Oncologic and Functional Outcomes After Stereotactic Body Radiation Therapy for High-Grade Malignant Spinal Cord Compression.

Autor:	Patel PP; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland., Cao Y; Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts., Chen X; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland., LeCompte MC; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland., Kleinberg L; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland., Khan M; Department of Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania., McNutt T; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland., Bydon A; Departments of Neurosurgery., Kebaish K; Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., Theodore N; Departments of Neurosurgery., Larry Lo SF; Department of Neurosurgery, Zucker School of Medicine at Hoftstra, Manhasset, New York., Lee SH; Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., Lubelski D; Departments of Neurosurgery., Redmond KJ; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	Advances in radiation oncology [Adv Radiat Oncol] 2023 Jul 28; Vol. 9 (1), pp. 101327. Date of Electronic Publication: 2023 Jul 28 (Print Publication: 2024).
DOI:	10.1016/j.adro.2023.101327
Abstrakt:	Purpose: Although surgical decompression is the gold standard for metastatic epidural spinal cord compression (MESCC) from solid tumors, not all patients are candidates or undergo successful surgical Bilsky downgrading. We report oncologic and functional outcomes for patients treated with stereotactic body radiation therapy (SBRT) to high-grade MESCC. Methods and Materials: Patients with Bilsky grade 2 to 3 MESCC from solid tumor metastases treated with SBRT at a single institution from 2009 to 2020 were retrospectively reviewed. Patients who received upfront surgery before SBRT were included only if postsurgical Bilsky grade remained ≥2. Neurologic examinations, magnetic resonance imaging, pain assessments, and analgesic usage were assessed every 3 to 4 months post-SBRT. Cumulative incidence of local recurrence was calculated with death as a competing risk, and overall survival was estimated by Kaplan-Meier. Results: One hundred forty-three patients were included. The cumulative incidence of local recurrence was 5.1%, 7.5%, and 14.1% at 6, 12, and 24 months, respectively. At first post-SBRT imaging, 16.2% of patients with initial Bilsky grade 2 improved to grade 1, and 53.8% of patients were stable. Five of 13 patients (38.4%) with initial Bilsky grade 3 improved to grade 1 to 2. Pain response at 3 and 6 months post-SBRT was complete in 45.4% and 55.7%, partial in 26.9% and 13.1%, stable in 24.1% and 27.9%, and worse in 3.7% and 3.3% of patients, respectively. At 3 and 6 months after SBRT, 17.8% and 25.0% of patients had improved ambulatory status and 79.7% and 72.4% had stable status. Conclusions: We report the largest series to date of patients with high-grade MESCC treated with SBRT. The excellent local control and functional outcomes suggest SBRT is a reasonable approach in inoperable patients or cases unable to be successfully surgically downgraded. Competing Interests: Palak P. Patel, Yilin Cao, Xuguang Chen, Michael C. LeCompte, and Todd McNutt have no disclosures. Lawrence Kleinberg reported clinical research support with Bristol-Myers Squibb, Incyte, Novartis, and Novocure. Majid Khan reported consulting for Stryker Medwaves, Avecure, Caerus Health, and Cohere Health. Sheng-fu Larry Lo reported consulting for Stryker, Depuy-Synthes, and SpineAlign and receiving travel expenses from Icotec. Nicholas Theodore reported receiving royalties, having stock ownership, and being a consultant for Globus Medical. Kristin J. Redmond reported receiving research support, travel expenses, and honoraria for educational seminars from Accuray, participating on a data and safety monitoring board for BioMimetix, travel expenses from Icotec, research funding and travel expenses from Elekta AB, research funding from Canon, and receiving travel expenses from Brainlab. (© 2023 The Authors.)
Databáze:	MEDLINE
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