Clinical application and individualized selection of precision radiotherapy for spinal metastases

WANG Bing; YU Xiu-chun; XU Ming; ZHENG Kai; CHEN Yu

doi:10.3969/j.issn.2095-252X.2017.06.003

Abstract：Objective To investigate the clinical application and the choice of individualized treatment of precision radiotherapy in the patients with spinal metastases. Methods A total of 29 patients with spinal metastases were treated by precision radiotherapy from May 2011 to August 2015. There were 20 males and 9 females, whose mean age was 58.0 ± 71.0 years ( range: 23 - 80 years ). We evaluated the survival of the patients with Tomita score and modified Tokuhashi score, the spinal stability with SINS score, and the nerve injury and spinal cord compression with Frankel score and ESCC score. The patients received precision radiotherapy to relieve pain when the expected survival was less than 3 months. The patients received different precision radiotherapy combined with surgery according to the stability of the spine when the expected survival was more than 3 months. Results Among the 29 patients, 3 patients were lost to follow-up. The average follow-up time was 14.8 ± 27.7 months ( range: 3 - 60 months ). Eleven cases were treated with precision radiotherapy alone, and preoperative and postoperative radiotherapy was performed on 2 cases, preoperative radiotherapy on 4 cases, and postoperative radiotherapy on 13 cases. Twelve cases were treated with Cyber-Knife, 13 cases with 3D-CRT and 4 cases with IMRT. The Kaplan-Meier survival analysis showed that 1-year survival rate was 68%, and 2-year survival rate was 22%. The multivariate Cox regression analysis showed that Tomita score and modified Tokuhashi score were the factors influencing prognosis of spinal metastases, and HR were 4.445 and 2.238 respectively. SINS score did not influence the prognosis. The timing of surgery and radiotherapy options with spinal metastasis survival time were not significantly correlated. Conclusions Precision radiotherapy combined with surgical treatment for spinal metastases can achieve the goal of stabilizing the spine, protecting the nerve function, controlling the progress of the tumor and relieving pain. According to the characteristics of different patients, the use of scoring system for comprehensive evaluation could help the selection of individualized treatment plan.