脊柱转移瘤放疗研究进展

Advances in radiotherapy of spinal metastases

目的放疗是目前脊柱转移瘤重要的治疗方式,在脊柱转移瘤患者的综合治疗中,尤其是止痛方面起到了重要的作用。本研究旨在探讨脊柱转移瘤的放疗剂量分割方式及其靶区勾画,以期达到精准放疗的效果。方法应用PubMed和中国知网文献数据库,以"脊柱、转移瘤、放疗"为中文关键词,以"spine、metastasis、radiotherapy"为英文关键词,联合检索1995-01-2018-12的相关文献。共检索到中文文献150条,英文文献1 280条。纳入标准:(1)脊柱转移瘤;(2)放射治疗。排除标准:(1)其他部位转移瘤;(2)脊柱原发肿瘤;(3)手术;(4)化疗。符合纳入标准的中文文献27条,英文文献275条,根据排除标准最后纳入分析42篇文献。结果脊柱转移瘤放射治疗最为常见的分割剂量为30Gy/10次,目前8Gy/次、20Gy/5次和24Gy/6次等超分割剂量也在临床中得到应用。随着影像及放疗技术的改进,特别是调强放射治疗/立体定向放射治疗技术的出现,使得脊柱转移瘤的靶区定位勾画更为精确。结论脊柱转移分段放疗尚无统一标准,但在保证平移误差≤2mm的连续放疗方案是可以接受的。在临床实践中,放疗作为骨转移重要的治疗方式,在控制肿瘤局部进展、保护和促进神经功能恢复及姑息治疗等方面发挥着重要的作用。

OBJECTIVE Radiotherapy,as the cornerstone of treatment of spinal metastases,plays an indispensable role in the comprehensive treatment of spinal metastases,especially in terms of pain relief.This article aimed to investigate the dose fraction of radiotherapy and its target delineation,In order to achieve the "precision radiotherapy" effect.METHODS Papers published between January 1995 and December 2018 were retrieved from the PubMed,CNKI database,with the key words of "spine,metastasis,radiotherapy".A total of 1 280 English literatures and 150 Chinese literatures were retrieved.Inclusion criteria:(1)spinal metastases;(2)radiotherapy.Exclusion criteria:(1)nonspinal metastases;(2)primary spine tumor;(3)surgery;(4)chemotherapy.A total of 42 articles were selected.RESULTS The most common fractionated dose for spinal metastases is 30 Gy/10 f,currently 8 Gy/f,20 Gy/5 f,24 Gy/6 fand other hyperfractionated doses,also achieve progress in the clinical application.With the improvement of imaging and radiotherapy technology,especially the emergence of IMRT/SBRT technology,the target delineation of spine metastases is become more accurate.CONCLUSIONS There is no uniform standard for segmental radiotherapy of spinal metastases,radiotherapy regimen that guarantees a translation error no more than 2 mm is acceptable.In clinical practice,radiotherapy,as an important treatment for bone metastasis,plays an important role in controlling local tumor progression,protecting and promoting neurological recovery,and palliative care.