唑来膦酸辅助治疗骨巨细胞瘤的疗效分析

Clinical efficacy of zoledronic acid in adjuvant treatment of giant cell tumor of bone

目的回顾性分析骨巨细胞瘤术后采用不同方法辅助治疗的病例,比较骨巨细胞瘤切刮术后辅助治疗方法的临床疗效。方法选择2008年7月至2016年7月收治的128例骨巨细胞瘤患者,唑来膦酸组患者33例,切刮植骨融合内固定术后每个月应用唑来膦酸4 mg辅助治疗,疗程24个月;伊班膦酸组32例,术后每个月应用伊班膦酸钠4 mg治疗,疗程24个月;帕米膦酸组32例,术后应用帕米膦酸二钠60 mg治疗,疗程24个月;常规放疗组31例,术后采用直线加速器X射线进行照射。照射野为肉眼所见的骨巨细胞瘤以及肿瘤床边缘向外扩大2 cm。照射肿瘤吸收剂量为30~50 Gy,每次2 Gy,每周5次。骨巨细胞瘤患者术前行MRI检查,术前及术后随访均行X线、CT平扫及二维重建检查。比较4组患者的实际手术时间、术中出血量、术后伤口愈合情况、伤口引流量等指标,比较4组患者的临床治疗效果评分、肿瘤复发率及不良反应情况。结果对脊柱切刮植骨融合内固定术后患者规律随访26~86个月,平均58个月。4组患者的实际手术时间、术中出血量、术后伤口愈合情况、伤口引流量等差异无统计学意义(P>0.05)。4组患者术后临床疗效VAS和JOA评分差异有统计学意义(P<0.05)。术后肿瘤复发率唑来膦酸组为6.1%,伊班膦酸组为12.5%,帕米膦酸组为18.8%,常规放疗组为32.3%;4组术后肿瘤复发率比较差异有统计学意义(P<0.05)。不良反应发生率唑来膦酸组为51.5%,伊班膦酸组为31.3%,帕米膦酸组为21.9%,常规放疗组为51.6%,差异有统计学意义(P<0.05)。4组修复重建率差异有统计学意义(P<0.05)。结论骨巨细胞瘤切刮植骨术后仅应用常规放疗的肿瘤复发率依然较高;与伊班膦酸、帕米膦酸比较,唑来膦酸能够明显降低骨巨细胞瘤切刮植骨术后复发率。

Objective To retrospectively analyzed the clinical data of patients with giant cell tumor of bone treated by different adjuvant therapies after operation,and to compare the therapeutic effects of these adjuvant treatment methods on giant cell tumor after curettage.Methods The clinical data about 128 patients with giant cell tumor of bone who were treated were retrospectively analyzed.The 33 patients in zoledronic acid group were treated by spinal resection and interbody fusion with internal fixation,then who were given zoledronic acid 4mg per month,for 24 months.The 32 patients in ibandronic acid group were treated by spinal resection and interbody fusion with internal fixation,then who were given ibandronic acid 4mg per month,for 24 months.The patients in pamidronic acid group were treated by pamidronic acid 60mg for 24 months after the operation,and the 31 patients in conventional radiotheraphy were treated by X ray irradiation with linear accelerator,and the absorbed dose of the irradiated tumor was 30~50 Gy,2Gy once,5 times a week.All the patients must be examined by MRI before operation,moreover,all the patients were followed up by X-ray,CT scan and the two dimensional reconstruction.The actual operation time,intraoperative bleeding,postoperative wound healing,wound flow rate and other indexes were observed and compared among the four groups.In addition the clinical curative effect score,recurrence rate of tumor and incidence rate of reverse reactions were observed and compared among the four groups.Results All the patients were followed up for 26~86 months,with average follow up time being 58 months after the operation.There were no significant differences in the actual operation time,intraoperative blood loss,postoperative wound healing,wound drainage and other indexes among the four groups(P>0.05).However there were significant differences in the clinical curative effects,VAS scores and JOA scores among the four groups(P<0.05).In addition of the relapse rate in zoledronic acid group was 6.1%,which in ibandronic acid group was 12.5%,pamidronic acid group was 18.8%,conventional radiotherapy group was 32.3%,there was a significant difference in relapse rate among the four groups(P<0.05).Moreover there were significant differences in the incidence rate of reverse reactions and repairing rebuilding rate among the four groups(P<0.05).Conclusion The recurrence rate of tumor after simple conventional radiotherapy is still higher after the resection of bone giant cell tumor of the spine.As compared with ibandronic acid and pamidronic acid,the zoledronic acid can significantly decrease the recurrence rate after resection of bone graft.