放化疗联合双磷酸盐治疗小细胞肺癌椎体转移的临床效果分析

Clinical analysis of chemoradiotherapy combined with bisphosphonates treatment on vertebral metastasis from small cell lung cancer

目的通过回顾性研究放化疗和双磷酸盐在治疗小细胞肺癌椎体转移中的作用，探讨小细胞肺癌椎体转移内科治疗方案的选择。方法回顾性分析2010年10月至2012年10月本院所收治的56例小细胞肺癌并发生椎体转移患者的临床资料。根据椎体转移灶治疗方式的不同分为3组：化疗组（n：18）、化疗＋双磷酸盐组（n=22）、放化疗＋双磷酸盐组（n=16）。对比各组疼痛缓解程度、脊髓功能分级改变、病理性骨折以及不良反应情况。结果随访时间3-24个月，中位随访时间9个月。化疗＋双磷酸盐组和放化疗＋双磷酸盐组治疗后转移灶骨痛明显缓解（P〈0．05），其中放化疗＋双磷酸盐组疼痛缓解程度较化疗组显著增大（P〈0．05）。放化疗＋双磷酸盐组椎体病理性骨折发生率为6．25％，与化疗组（38．89％）比较显著降低（P〈0．05）。结论放化疗联合双磷酸盐治疗能够明显减轻小细胞肺癌椎体转移灶的疼痛，并可能预防或延缓病理性骨折的发生。

Objective To investigate the medical therapy cell lung cancer （SCLC）. Methods Fifty-six patients （41 males, strategy on vertebral metastasis from small 15 females） with vertebral metastases from SCLC from October 2010 to October 2012 were retrospectively evaluated. According to therapeutic methods, they were randomly divided into 3 groups, chemotherapy （n = 18） group, chemotherapy plus bisphosphonates （ n = 22） group, and chemoradiotherapy plus bisphosphonates （ n = 16） group. Pain relief, spinal cord classifi- cation, pathologic fractures, and adverse effect were compared among the groups. Results The follow-up las-ted 3 -24 months, median 9 months. Patients in both the chemotherapy plus bisphosphonates group and the chemoradiotherapy plus bisphosphonates group gained significant pain relief after treatment （ P 〈 0. 05 ）. The degree of pain relief in the chemoradiotherapy plus bisphosphonates group was significantly higher than that in the chemotherapy group （P 〈 0. 05 ）. The incidence of pathological vertebral fractures in the chemoradiotherapy plus bisphosphonates group （6.25%） was significantly lower than that in the chemotherapy group （38.89%） （P 〈 0. 05 ）. Conclusion Chemoradiotherapy combined with bisphosphonates treatment can significantly relieve pain caused by vertebral metastases from SCLC, and may prevent or delay the occurrence of pathological vertebral fractures.