螺旋断层调强放射治疗35例脊柱转移瘤

Tomotherapy for 35 patients with spinal tumor metastasis

目的评价螺旋断层调强放射治疗脊柱转移瘤的疗效及不良反应等。方法2011年12月-2012年12月空军总医院收治的35例符合条件的脊柱转移瘤患者共计51处病灶，均采用螺旋断层调强放射治疗技术实现靶区层层递增的剂量模式，靶区勾画为肿瘤靶区、临床靶区，分别给予40～50Gv、50—60Gv的处方剂量，连续照射15～20次。结果随访率97．14％，完全缓解（CR）31．43％（11／35），中度缓解（PR）54．29％（19／35），轻度缓解（MR）8．57％（3／35），总有效率94．29％（33／35）；中位起效时间为治疗后第6．5次；中位维持时间7个月；治疗部位病灶改善17例（50％）；稳定状态16例（47．06％）；恶化1例（2．94％）；中位局部无进展生存期为7个月；急性不良反应主要有血液学毒性，I级11．43％，II级25．71％，III级2．86％，无Ⅳ级骨髓抑制。结论采用螺旋断层放射治疗技术实现靶区剂量层层递增的模式治疗脊柱转移瘤疼痛缓解率高，维持时间久，不良反应小，是一种安全有效的治疗方式。

Objective To assess the efficacy and adverse reactions of tomotherapy in patients with spinal tumor metastasis. Methods Thirty- five spinal tumor metastasis patients （51 lesions） admitted to our hospital from December 2011 to December 2012 were included in this study and underwent tomotherapy. The target area was outlined into GTV and CTV which received 15-20 times of tomotherapy at the dose of 40-50 Gy and 50-60 Gy. Results Of the 97.14% followed up patients, 31.43% （11/35） had CR, 54.29% （19/35） had PR, and 8.57% （3/35） had MR, with a total response rate of 94.29%（33/35）. The tomotherapy began to exert its effect 6.5 times after treatment and its median maintenance time was 7 months. The lesions improved in 17 patients （50%）, became stable in 16 patients （47.06%）, and deteriorated in 1 patient （2.94%）. The median survival time of patients without local progression was 7 months. The main acute side effects were hematologic toxicity, including grade 1 bone marrow depression in 11.43% of the patients, grade 2 bone marrow depression in 25.71% of the patients and grade 3 bone marrow depression in 2.86% of the patients. However, grade 4 bone marrow depression was not observed in any of the patients. Conclusion Tomotherapy can alleviate the pain in spinal tumor metastasis patients with a long maintenance time and less adverse reactions, and is thus a safe and effective treatment modality for spinal tumor metastasis.