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目的探讨精确放射治疗在脊柱转移瘤中的临床应用,分析脊柱转移瘤患者个体化治疗方案的选择。方法自2011年5月至2015年8月应用精确放射治疗的脊柱转移瘤患者共29例,其中男20例,女9例;平均年龄58.0±71.0(23~80)岁;利用Tomita评分和修正的Tokuhashi评分评估患者生存期,SINS评分评估脊柱稳定性,Frankel评分和ESCC评分估计神经损伤及脊髓压迫程度:预期生存<3个月患者给予单纯放疗以减轻患者疼痛,>3个月患者根据脊柱稳定性以及脊髓压迫程度,选择不同的精确放疗与外科手术结合治疗。结果 29例中随访26例,3例失访,平均随访14.8±27.7(3~60)个月。单纯行放疗治疗11例,术前+术后放疗2例,术前放疗4例,术后放疗13例。应用放疗手段包括:射波刀(Cyber-Knife)12例,三维适行放疗(3D-CRT)13例,三维调强放疗(IMRT)4例。Kaplan-Meier生存分析结果显示该组1年生存率为68%,2年生存率为22%。Cox回归模型多因素分析显示Tomita评分和修正的Tokuhashi评分是脊柱转移瘤预后的影响因素,危险度HR分别为4.445和2.238,而SINS评分并不是影响预后的独立危险因素,手术干预的时机和放疗方式的不同均与脊柱转移瘤生存时间差异无统计学意义。结论精确放射治疗结合外科手术治疗脊柱转移瘤,能够达到脊柱稳定,保护神经功能,控制肿瘤进展以及缓解疼痛的目的。根据不同患者的特点,利用各项评分系统进行综合评估,以选择更加个体化的治疗方案。
Objective To investigate the clinical application of precise radiotherapy in spinal metastases and to analyze the individualized treatment options in patients with spinal metastases. Methods From May 2011 to August 2015, 29 patients with spinal metastases underwent precise radiotherapy, including 20 males and 9 females, with an average age of 58.0 ± 71.0 (range, 23-80 years). Tomita’s score and revision Of the Tokuhashi score to assess patient survival, SINS score to assess spinal stability, Frankel score and ESCC score to estimate nerve injury and spinal cord compression: Expected survival <3 months of patients treated with radiotherapy alone to reduce the patient’s pain,> 3 months patients according to the spine Stability and degree of spinal cord compression, choose a different combination of precise radiotherapy and surgical treatment. Results Totally 26 cases were followed up in 29 cases and 3 cases were lost to follow up. The average follow - up was 14.8 ± 27.7 (3 ~ 60) months. Simple radiotherapy in 11 cases, preoperative + postoperative radiotherapy in 2 cases, 4 cases of preoperative radiotherapy, postoperative radiotherapy in 13 cases. Radiotherapy methods include: 12 cases of Cyber-Knife, 13 cases of 3D-CRT, 4 cases of IMRT. The Kaplan-Meier survival analysis showed that the 1-year survival rate was 68% and the 2-year survival rate was 22%. Cox regression model multivariate analysis showed that the Tomita score and the revised Tokuhashi score were the prognostic factors of spinal metastases, the risk of HR were 4.445 and 2.238, respectively. However, the SINS score was not an independent risk factor for prognosis. The timing of surgical intervention and radiotherapy There was no significant difference in the survival time of spinal metastases between different modes. Conclusions Precise radiotherapy combined with surgical treatment of spinal metastases can achieve spinal stabilization, neurological protection, tumor progression control and pain relief. According to the characteristics of different patients, using the scoring system to conduct a comprehensive assessment to select more individualized treatment options.