59例脊椎血管瘤放射治疗疗效分析

The efficacy of radiotherapy for 59 patients with vertebral hemangioma

目的 探讨脊椎血管瘤放射治疗的适应证、剂量、疗效。方法 脊椎血管瘤 5 9例 ,女 36例 ,男 2 3例。 5 7例有脊椎局部疼痛和 (或 )肢体感觉和 (或 )运动功能障碍。 6例曾在外院接受手术治疗 ,其中 4例为椎板减压加部分肿瘤切除术后复发。采用深部X线、电子线、60 Coγ线、6～ 8MVX线等照射 ,总剂量 2 8～ 90Gy ,中位剂量 4 0Gy。结果 5 4例可评价疗效 ,总有效率为 87.0 % ;其中剂量30～ 4 0Gy和剂量 >4 0Gy组的有效率分别为 90 .2 %和 83.3% (χ2 =0 .4 1,P =0 .6 0 8)。 9例不完全截瘫者中 ,治愈和显效各 4例 ,1例无效。结论 (1)放射治疗对有症状的脊椎血管瘤是安全有效的方法 ,有效剂量在 30～ 4 0Gy;而无症状或症状轻微无神经压迫症状者可暂不治疗 ;(2 )放射治疗起效慢 ,大多数病例在疗后 3个月至 7年内 (中位时间 1.5年 )症状逐步减轻或消失 ;(3)放射治疗后影像检查多无明显改变。

Objective To investigate the indication, total dose and efficacy of radiotherapy for vertebral hemangiomas. Methods Between 1967 and 2000, 59 patients(36 female, 23 male)with vertebral hemangioma were treated with deep X-ray,electron beam, 60 Co or 6-8?MV X-ray with a total dose ranging from 28 to 90?Gy and a median of 40?Gy. Results Of the 54 evaluable cases, the overall response rate was 87.0%. The response rates were 90.2% and 83.3%, respectively, for patients treated with 34-40?Gy and more than 40?Gy(χ 2 = 0.41, P = 0.608). Among the 9 patients with paraplegic patients, 4 achieved complete response, 4 partial response, and only one showed no response to the treatment. Conclusions Radiotherapy is effective and safe for symptomatic vertebral hemangioma, on condition of a suitable total dose range of 30 to 40?Gy. Patients with asymptomatic or minor symptomatic lesion should be watched and followed rather than giving immediate treatment. Radiation therapy shows slow and delayed improvement in vertebral hemangioma and the symptoms are gradually relieved or disappear in three months to seven years with a median interval of 1.5 years, even though diagnostic images show no or only minor changes after treatment.