恶性硬膜外脊髓压迫(MESCC)的个体化放射治疗

IF 2.6 3区 医学 Q3 ONCOLOGY Seminars in Radiation Oncology Pub Date : 2023-04-01 DOI:10.1016/j.semradonc.2022.11.005
Dirk Rades , Steven E. Schild
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引用次数: 0

摘要

“真”恶性硬膜外脊髓压迫(MESCC)用于描述与神经功能缺损相关的浸润性脊髓压迫病变。单独的放射治疗是最常见的治疗方法,有几种剂量分割方案可供选择,包括单次、短期和长期方案。由于这些方案在功能结果方面同样有效,生存率低的患者最好接受短疗程甚至单次放疗。较长疗程的放射治疗可更好地局部控制恶性硬膜外脊髓压迫。由于大多数现场复发发生在6个月或6个月后,局部控制对长期幸存者尤为重要,因此,他们应该接受更长疗程的放射治疗。在治疗前评估生存率很重要,评分工具有助于评估生存率。如果可能的话,放射治疗应辅以皮质类固醇。双膦酸酯和RANK配体抑制剂可以改善局部控制。选定的患者可以从前期减压手术中受益。通过考虑压迫程度、脊髓病、放射敏感性、脊柱稳定性、治疗后的动态状态以及患者的表现状态和生存预后的预后工具,有助于识别这些患者。在设计个性化治疗方案时,必须考虑包括患者偏好在内的许多因素。
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Personalization of Radiation Therapy in the Primary Treatment of Malignant Epidural Spinal Cord Compression (MESCC)

“True” malignant epidural spinal cord compression (MESCC) is used here to describe a lesion compressing of infiltrating the spinal cord associated with neurologic deficits. Radiotherapy alone is the most common treatment, for which several dose-fractionation regimens are available including single-fraction, short-course and longer-course regimens. Since these regimens are similarly effective regarding functional outcomes, patients with poor survival are optimally treated with short-course or even single-fraction radiotherapy. Longer-course radiotherapy results in better local control of malignant epidural spinal cord compression. Since most in-field recurrences occur 6 months or later, local control is particularly important for longer-term survivors who, therefore, should receive longer-course radiotherapy. It is important to estimate survival prior to treatment, which is facilitated by scoring tools. Radiotherapy should be supplemented by corticosteroids, if safely possible. Bisphosphonates and RANK-ligand inhibitors may improve local control. Selected patients can benefit from upfront decompressive surgery. Identification of these patients is facilitated by prognostic instruments considering degree of compression, myelopathy, radio-sensitivity, spinal stability, post-treatment ambulatory status, and patients’ performance status and survival prognoses. Many factors including patients’ preferences must be considered when designing personalized treatment regimens.

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来源期刊
CiteScore
5.80
自引率
0.00%
发文量
48
审稿时长
>12 weeks
期刊介绍: Each issue of Seminars in Radiation Oncology is compiled by a guest editor to address a specific topic in the specialty, presenting definitive information on areas of rapid change and development. A significant number of articles report new scientific information. Topics covered include tumor biology, diagnosis, medical and surgical management of the patient, and new technologies.
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