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Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review

医学 放射外科 梅德林 脊髓病 放射治疗 科克伦图书馆 系统回顾 立体定向放射治疗 指南 放射科 随机对照试验 外科 脊髓 法学 病理 精神科 政治学
作者
Sten Myrehaug,Arjun Sahgal,Motohiro Hayashi,Marc Levivier,Lijun Ma,Roberto Martínez,Ian Paddick,Jean Régis,Samuel Ryu,Ben J. Slotman,Antônio De Salles
出处
期刊:Journal of neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:27 (4): 428-435 被引量:125
标识
DOI:10.3171/2017.2.spine16976
摘要

OBJECTIVE Spinal metastases that recur after conventional palliative radiotherapy have historically been difficult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical efficacy and safety of spine SBRT specific to previously irradiated spinal metastases. METHODS A systematic literature review was conducted, which was specific to SBRT to the spine, using MEDLINE, Embase, Cochrane Evidence-Based Medicine Database, National Guideline Clearinghouse, and CMA Infobase, with further bibliographic review of appropriate articles. Research questions included: 1) Is retreatment spine SBRT efficacious with respect to local control and symptom control? 2) Is retreatment spine SBRT safe? RESULTS The initial literature search retrieved 2263 articles. Of these articles, 160 were potentially relevant, 105 were selected for in-depth review, and 9 studies met all inclusion criteria for analysis. All studies were single-institution series, including 4 retrospective, 3 retrospective series of prospective databases, 1 prospective, and 1 Phase I/II prospective study (low- or very low-quality data). The results indicated that spine SBRT is effective, with a median 1-year local control rate of 76% (range 66%-90%). Improvement in patients' pain scores post-SBRT ranged from 65% to 81%. Treatment delivery was safe, with crude rates of vertebral body fracture of 12% (range 0%-22%) and radiation-induced myelopathy of 1.2%. CONCLUSIONS This systematic literature review suggests that SBRT to previously irradiated spinal metastases is safe and effective with respect to both local control and pain relief. Although the evidence is limited to low-quality data, SBRT can be a recommended treatment option for reirradiation.
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