立体定向放射和调强放射治疗原发性肝癌椎体继发性恶性肿瘤的效果比较

Effect of stereotactic body radiotherapy versus intensity-modulated radiotherapy in primary liver cancer patients with secondary malignant tumor of vertebra

目的分析原发性肝癌(PLC)椎体继发性恶性肿瘤患者行立体定向放射治疗和调强放射治疗的效果比较。方法收集2011年12月-2014年1月于解放军第三○二医院接受治疗的PLC伴椎体继发性转移瘤患者49例,分为A组(行立体定向放射治疗,n=20)和B组(行调强放射治疗,n=29)。分别给予35 Gy/5 F和35 Gy/10 F的处方剂量。通过患者疼痛缓解时间评估止痛效果、影像学评估病变情况、生存期评估对生存的影响。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,两组生存率曲线运用K-M方法绘制,两组总生存率比较运用log-rank检验。结果两组放射治疗后影像学检查提示病情完全或部分缓解及稳定的患者比例、患者疼痛缓解率差异无统计学意义(P值均>0.05);两组患者止痛时间比较差异有统计学意义(t=-3.353,P<0.01);两组总生存率比较差异无统计学意义(P=0.346)。结论放射治疗对PLC椎体继发性恶性肿瘤疗效确切。立体定向放射治疗在相同处方剂量的前提下,不仅缓解疼痛时间短,同时并未使临近的快反应组织产生严重的不可耐受的急性或晚期毒副反应。

Objective To investigate the effect of stereotaetic body radiotherapy （SBRT） versus intensity - modulated radiotherapy （IMRT） in primary liver cancer （PLC） patients with secondary malignant tumor of vertebra. Methods A total of 49 PLC patients with secondary metastatic tumor of vertebra, who were treated in our hospital from December 2011 to January 2014, were enrolled and divided into group A （20 patients treated with SBRT） and group B （29 patients treated with IMRT）. The prescribed dose was 35 Gy in 5 fractions in group A and 35 Gy in 10 fractions in group B. The time to pain relief, imaging findings, and survival analysis were used to evaluate pain - relieving effect, the condition of lesions, and survival time. The t - test was used to compare continuous data between groups, and the chi - square test was used to compare categorical data between groups. The K - M method was used to plot survival curves for both groups, and the log - rank test was used for survival difference analysis. Results The proportion of patients who achieved complete or partial remission and stable disease shown by radiological examination after radiotherapy showed no significant difference between group A and group B （ P = 0. 873 ）. The pain relief rate also showed no significant difference between group A and group B （ P = 0. 908 ）. The time of pain relief showed a signif- icant difference between group A and group B （t = -3. 353, P 〈0.01 ）. The overall survival showed no significant difference between the two groups （ P = 0.346）. Conclusion Radiotherapy has a definite therapeutic effect in PLC patients with secondary malignant tumor of ver- tebra. SBRT and IMRT have similar pain -relieving effects. However, with the same prescribed dose, SBRT has a short time to pain relief and does not lead to serious intolerable acute or late toxic and side effects in surrounding fast - response tissues.