脊柱转移瘤的立体定向放射治疗

Stereotactic Body Radiotherapy in the Treatment of Spinal Metastases

随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通过外照射的方式聚焦到肿瘤部位,达到消灭肿瘤的目的。目前越来越多SBRT技术用于脊柱转移瘤的治疗。为更好地治疗脊柱转移瘤,NOMS(neurologic,oncologic,mechanical,and systemic)决策框架的概念被引入临床实践中,它将立体定向放射治疗、分离手术、脊柱的稳定和常规分割放疗联合起来,为脊柱转移瘤提供最佳治疗策略。脊柱转移瘤SBRT,局控率高,副作用小,但是需要注意危及器官剂量的限制。该文对NOMS中关于脊柱转移瘤SBRT的一些建议进行解读,为临床肿瘤放射医师提供参考。

Due to the development of comprehensive treatment of malignant tumor,the life expectancy of patients with spinal metastases is prolonged.To improve the local control rate of spinal metastases has become the focus of clinical attention.Stereotactic body radiotherapy(SBRT),which uses highly conformal treatment planning techniques coupled with image guided technology,has enabled the safe delivery of tumor-ablative doses of radiotherapy.At present,more and more SBRT technology is used in the treatment of spinal metastases.The neurologic,oncologic,mechanical,and systemic(NOMS)framework has been developed as a tool to aid in the determination of the optimal treatment of spinal metastases,incorporating radiosurgery,separation surgery,stabilization techniques,and conventional radiation.Spine SBRT can provide a high likelihood of durable tumor control with very low rates of serious toxicity,and careful attention should be paid to dose constraints of organs at risk.Here,some suggestions on SBRT of spinal metastases in NOMS were interpreted to provide reference for clinical tumor radiologists.