural and soft tissue involvement were predictive of local failure (HR = 1.77 and 2.30). Conclusions Spine SBRT offers favorable local control; however, minimum dose to the GTV has a strong association with local control. Achieving GTV minimum dose of 14–15.3 Gy with single fraction SBRT is recommended whenever possible.
科研通智能强力驱动
Strongly Powered by AbleSci AI