Objective:The optimal treatment of patients with metastatic spinal cord compression(MSCC) is still being debated.This randomized trial was planned to compare the functional outcome and its related prognostic factors,t...Objective:The optimal treatment of patients with metastatic spinal cord compression(MSCC) is still being debated.This randomized trial was planned to compare the functional outcome and its related prognostic factors,toxicity and in-field recurrence of the three schedules of radiotherapy.Methods:Two hundred and eighty five patients enrolled in the study of which 95 received 1 × 8 Gy,100 received 10 x 3 Gy and 90 received the radiation treatment of 20 × 2 Gy.Irradiation was performed with 6-10 Mv linear accelerators or cobalt-60 units by single posterior field or parallel opposed fields according to depth of irradiation spines.Premedication with dexamethasone was started from the first day of clinico-radiologic diagnosis till 4-5 days after the end of radiotherapy(RT) then tapered off during 10 days.Potential prognostic factors were evaluated with respect to functional outcome.Results:All groups were balanced for patient's characteristics and potential prognostic factors.No statistically significant difference was observed between the 3 groups as regard functional outcome and toxicity while single fraction was associated with higher in-field recurrences(22.8%) with statistically significant difference between the 3 groups(P = 0.01).Functional outcome was significantly better with younger age(≤ 60 y),Eastern Cooperative Oncology Group performance status(ECOG-PS) of 1-2,involved vertebra of 1-2,favorable tumor type,absence of visceral or other bone metastasis,decreased time of developing motor deficit before radiotherapy,long interval between cancer diagnosis to metastatic spinal cord compression,and normal ambulatory status.Conclusion:The three schedules provided similar functional outcome.Single-radiation dose was associated with higher in-field recurrence.To minimize treatment time and costs,the dose of 1 × 8 Gy is recommended for patients with poor predicated survival and 10 × 3 Gy for other patients.展开更多
目的分析恶性肿瘤所致脊髓压迫症的放射治疗疗效。方法选取放疗科2003年4月-2010年8月住院治疗的45例恶性肿瘤所致脊髓压迫症患者,采用放射治疗加激素治疗。直线加速器6MV-X线外照射,照射野范围包括转移椎体上、下各一个正常椎体,位于...目的分析恶性肿瘤所致脊髓压迫症的放射治疗疗效。方法选取放疗科2003年4月-2010年8月住院治疗的45例恶性肿瘤所致脊髓压迫症患者,采用放射治疗加激素治疗。直线加速器6MV-X线外照射,照射野范围包括转移椎体上、下各一个正常椎体,位于颈段的病灶用两侧对穿照射,位于胸、腰骶部的病灶照射方式从后背单野或前后野垂直照射。照射剂量300 cGy×10次,5次/周,或200 cGy×20次,5次/周。所有病例放射治疗时辅助使用地塞米松(10mg/d)加20%甘露醇(250 m l/d)静脉滴注。放疗结束后1个月记录患者症状和体征变化,评价疗效。结果背痛总有效率达84.4%(38/45);运动功能改善总有效率为75.6%(34/45);膀胱括约肌功能恢复率37.5%(3/8)。结论恶性肿瘤所致脊髓压迫症患者采用放射治疗加激素治疗症状缓解率高。展开更多
文摘Objective:The optimal treatment of patients with metastatic spinal cord compression(MSCC) is still being debated.This randomized trial was planned to compare the functional outcome and its related prognostic factors,toxicity and in-field recurrence of the three schedules of radiotherapy.Methods:Two hundred and eighty five patients enrolled in the study of which 95 received 1 × 8 Gy,100 received 10 x 3 Gy and 90 received the radiation treatment of 20 × 2 Gy.Irradiation was performed with 6-10 Mv linear accelerators or cobalt-60 units by single posterior field or parallel opposed fields according to depth of irradiation spines.Premedication with dexamethasone was started from the first day of clinico-radiologic diagnosis till 4-5 days after the end of radiotherapy(RT) then tapered off during 10 days.Potential prognostic factors were evaluated with respect to functional outcome.Results:All groups were balanced for patient's characteristics and potential prognostic factors.No statistically significant difference was observed between the 3 groups as regard functional outcome and toxicity while single fraction was associated with higher in-field recurrences(22.8%) with statistically significant difference between the 3 groups(P = 0.01).Functional outcome was significantly better with younger age(≤ 60 y),Eastern Cooperative Oncology Group performance status(ECOG-PS) of 1-2,involved vertebra of 1-2,favorable tumor type,absence of visceral or other bone metastasis,decreased time of developing motor deficit before radiotherapy,long interval between cancer diagnosis to metastatic spinal cord compression,and normal ambulatory status.Conclusion:The three schedules provided similar functional outcome.Single-radiation dose was associated with higher in-field recurrence.To minimize treatment time and costs,the dose of 1 × 8 Gy is recommended for patients with poor predicated survival and 10 × 3 Gy for other patients.
文摘目的分析恶性肿瘤所致脊髓压迫症的放射治疗疗效。方法选取放疗科2003年4月-2010年8月住院治疗的45例恶性肿瘤所致脊髓压迫症患者,采用放射治疗加激素治疗。直线加速器6MV-X线外照射,照射野范围包括转移椎体上、下各一个正常椎体,位于颈段的病灶用两侧对穿照射,位于胸、腰骶部的病灶照射方式从后背单野或前后野垂直照射。照射剂量300 cGy×10次,5次/周,或200 cGy×20次,5次/周。所有病例放射治疗时辅助使用地塞米松(10mg/d)加20%甘露醇(250 m l/d)静脉滴注。放疗结束后1个月记录患者症状和体征变化,评价疗效。结果背痛总有效率达84.4%(38/45);运动功能改善总有效率为75.6%(34/45);膀胱括约肌功能恢复率37.5%(3/8)。结论恶性肿瘤所致脊髓压迫症患者采用放射治疗加激素治疗症状缓解率高。
