限制GTV外的热点是否能降低接受脊柱支架治疗的患者椎体压缩性骨折的风险？单一机构经历

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-01 DOI:10.1016/S0167-8140(25)04755-3

Zhang Hao (Jim) Li , Adrian Wai Chan , Alanah M. Bergman , Haley Patrick , Mitchell Liu , Emma M. Dunne

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引用次数: 0

摘要

目的：椎体压缩性骨折（VCF）是脊柱立体定向放射治疗（SBRT）后最常见和最具挑战性的不良事件之一。在许多可能的VCF预测因素中，每部分的辐射剂量一直被发现会增加风险。针对这一情况，本机构最近采用了新的限制条件，将PTV - (GTV+2mm)区域的剂量限制在110%，假设限制GTV外的热点（HS）可以降低VCF的风险。本研究旨在验证这一假设，并评估这一新约束对VCF率和局部控制的影响。材料和方法：对2014年10月至2022年12月期间接受SBRT治疗的所有新发脊柱转移患者进行回顾性研究。接受治疗前和治疗后mri检查的患者被选入研究队列。收集临床、剂量学和生存数据，使用Kaplan-Meier方法进行生存分析，比较符合和超过HS约束的方案的结果。结果：80例患者接受SBRT治疗117个脊柱节段，其中35个符合PTV-(GTV+2mm) HS约束。中位年龄为64岁（范围：28-83岁）。在平均33个月的随访中，36名患者死亡。平均总生存期为60个月（95% CI: 50-69个月）。在24个月时，接受hs限制约束的节段发生VCF的累积风险为6% (95% CI: 0-15%)，而未接受hs限制约束的节段发生VCF的累积风险为19% (95% CI: 9-28%) （p=0.10）。24个月时局部控制率分别为88% （95% CI: 76%-99%）和82% (95% CI: 73-91%) （p=0.31）。结论：虽然我们的小样本量没有显示出任何显著差异，但观察到的较低的VCF率表明应用PTV - (GTV+2mm) <；110%约束在降低与SBRT相关的VCF率方面具有潜在的益处。未来的前瞻性研究可以进一步评价这一点。

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DOES LIMITING HOTSPOTS OUTSIDE THE GTV DECREASE THE RISK OF VERTEBRAL COMPRESSION FRACTURE IN PATIENTS BEING TREATED WITH SPINE SBRT? A SINGLE INSTITUTION EXPERIENCE

Purpose:

Vertebral compression fracture (VCF) is one of the most common and challenging adverse events following stereotactic body radiation (SBRT) to the spine. Among the many possible predictive factors for VCF, radiation dose per fraction has consistently been found to increase the risk. In response to this, our institution has recently adopted a new constraint to limit dose in the PTV – (GTV+2mm) region to <110% under the hypothesis that limiting the hotspots (HS) outside the GTV will decrease the risk of VCF. This study aims to test this hypothesis and evaluate the effects of this new constraint on VCF rates and local control.

Materials and Methods:

A retrospective review was conducted of all patients treated with SBRT between October 2014 and December 2022 for de novo spinal metastases. Patients with pre- and post-treatment MRIs were selected for the study cohort. Clinical, dosimetric, and survival data were collected, and survival analyses were performed using the Kaplan-Meier method to compare outcomes between plans that respected and exceeded the HS constraint.

Results:

80 patients underwent SBRT treatment to 117 spine segments, 35 of which respected the PTV-(GTV+2mm) HS constraint. The median age was 64 (range: 28-83). At a median follow up of 33 months, 36 patients died. The mean overall survival was 60 months (95% CI: 50-69 months). The cumulative risk of VCF at 24 months was 6% (95% CI: 0-15%) for segments treated with the HS-limiting constraint and 19% (95% CI: 9-28%) for those without (p=0.10). Local control at 24 months was 88% (95% CI: 76%-99%) and 82% (95% CI: 73-91%), respectively (p=0.31).

Conclusions:

Although our small sample size did not show any significant differences, the lower VCF rates observed suggest a potential benefit of applying the PTV – (GTV+2mm) <110% constraint in reducing VCF rates associated with SBRT. Future prospective studies could be performed to further evaluate this.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.