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Pathological characteristics of spine metastases treated with high-dose single-fraction stereotactic radiosurgery

机译：大剂量单次立体定向放射外科治疗脊柱转移的病理特征

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OBJECTIVE Spine radiosurgery is increasingly being used to treat spinal metastases. As patients are living longer because of the increasing efficacy of systemic agents, appropriate follow-up and posttreatment management for these patients is critical. Tumor progression after spine radiosurgery is rare; however, vertebral compression fractures are recognized as a more common posttreatment effect. The use of radiographic imaging alone posttreatment may makeit difficult to distinguish tumor progression from postradiation changes such as fibrosis. This is the largest series from a prospective database in which the authors examine histopathology of samples obtained from patients who underwent surgical intervention for presumed tumor progression or mechanical pain secondary to compression fracture. The majority of patients had tumor ablation and resulting fibrosis rather than tumor progression. The aim of this study was to evaluate tumor histopathology and characteristics of patients who underwent pathological sampling because of radiographic tumor progression, fibrosis, or collapsed vertebrae after receiving high-dose single-fraction stereotactic radiosurgery. METHODS Between January 2005 and January 2014, a total of 582 patients were treated with linear accelerator–based single-fraction (18–24 Gy) stereotactic radiosurgery. The authors retrospectively identified 30 patients (5.1%) who underwent surgical intervention for 32 lesions with vertebral cement augmentation for either mechanical pain or instability secondary to vertebral compression fracture (n = 17) or instrumentation (n = 15) for radiographic tumor progression. Radiation and surgical treatment, histopathology, and long-term outcomes were reviewed. Survival and time to recurrence were calculated using the Kaplan-Meier method. RESULTS The mean age at the time of radiosurgery was 59 years (range 36–80 years). The initial pathological diagnoses were obtained for all patients and primarily included radioresistant tumor types, including renal cell carcinoma in 7 (22%), melanoma in 6 (19%), lung carcinoma in 4 (12%), and sarcoma in 3 (9%). The median time to surgical intervention was 24.7 months (range 1.6–50.8 months). The median follow-up and overall survival for all patients were 42.5 months and 41 months (overall survival range 7–86 months), respectively. The majority of assessed lesions showed no evidence of tumor on pathological review (25 of 32, 78%), while a minority of lesions revealed residual tumor (7 of 32, 22%). The median survival for patients after tumor recurrence was 5 months (range 2–70 months). CONCLUSIONS High-dose single-fraction radiosurgery is tumor ablative in the majority of instances. In a minority of cases, tumor persists and salvage treatments should be considered.
机译：目的脊柱放射外科正越来越多地用于治疗脊柱转移瘤。由于全身性药物疗效的提高，患者的寿命更长，因此对这些患者进行适当的随访和治疗后治疗至关重要。脊柱放射手术后肿瘤进展很少;然而，椎骨压缩性骨折被认为是更常见的后处理效果。单独使用放射成像成像进行后处理可能难以区分肿瘤进展与放射后变化（例如纤维化）。这是前瞻性数据库中最大的系列，在该数据库中，作者检查了从接受手术干预的患者中获得的样品的组织病理学，这些患者可能因肿瘤发展或继发于压迫性骨折而出现机械性疼痛。大多数患者患有肿瘤消融并导致纤维化，而不是肿瘤进展。这项研究的目的是评估接受高剂量单次立体定向放射外科手术后因影像学上的肿瘤进展，纤维化或椎骨塌陷而进行病理取样的患者的肿瘤组织病理学和特征。方法在2005年1月至2014年1月之间，共582例患者接受了基于线性加速器的单次（18-24 Gy）立体定向放射外科手术治疗。作者回顾性地确定了30例（5.1％）接受手术治疗的32例椎体骨水泥增生病灶，这些患者是由于机械性疼痛或因椎体压缩性骨折（n = 17）继发的不稳定或因放射影像学进展而使用器械（n = 15）所致。放射和外科治疗，组织病理学和长期结果进行了审查。使用Kaplan-Meier方法计算生存率和复发时间。结果放射外科手术时的平均年龄为59岁（36-80岁）。所有患者均获得了初步的病理学诊断，主要包括放射线肿瘤类型，包括肾细胞癌7例（22％），黑色素瘤6例（19％），肺癌4例（12％）和肉瘤3例（9 ％）。接受手术干预的中位时间为24.7个月（范围1.6-50.8个月）。所有患者的中位随访时间和总生存期分别为42.5个月和41个月（总生存期7-86个月）。经病理学检查，大多数评估病变均未显示肿瘤证据（25例，占32％，78％），而少数病变显示残留肿瘤（32例，占7％，22％）。肿瘤复发后患者的中位生存期为5个月（2–70个月）。结论在大多数情况下，大剂量单次放射外科手术可消融肿瘤。在少数情况下，肿瘤持续存在，应考虑挽救治疗。

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