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Spine radiosurgery: lessons learned from the first 100 treatment sessions

机译：脊柱放射外科：从前100疗程中吸取的教训

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OBJECTIVE Local therapy to spine tumors has been shown to be effective in selected cases. Spinal radiosurgery (SRS) is an evolving radiotherapy regimen allowing for noninvasive, highly efficacious local treatment. The learning curve can compromise the results of any newly employed technology and should be studied to minimize its effects. In this paper the first 100 SRSs performed at several medical centers are presented and analyzed for the effects of the learning curve on outcome. METHODS A retrospective analysis was undertaken to evaluate data from patients treated with SRS at Sheba Medical Center and Assuta Medical Centers in the period from September 2011 to February 2016. Medical history, clinical and neurological findings, pathological diagnoses, SRS variables, complications, and follow-up data were collected and analyzed. Local control rates were calculated, and local treatment failure cases were qualitatively studied. RESULTS One hundred treatment sessions were performed for 118 lesions at 179 spinal levels in 80 patients. The complication rate was low and did not correlate with a learning curve. Mean follow-up time was 302 days, and the overall local control rate was 95%. The local control rate was dose dependent and increased from 87% (among 35 patients receiving a dose of 16 Gy) to 97% (among 65 patients receiving a dose of 18 Gy). The 6 treatment failure cases are discussed in detail. CONCLUSIONS Spinal radiosurgery is a safe and effective treatment. Comprehensive education of the treating team and continuous communication are essential to limit the effects of the learning curve on outcome.
机译：目的已证明脊柱肿瘤的局部治疗在某些情况下是有效的。脊柱放射外科手术（SRS）是一种不断发展的放射疗法，可实现无创，高效的局部治疗。学习曲线可能会损害任何新采用的技术的结果，应进行研究以最大程度地减少其影响。本文介绍了在多个医疗中心执行的前100个SRS，并分析了学习曲线对结果的影响。方法回顾性分析2011年9月至2016年2月在Sheba医疗中心和Assuta医疗中心接受SRS治疗的患者的数据。病史，临床和神经系统发现，病理诊断，SRS变量，并发症及随访收集数据并进行分析。计算了局部控制率，并对定性失败的病例进行了定性研究。结果80例患者共进行了一百次治疗，治疗了179处脊柱内的118处病变。并发症发生率低，与学习曲线不相关。平均随访时间为302天，总体局部控制率为95％。局部控制率是剂量依赖性的，从87％（35例接受16 Gy的患者）增加到97％（65例接受18 Gy的患者）。详细讨论了6个治疗失败案例。结论脊柱放射外科手术是一种安全有效的治疗方法。治疗团队的全面教育和持续沟通对于限制学习曲线对结果的影响至关重要。

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