Mohammad Amin Dabbagh Ohadi, Pouria Delbari, Muhammad Hussain Ahmadvand, Raha Zamani, Amirmasoud Karimi, Neshat Ohadi, Constantinos G Hadjipanayis
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引用次数: 0
Abstract
Objective: Stereotactic radiosurgery (SRS) plays an important role in the treatment of spinal metastases by delivering precise, high-dose radiation to the target region while sparing critical structures. Although various dosing and fractionation schemes have been reported, the optimal regimen remains a topic of debate. The aim of this study was to compare single- versus multifraction SRS (≤ 5 fractions) in the treatment of spinal metastases regarding oncological outcome, pain improvement, and complications, with special concern about vertebral compression fracture (VCF).
Methods: A systematic review was conducted using the PubMed, Scopus, and Embase databases in October 2024 in accordance with PRISMA guidelines. The random-effects model was used for statistical analysis and quality appraisal was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool.
Results: A total of 26 studies comprising 4125 patients and 5408 lesions were included in this study. Single-fraction treatment demonstrated superior local control (HR 0.58, p = 0.023), particularly at doses exceeding 20 Gy (HR 0.28, p < 0.0001). However, overall survival did not differ significantly between the two groups (HR 0.78, p = 0.761). Pain relief was comparable between the groups (OR 0.94, p = 0.63). Although the VCF rate was higher in the single-fraction group (OR 1.32, p = 0.32), the difference was not statistically significant, even at doses greater than 20 Gy. Additionally, no significant differences were observed in overall complication rates (OR 1.98, p = 0.12).
Conclusions: This study highlights the superiority of high-dose single-fraction regimen in controlling spinal metastatic tumors compared with multifraction lower doses, with comparable overall survival, complication rates, and VCF incidence. However, prospective randomized studies are necessary to better determine the optimal regimen for different patient populations.
目的：立体定向放射外科（SRS）通过向靶区提供精确的高剂量辐射，同时保留关键结构，在脊柱转移治疗中发挥重要作用。虽然各种剂量和分离方案已被报道，但最佳方案仍然是一个有争议的话题。本研究的目的是比较单段SRS与多段SRS（≤5段）治疗脊柱转移的肿瘤预后、疼痛改善和并发症，特别关注椎体压缩性骨折（VCF）。方法：根据PRISMA指南，于2024年10月使用PubMed、Scopus和Embase数据库进行系统评价。采用随机效应模型进行统计分析，采用ROBINS-I （Risk of Bias in non - random Studies-of Interventions）工具进行质量评价。结果：本研究共纳入26项研究，4125例患者，5408个病变。单组分治疗显示出更好的局部控制（HR 0.58, p = 0.023），特别是在剂量超过20 Gy时（HR 0.28, p < 0.0001）。然而，两组患者的总生存率无显著差异（HR 0.78, p = 0.761）。两组间疼痛缓解具有可比性（OR 0.94, p = 0.63）。虽然单组分组的VCF率较高（OR 1.32, p = 0.32），但即使剂量大于20 Gy，差异也无统计学意义。此外，两组总并发症发生率无显著差异（OR 1.98, p = 0.12）。结论：本研究强调了高剂量单组分方案在控制脊柱转移瘤方面的优势，与多组分低剂量方案相比，总生存期、并发症发生率和VCF发生率相当。然而，为了更好地确定不同患者群体的最佳方案，前瞻性随机研究是必要的。
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