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放射性脊髓炎风险在低分离的脊柱立体性身体辐射疗法后
Christopher B Jackson1, Lillian A Boe2, Lei Zhang3
1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA oncology
|December 19, 2024
概括
脊髓转移的立体体辐射疗法 (SBRT) 可以导致辐射髓炎 (RM). 提出了新的剂量测量约束,包括D0.1cc为19.1 Gy和Dmax为20.8 Gy,以限制脊柱SBRT后严重RM的风险.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 神经外科 神经外科
背景情况:
- 与传统放射治疗相比,立体体辐射疗法 (SBRT) 在脊髓转移方面提供了更好的结果.
- 在外周腔内治疗失败受到辐射髓炎 (RM) 风险的限制.
- 目前对脊柱SBRT的RM预防约束缺乏可靠的数据.
研究的目的:
- 评估脊柱SBRT后的RM风险.
- 更新剂量测量约束,以防止RM.
主要方法:
- 一个单中心队列研究 (2014-2023) 包括1423名接受脊柱SBRT (27-36 Gy分为3个部分) 的患者.
- RM是根据放射性证据定义的,并使用CTCAE v5.0.0进行分级.
- 分析了包括D0.1cc和Dmax在内的剂量参数,以确定与RM风险的关联.
主要成果:
- 在1904年治疗的转移中,发现了30例RM病例 (19级3-4).
- 一至四年级RM的两年率为1.8%,三至四年级RM为1.1%.
- 脊髓D0.1cc是RM最强的预测因素 (HR为G3-4RM的2.14).
结论:
- 19.1 Gy的D0.1cc限制和20.8 Gy的Dmax与2年后3-4级RM的1.0%风险有关.
- 这些更新的约束可以帮助最大限度地减少脊柱SBRT中的RM风险.
- 这项研究提供了基于证据的指导方针,用于更安全的脊柱SBRT输送.
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