Objective

Retrospective analysis of the long-term clinical outcome and acute toxicity of the primary malignant tumor of cervical spine receiving CBCT image-guided VMAT.

Methods

Thirty patients with primary malignant tumor of the cervical spine included in our center, from December 2013 to January 2016, 28 patients were retrospectively studied. The prescription dosage 95% PTV volume dose was 44 Gy, 2.0 Gy/fraction, and a total of 22 times. The median PGTV synchronized volume dose was 60 Gy (45–62.1 Gy), median 2.5 Gy (2–2.7 Gy)/fraction. In volumetric modulated, two arc volumetric modulated arc therapy (VMAT) was used, with spinal cord dosage D_MAX< 45 Gy. Early response rate and acute toxicities were analyzed.

Result

The follow-up duration was 6–76 months (median 53 months). At the end of follow-up of June 1, 2019, 78.6% (22/28) patients were still alive. 3 and 5-y local control rates were 67.3% and 56.5% while 3 and 5-y OS were both 78.6% in the whole group of patients, respectively. Fourteen patients with chordoma 5-y local control rates and OS were 57.1% and 85.7%, respectively. Nine patients with giant-cell tumor of bone had a 5-y local control rate and OS were 77.8% and 85.7%, respectively. The response rate for moderate pain or above was 80% (8/10). Eleven patients (39.3%) suffered from grade 1 acute skin toxicity. Twenty-four patients (85.7%) had grade 1/2 mucositis. No radiation-induced spinal cord injury was found.

Conclusion

The image-guided VMAT for primary malignant tumor of the cervical spine provided a satisfactory long-term local control rate.

中文翻译：

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影像引导下容积调制弧光疗法（VMAT）治疗颈椎原发性恶性肿瘤的远期疗效分析。

客观的

颈椎原发恶性肿瘤接受CBCT图像引导VMAT的远期临床结局及急性毒性回顾性分析

方法

我中心纳入30例颈椎原发性恶性肿瘤患者，2013年12月至2016年1月，28例患者进行回顾性研究。处方剂量95%PTV体积剂量为44 Gy，2.0 Gy/次，共22次。PGTV 同步体积剂量中位数为 60 Gy (45–62.1 Gy)，中位数 2.5 Gy (2–2.7 Gy)/次。在容积调制中，使用了两弧容积调制弧疗法 (VMAT)，脊髓剂量 D _MAX < 45 Gy。分析了早期反应率和急性毒性。

结果

随访时间为 6-76 个月（中位数 53 个月）。在 2019 年 6 月 1 日的随访结束时，78.6%（22/28）的患者仍然活着。全组患者3年和5年局部控制率分别为67.3%和56.5%，3年和5年OS分别为78.6%。14 名脊索瘤患者 5 年局部控制率和 OS 分别为 57.1% 和 85.7%。9 例骨巨细胞瘤患者 5 年局部控制率和 OS 分别为 77.8% 和 85.7%。中度疼痛或以上的缓解率为 80% (8/10)。11 名患者 (39.3%) 患有 1 级急性皮肤毒性。24 名患者 (85.7%) 患有 1/2 级粘膜炎。未发现辐射引起的脊髓损伤。

结论

颈椎原发性恶性肿瘤的图像引导 VMAT 提供了令人满意的长期局部控制率。