Local Control After Adjuvant Radiosurgery for Spinal Metastasis Treated With Decompression and Posterior Segmental Stabilization: A Comparison Between Carbon Fiber/Polyetheretherketone-Based and Metallic Implants

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-06-10 DOI:10.1016/j.adro.2025.101806

Romulo A. Andrade-Almeida MD , Francisco Call-Orellana MD , Juan P. Zuluaga-Garcia MD, MSc , Esteban Ramirez-Ferrer MD , Gil Kimchi MD , Brian S. De MD , Alexandre B. Guimaraes MD , Christopher A. Alvarez-Breckenridge MD, PhD , Jing Li MD, PhD , Amol J. Ghia MD , Laurence Rhines MD , Martin C. Tom MD , Chenyang Wang MD, PhD , Thomas H. Beckham MD, PhD , Behrang Amini MD, PhD , Robert Y. North MD, PhD , Claudio E. Tatsui MD

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引用次数: 0

Abstract

Purpose

Carbon fiber-reinforced polyetheretherketone (CFRP) spinal implants are gaining popularity in the surgical management of spinal metastasis because of their physical and radiographic properties, which facilitate adjuvant radiation planning and tumor surveillance. Their impact on clinical outcomes is still under investigation. We evaluated the role of hardware material (CFRP vs titanium) in local control and hardware durability in metastatic cases receiving decompressive surgery and adjuvant spinal stereotactic radiosurgery (SSRS).

Methods and Materials

This single-institution, retrospective cohort study was approved by the local institutional review board. Patients who underwent decompressive surgery with posterior segmental instrumentation followed by treatment with SSRS for metastatic spine disease were included. Exclusion criteria were as follows: (1) cervical implants, (2) mixed-type hardware, (3) SSRS greater than 60 days after surgery, and (4) less than 3 months magnetic resonance imaging follow-up. Only tumor progression occurring inside or at the margins of the irradiated field was considered.

Results

Eighty-three spinal segments (55 titanium, 28 CFRP; from 82 patients) were evaluated. Except for the number of radiation fractions, proportion of single-fraction 24 Gy cases, and radiation equivalent dose in 2-Gy fractions, no significant differences were found between groups. The median follow-up time was 14.5 months (range, 3.0-70.4 months). Sixteen local progressions were identified, with 15 in the titanium group (P = .009). Using death as a competing factor, local progression-free survival was longer in the CFRP group (HR, 0.127; 95% CI, 0.017-0.945; P = .044). The median time to progression was 9.27 months (IQR, 4.5-15.65 months). Higher equivalent dose in 2-Gy fractions was the only variable associated with local tumor control in both univariate and multivariate analyses (P = .025 and P = .019, respectively). The titanium cohort experienced 4 hardware adverse events, whereas the CFRP group had 2 adverse events (P > .05).

Conclusions

CFRP implants were associated with lower rates of local progression in crude analyses, but did not reach statistical significance in multivariable models. No differences in hardware durability were identified.

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用减压和后路稳定治疗脊柱转移的辅助放疗后局部控制：碳纤维/聚醚酮基和金属植入物的比较

碳纤维增强聚醚醚酮（CFRP）脊柱植入物由于其物理和放射学特性，有助于辅助放射计划和肿瘤监测，在脊柱转移的外科治疗中越来越受欢迎。它们对临床结果的影响仍在调查中。我们评估了硬体材料（CFRP vs钛）在接受减压手术和辅助脊柱立体定向放射手术（SSRS）的转移病例的局部控制和硬体耐久性中的作用。方法与材料本研究为单机构、回顾性队列研究，经当地机构审查委员会批准。患者接受减压手术与后路内固定，随后与SSRS治疗转移性脊柱疾病。排除标准为：(1)颈椎植入物，(2)混合型硬体，(3)术后SSRS大于60天，(4)磁共振成像随访时间小于3个月。仅考虑在照射场内部或边缘发生的肿瘤进展。结果脊柱节段83节(钛55节，CFRP 28节；对82例患者进行评估。除辐射段数、单段24 Gy病例比例、2 Gy段辐射当量剂量外，各组间无显著差异。中位随访时间为14.5个月（范围3.0-70.4个月）。16例局部进展，其中钛组15例（P = 0.009）。将死亡作为竞争因素，CFRP组的局部无进展生存期更长(HR, 0.127；95% ci, 0.017-0.945；P = .044)。中位进展时间为9.27个月（IQR, 4.5-15.65个月）。在单变量和多变量分析中，较高的2 gy当量剂量是与局部肿瘤控制相关的唯一变量（P = 0.025和P = 0.019）。钛组有4个硬体不良事件，而CFRP组有2个不良事件(P >；. 05)。结论scfrp植入物在粗分析中与较低的局部进展率相关，但在多变量模型中无统计学意义。没有发现硬件耐用性的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.