地塞米松在椎体转移立体定向和大分割放疗中预防疼痛爆发的研究

Prophylactic Dexamethasone on Pain Flare in Spine Metastasis Stereotactic Body Radiotherapy and Hypofractionated Radiotherapy

目的探讨椎体转移立体定向放疗(SBRT)或大分割放疗(HF)疼痛爆发(PF)的发生率及地塞米松在预防疼痛爆发中的作用。方法行椎体转移SBRT治疗的65例患者随机分为对照组(32例,仅行SBRT或大分割放疗)和治疗组(33例,行SBRT或大分割放疗同时给予4.5 mg地塞米松治疗)。简明疼痛量表(BPI)用来评估治疗前、治疗过程中和治疗后患者疼痛评分。记录每组患者疼痛爆发情况,比较两组患者PF发生率。结果全组患者发生PF为24.6%,对照组发生率为37.5%例,治疗组发生率为12.1%例,两组PF比较差异有统计学意义(P=0.018)。两组患者PF主要发生在d1~2,占整个PF的62.5%,其中对照组为66.7%,治疗组为50%,在d1~2发生PF两组比较差异无统计学意义(P=0.551)。比较不同分次方案与PF关系,对照组3F与10F中PF发生率分别为66.7%和33.3%(P=0.001)。治疗组3F与10F中PF发生率分别为50%和50%(P=0.643)。结论口服地塞米松在预防和治疗椎体转移SBRT或HF的PF具有较好的疗效,显著降低PF发生率。

Objective To explore the incidence of pain flare(PF)in spine metastasis stereotactic body radiotherapy(SBRT)or hypofractionated radiotherapy(HF)and the prophylactical effect of dexamethasone.Methods Sixty-five patients were treated with spine metastasis SBRT and randomly divided into control group(SBRT or HF,n=32)and treatment group(SBRT or HF and 4.5 mg dexamethasone,n=33).The brief pain inventory(BPI)was used to score the pain before,during and after treatment.PF was recorded and compared between two groups.Results The incidence of PF was 24.6%in all patients(control group:37.5%,treatment group:12.1%,P=0.018).PF in both group occurred in d1-2,accounting for 62.5%in all PF(control group:66.7%,treatment group:50%,P=0.551).The incidences of PF in control group were 66.7%and 33.3%for three and ten fractions scheme,respectively(P=0.001).However,the incidences of PF in treatment group were 50%and 50%for three and ten fractions scheme,respectively(P=0.643).Conclusion Oral dexamethasone has an excellent efficacy in prevention and treatment of PF in spine metastasis SBRT or HF,with significantly decreased incidence of PF.A phaseⅢclinical trial is required to finalize the optimal dose and schedule.