图像引导下的大分割调强放射治疗骨转移癌临床研究

IMAGE-GUIDED HYPOFRACTIONATED IMRT IN THE TREATMENT OF MALIGNANT BONE METASTASIS

目的：本研究采用图像引导下的大分割调强放疗技术,治疗癌症骨转移.评价该方案的可行性、安全性及有效率.方法：选取我科2011～2012年收治椎体骨转移患者21名,骨转移灶28处,予肿瘤所在椎体24 Gy/6次,同步予肿瘤加量至36 Gy/6次,限制脊髓D0.1ml小于25 Gy.结果：病灶疗前疼痛评分7.54±0.84分;疗后即刻评分4.00±1.59分,缓解程度47.38％±17.75％;疗后1月评分2.46±2.01分,缓解程度67.54％±24.84％;疗后3月评分2.07±1.92分,缓解程度72.92％±24.09％.治疗后即刻、1月、3月疼痛评分较疗前均有显著差异（P＜0.01）.疗后即刻有效率为57.14％（16/28）,1月有效率为82.14％（23/28）,3月有效率为82.14％（23/28）.l例患者出现Ⅱ度食管副反应,无患者出现神经系统副反应.结论：本研究表明图像引导下的大分割调强放射治疗骨转移癌是安全有效的治疗选择,其长期疗效尚需进一步研究.

Objective：To evaluate feasibility,safety and efficiency of an image-guided hypofractionated IMRT technique in the treatment of malignant bone metastasis.Methods：21 patients with 28 vertebral bone metastases treated in our department were enrolled.The vertebrae involved were treated with 24 Gy/6 fractions,and the gross tumors were simultaneous integrated boosted to 36 Gy/6 fractions.D 0.1 ml of spinal cord was limited to less than 25 Gy.Pain intensity was assessed by using numeric rating scale （NRS） and side effects were carefully observed and recorded.Results：The mean NRS Pain intensity scores before treatment were 7.54± 0.84.Pain scores immediately after treatment were 4.00 ± 1.59,and pain relief rate was 47.38％ ± 17.75％.One month after the treatment,the mean pain score was 2.46 ± 2.01,and pain relief rate was 67.54％±24.84％.Pain scores three months after treatment were 2.07 ±1.92 points,and relief rate was 72.92％ ± 24.09％.Pain scores immediately after treatment,one month after treatment and three months after treatment were significantly better than pain scores before treatment （P ＜ 0.01）.Effective rates were 57.14％ （16/28） immediately after treatment,82.14％ （23/28） one month after treatment,and 82.14％ （23/28） three months after treatment.One patient developed grade Ⅱ esophageal side effects,no patient had nervous system side effects.Conclusion：This study showed that image-guided hypofractionated IMRT was a safe and effective treatment option to malignant bone metastases.However its long-term efficacy needs to be further studied.