臨床整形外科56巻10号

2021年10月発行

特集 脊椎転移の治療　最前線

転移性脊椎腫瘍に対する根治的手術の意義と適応

著者： 加藤仁志¹ 出村諭¹ 村上英樹² 土屋弘行¹

所属機関： ¹金沢大学整形外科 ²名古屋市立大学整形外科

ページ範囲：P.1277 - P.1282

　脊椎転移に対する根治的手術が望ましいがん腫の特徴は，がん全身治療，放射線治療に抵抗性であり，骨破壊性で病的骨折や麻痺などの骨関連事象を来しやすいこと，さらにガイドラインで転移巣切除が推奨されていることであり，腎癌，甲状腺癌，低悪性肉腫の孤立性転移がよい適応といえる．脊椎転移は孤立性病変であることが必須だが，これらのがん腫であれば肺転移があっても根治的手術の成績は良好であり手術適応となる．根治的手術の治療成績(意義)の向上に関しては，がん腫や病態など患者因子だけでなく，合併症や再発が少ない手術が可能かどうかという医療者側の因子も大きい．したがって，脊椎転移の根治的切除はhigh-volume center(経験値の高いチーム)で行うことにより，リスクの軽減や成績の向上が得られる．

参考文献

1) Kato S, Demura S, Shinmura K, et al. Surgical metastasectomy in the spine:a review article. Oncologist 2021 Jun 2. doi:10.1002/onco.13840. Online ahead of print.

2) Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer 2015;121(5):747-57.

3) Brouquet A, Abdalla EK, Kopetz S, et al. High survival rate after two-stage resection of advanced colorectal liver metastases:response-based selection and complete resection define outcome. J Clin Oncol 2011;29(8):1083-90.

4) Dossett LA, Toloza EM, Fontaine J, et al. Outcomes and clinical predictors of improved survival in a patients undergoing pulmonary metastasectomy for sarcoma. J Surg Oncol 2015;112(1):103-6.

5) Sosman JA, Moon J, Tuthill RJ, et al. A phase 2 trial of complete resection for stage IV melanoma:results of Southwest Oncology Group Clinical Trial S9430. Cancer 2011;117(20):4740-6.

6) Faries MB, Mozzillo N, Kashani-Sabet M, et al;MMAIT-IV Clinical Trial Group. Long-term survival after complete surgical resection and adjuvant immunotherapy for distant melanoma metastases. Ann Surg Oncol 2017;24(13):3991-4000.

7) Bello DM, Panageas KS, Hollmann T, et al. Survival outcomes after metastasectomy in melanoma patients categorized by response to checkpoint blockade. Ann Surg Oncol 2020;27(4):1180-8.

8) Cheung FP, Alam NZ, Wright GM. The past, present and future of pulmonary metastasectomy:a review article. Ann Thorac Cardiovasc Surg 2019;25(3):129-41.

9) Kato S, Demura S, Murakami H, et al. Clinical outcomes and prognostic factors following the surgical resection of renal cell carcinoma spinal metastases. Cancer Sci 2021;112(6):2416-25.

10) Kato S, Murakami H, Demura S, et al. The impact of complete surgical resection of spinal metastases on the survival of patients with thyroid cancer. Cancer Med 2016;5(9):2343-9.

11) Jia Q, Yin H, Yang J, et al. Treatment and outcome of metastatic paraganglioma of the spine. Eur Spine J 2018;27(4):859-67.

12) Kato S, Demura S, Shinmura K, et al. Clinical outcomes and survivals after total en bloc spondylectomy for metastatic leiomyosarcoma in the spine. Eur Spine J 2020;29(12):3237-44.

13) Roser S, Maharaj MM, Taylor MA, et al. Vertebrectomy in metastatic spinal tumours:a 10 year, single-centre review of outcomes and survival. J Clin Neurosci 2019;68:218-23.

14) Zhou RP, Mummaneni PV, Chen KY, et al. Outcomes of posterior thoracic corpectomies for metastatic spine tumors:an analysis of 90 patients. World Neurosurg 2019;123:e371-8.

15) Spiessberger A, Arvind V, Gruter B, et al. Thoracolumbar corpectomy/spondylectomy for spinal metastasis:a pooled analysis comparing the outcome of seven different surgical approaches. Eur Spine J 2020;29(2):248-56.

16) Fang T, Dong J, Zhou X, et al. Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine. J Neurosurg Spine 2012;17(4):271-9.

17) Al-Omair A, Masucci L, Masson-Cote L, et al. Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol 2013;15(10):1413-9.

18) Ito K, Ogawa H, Shimizuguchi T, et al. Stereotactic body radiotherapy for spinal metastases:clinical experience in 134 cases from a single Japanese institution. Technol Cancer Res Treat 2018;17:1533033818806472.

19) Tseng CL, Soliman H, Myrehaug S, et al. Imaging-based outcomes for 24 Gy in 2 daily fractions for patients with de novo spinal metastases treated with spine stereotactic body radiation therapy (SBRT). Int J Radiat Oncol Biol Phys 2018;102(3):499-507.

20) Sohn S, Chung CK, Sohn MJ, et al. Stereotactic radiosurgery compared with external radiation therapy as a primary treatment in spine metastasis from renal cell carcinoma:a multicenter, matched-pair study. J Neurooncol 2014;119(1):121-8.

21) Thibault I, Al-Omair A, Masucci GL, et al. Spine stereotactic body radiotherapy for renal cell cancer spinal metastases:analysis of outcomes and risk of vertebral compression fracture. J Neurosurg Spine 2014;21(5):711-8.

22) Sellin JN, Reichardt W, Bishop AJ, et al. Factors affecting survival in 37 consecutive patients undergoing de novo stereotactic radiosurgery for contiguous sites of vertebral body metastasis from renal cell carcinoma. J Neurosurg Spine 2015;22(1):52-9.

23) Abbouchie H, Chao M, Tacey M, et al. Vertebral fractures following stereotactic body radiotherapy for spine oligometastases:a multiinstitutional analysis of patient outcomes. Clin Oncol (R Coll Radiol) 2020;32(7):433-41.

24) Demura S, Kato S, Shinmura K, et al. Perioperative complications of total en bloc spondylectomy for spinal tumours. Bone Joint J 2021;103-B(5):976-83.