VMAT联合唑来膦酸对椎体转移瘤患者远期生存质量的影响

Effect on Long-term Quality of Life in Patients with Vertebral Metastases Using VMAT Combined with Zoledronic Acid

目的探讨容积旋转调强放射治疗(VMAT)联合唑来膦酸对椎体转移瘤患者远期生存质量的影响。方法将82例椎体转移瘤患者,随机分为观察组及对照组,每组41例。对照组采用VMAT治疗,观察组采用VMAT+唑来膦酸治疗。比较两组患者实验室指标、生活质量、新的骨转移灶与疼痛缓解情况。结果治疗后观察组的疼痛缓解率(90.24%)显著高于对照组的疼痛缓解率(70.73%),差异具有统计学意义(P<0.05)。治疗后两组患者的肿瘤坏死因子-α(TNF-α)、血钙(Ca2+)及碱性磷酸酶(AKP)水平均降低,且观察组患者的TNF-α、Ca2+及AKP水平均低于对照组(P<0.05)。治疗结束后12个月,两组患者的疼痛部位、疼痛程度、功能及QLQ-BM22总评分均降低(P<0.05);且观察组患者的疼痛部位、疼痛程度、功能及QLQ-BM22总评分均低于对照组,差异具有统计学意义(P<0.05),而治疗前后社会心理评分组间及组内对比均无统计学差异(P>0.05)。治疗结束后的6个月,两组患者新的骨转移灶情况无统计学差异(P>0.05);治疗结束后12个月,观察组新的骨转移灶发生率(29.27%)显著低于对照组(58.54%),差异具有统计学意义(P<0.05)。结论VMAT联合唑来膦酸治疗椎体转移瘤效果较好,可有效减轻肿瘤所致骨吸收,抑制远期新的骨转移灶的形成,缓解疼痛,进而提高患者远期生存质量,值得临床推广。

Objective To explore the effect on long-term quality of life in patients with vertebral metastases using volume modulated arc therapy(VMAT)combined with zoledronic acid.Methods 82 patients with vertebral metastases were randomly divided into the observation group and the control group,with 41 cases in each group.The control group was treated with VMAT and the observation group was treated with VMAT combined with zoledronic acid.The laboratory indexes,quality of life,new bone metastases and pain relief were compared between the 2 groups.Results The rate of pain relief in the observation group was significantly higher than that of the control group(90.24%vs 70.73%,P<0.05).After treatment,the levels of tumor necrosis factor-α(TNF-α),serum calcium(Ca2+)and alkaline phosphatase(AKP)decreased in both groups,and the levels of TNF-α,Ca2+and AKP in the observation group were lower than those of the control group(P<0.05).12 months after treatment,the scores of pain site,pain degree,function and the total scores of QLQ-BM22 in the 2 groups decreased(P<0.05),and the scores of pain site,pain degree,function and the total scores of QLQ-BM22 in the observation group were significantly lower than those of the control group(P<0.05),but there were no significant differences in the score of social psychology between and within groups before and after treatment(P>0.05).6 months after treatment,there was no significant difference in the incidence of new bone metastasis between the 2 groups(P>0.05).12 months after treatment,the incidence of new bone metastases in the observation group was significantly lower than that of the control group(29.27%vs 58.54%,P<0.05).Conclusion VMAT combined with zoledronic acid can effectively reduce bone resorption,inhibit the formation of long-term new bone metastases,relieve pain,and improve the long-term quality of life of patients,which is worthy for clinical promotion.