常规放疗与靶中靶放疗联合唑来膦酸治疗脊柱转移瘤的临床观察

Clinical observation of spinal metastase treated with conventional irradiation and target in target radio-therapy combined with zoledronic acid

目的探讨比较常规放疗与靶中靶放疗联合唑来膦酸治疗脊柱转移瘤的疗效。方法对空军总医院自2011年1月-2012年12月收治的79例脊柱转移瘤患者放疗止痛疗效进行回顾性分析。所有病人采用直线加速器6MV-X或螺旋断层调强放射治疗，分为两组，A组：常规放疗＋唑来膦酸，39例，PTV：（30～40） Gy/（10～20）次；B组：靶中靶放射治疗＋唑来膦酸，40例，PTV、GTV的总剂量分别为40～50 Gy，50～60 Gy，15～20次。对比分析两组有效率、疼痛降低分值、起效时间、维持时间、疼痛复发率以及不良反应。结果随访率96．2％，两组总有效率为88．61％， A组与B组有效率分别为84．62％、92．5％；平均疼痛降低分值分别为2．55、3．54；平均起效时间分别为第7．25 d、8．32 d；平均维持月数分别为6．68个月、8．41个月；治疗部位疼痛复发率分别为25．81％、5．41％；急性不良反应主要为血液学毒性，Ⅰ级骨髓抑制发生率分别为12．82％、12．5％，Ⅱ级23．08％、20％，Ⅲ级2．56％、2．5％，Ⅳ级2．46％、0％。两组不同的放疗模式比较，有效率、起效时间、维持时间及不良反应差异均无统计学意义（P＞0．05），但靶中靶放疗较常规放疗疼痛评分下降更为明显，疼痛复发率明显下降，差异有统计学意义（P＜0．05）。结论靶中靶放疗联合唑来膦酸治疗骨转移瘤是安全有效的，毒副反应轻，且疼痛缓解程度明显、复发率低，对于预期生存期较长者，可首选靶中靶放疗联合唑来膦酸，值得临床推广应用。

Objective To compare the efficacy of conventional radiotherapy and Tomo radiotherapy com -bined with zoledronic acid in spinal metastase .Methods Seventy -nine patients with spinal metastases in our department of Air Force General Hospital were recruited from January 2011 to December 2012 .All patients were divided into two groups：group A：39 cases were treated with conventional radiotherapy combined with zoledronic （ PTV：30-40 Gy/10-20 f）;40 patients with target in target Tomo radiotherapy combined with zoledronic acid were separated into group B（PTV/GTV/40-50 Gy/50-60 Gy/15-20 f）.Results The overall following -up rate was 96.2%.The total response rate was 88.61%,the analgesic effect of radiotherapy in group A and group B were 84.62%、92.5%,respectively.The average pain scores were decreased by 2.55 and 3.54 in two gourps u-sing a numerical rating scale;the average pain relieve time were 7.25d and 8.32d,respectively;the median last-ing time of pain relieves were 6.68 and 8.41months;and the pain recurrence rate were 25.81% and 5.41% in corresponding group A and group B .The main acute side effects were hematologic toxicity , in which occurring rates were 12.82%and 12.5%in RTOG gradeⅠ,23.08% and 20%in RTOG grade Ⅱ,2.56% and 2.5% in RTOG gradeⅢ,2.46%and 0%in RTOG grade Ⅳin group A and group B,respectively.There were no signifi-cant differences in pain relief rate ,start-effect time,lasting time and acute side effects between the two different radiotherapy methods .However ,the decreased degree of pain relief and recurrence rate were obviously decreased in group B when compared with group A ,and the differences were statistically significance （P＆lt;0.05）.Conclu-sion Target in target Tomo radiotherapy combined with zoledronic acid in the treatment of spinal metastasies is safe and effective,mild toxicity,and the degree of pain relief was significantly improved .Moreover,pain recurrence rate is lower than conventional radiotherapy .Hence ,it is worth of recommendation in clinical practice .