A systematic review of stereotactic radiosurgery for metastatic spinal sarcomas.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY Journal of Neuro-Oncology Pub Date : 2024-11-28 DOI:10.1007/s11060-024-04892-z

Trent Kite, Stephen Jaffe, Vineetha Yadlapalli, Rhea Verma, Jenna Li, Stephen Karlovits, Rodney E Wegner, Matthew J Shepard

{"title":"A systematic review of stereotactic radiosurgery for metastatic spinal sarcomas.","authors":"Trent Kite, Stephen Jaffe, Vineetha Yadlapalli, Rhea Verma, Jenna Li, Stephen Karlovits, Rodney E Wegner, Matthew J Shepard","doi":"10.1007/s11060-024-04892-z","DOIUrl":null,"url":null,"abstract":"Purpose: Sarcomas metastasizing to the spine are a rare entity. Ideally an En-bloc resection is necessary to achieve durable local control (LC) rates. However, anatomical constraints often limit the degree of tumor resection. Because of this, other therapeutic modalities either replacing or as an adjuvant to resection are necessary. Stereotactic radiosurgery (SRS) is a reasonable candidate therapy.Methods: We conducted a systematic review of the literature using the following databases: PubMed, Science Direct, and Cochrane library. We used a combination of the following terms connected by boolean operators: \"Metastatic Sarcoma, Sarcoma of the Spine, Spine Sarcoma, Metastasis, stereotactic radiosurgery, SRS.\" All retrospective and prospective cohorts, as well as randomized control trials reporting on patients with histopathologically confirmed metastatic sarcomas of the bony elements of the vertebrae, thecal sac, cord, or associated soft tissues of the spine were included. We excluded animal studies, case reports, case series, patients < 18 (pediatric cohorts), review articles and meta-analyses. No date filters were applied to our search.Results: Our final analysis included 5 studies ranging from 2009 to 2024 reporting on 260 patients and 371 associated lesions. Leiomyosarcoma was the most frequently reported histologic subtype (60%). Most lesions were localized to the thoracic spine (48.6%). 75% of studies reported a median dose < 30 Gy, and achieved biologically equivalent doses (BEDs) ranging from < 50-100. Pooled 1-year median survival was 64.5% (IQR: 61.8-75.10). Pooled 1-year median LC was 86% (IQR: 79.4-88.5). Three of five studies (60%) for OS and 4/5 (80%) for LC had data availability suitable for meta-analysis. The 1-year OS and LC rates proportions across these studies were 67% (proportion = 0.67, 95% CI: 0.57-0.75, p = 0.07, I2 = 63%), and 84% (proportion = 0.84, 95% CI: 0.78-0.89, p = 0.10, I2 = 52%) respectively. Median follow up across all studies was 18 months (IQR:12.7-31.3).Conclusions: SRS is a reasonable alternative therapy in either the up front, salvage or adjuvant setting which can facilitate durable LC.","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuro-Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11060-024-04892-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Sarcomas metastasizing to the spine are a rare entity. Ideally an En-bloc resection is necessary to achieve durable local control (LC) rates. However, anatomical constraints often limit the degree of tumor resection. Because of this, other therapeutic modalities either replacing or as an adjuvant to resection are necessary. Stereotactic radiosurgery (SRS) is a reasonable candidate therapy.

Methods: We conducted a systematic review of the literature using the following databases: PubMed, Science Direct, and Cochrane library. We used a combination of the following terms connected by boolean operators: "Metastatic Sarcoma, Sarcoma of the Spine, Spine Sarcoma, Metastasis, stereotactic radiosurgery, SRS." All retrospective and prospective cohorts, as well as randomized control trials reporting on patients with histopathologically confirmed metastatic sarcomas of the bony elements of the vertebrae, thecal sac, cord, or associated soft tissues of the spine were included. We excluded animal studies, case reports, case series, patients < 18 (pediatric cohorts), review articles and meta-analyses. No date filters were applied to our search.

Results: Our final analysis included 5 studies ranging from 2009 to 2024 reporting on 260 patients and 371 associated lesions. Leiomyosarcoma was the most frequently reported histologic subtype (60%). Most lesions were localized to the thoracic spine (48.6%). 75% of studies reported a median dose < 30 Gy, and achieved biologically equivalent doses (BEDs) ranging from < 50-100. Pooled 1-year median survival was 64.5% (IQR: 61.8-75.10). Pooled 1-year median LC was 86% (IQR: 79.4-88.5). Three of five studies (60%) for OS and 4/5 (80%) for LC had data availability suitable for meta-analysis. The 1-year OS and LC rates proportions across these studies were 67% (proportion = 0.67, 95% CI: 0.57-0.75, p = 0.07, I² = 63%), and 84% (proportion = 0.84, 95% CI: 0.78-0.89, p = 0.10, I² = 52%) respectively. Median follow up across all studies was 18 months (IQR:12.7-31.3).

Conclusions: SRS is a reasonable alternative therapy in either the up front, salvage or adjuvant setting which can facilitate durable LC.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

立体定向放射外科治疗转移性脊柱肉瘤的系统性综述。

目的：转移至脊柱的肉瘤非常罕见。理想情况下，必须进行全切才能达到持久的局部控制（LC）率。然而，解剖上的限制往往会限制肿瘤切除的程度。因此，有必要采用其他治疗方法来替代切除术或作为切除术的辅助手段。立体定向放射手术（SRS）是一种合理的候选疗法：我们使用以下数据库对文献进行了系统性回顾：PubMed、Science Direct 和 Cochrane 图书馆。我们使用了由布尔运算符连接的以下术语组合："转移性肉瘤、脊柱肉瘤、脊柱肉瘤、转移、立体定向放射外科、SRS"。所有回顾性和前瞻性队列研究以及随机对照试验均被纳入，这些研究报告的对象是经组织病理学证实的脊椎骨、椎囊、脊髓或脊柱相关软组织转移性肉瘤患者。我们排除了动物研究、病例报告、病例系列、患者结果：我们的最终分析纳入了 2009 年至 2024 年的 5 项研究，报告了 260 名患者和 371 个相关病灶。报告最多的组织学亚型是线粒体肉瘤（60%）。大多数病变位于胸椎（48.6%）。75%的研究报告了中位剂量（2 = 63%），84%的研究报告了中位剂量（比例 = 0.84，95% CI：0.78-0.89，P = 0.10，I2 = 52%）。所有研究的中位随访时间为18个月（IQR：12.7-31.3）：SRS是一种合理的替代疗法，无论是前期治疗、挽救治疗还是辅助治疗，都能促进LC的持久性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.