不同剂量全椎体适形调强放疗对椎体转移瘤的疗效  

Efficacy of different doses of intensity modulated radiation therapy on metastatic tumor of the spine

作　　者：陈刚[1] 徐万龙[2] 锡林宝勒日 白靖平[2] 

机构地区：[1]新疆医科大学第一附属医院骨科,830011 [2]新疆医科大学附属肿瘤医院骨与软组织肿瘤科

出　　处：《江苏医药》2013年第8期874-877,共4页Jiangsu Medical Journal

基　　金：新疆维吾尔自治区科技攻关(含重大专项)和重点项目(200833116)

摘　　要：目的探讨不同剂量全椎体适形调强放疗(IMRT)对椎体转移瘤治疗有效性的差异。方法选取纯种比格犬30只,随机均分为五组。模拟犬T9-T10椎体肿瘤,以全椎体IMRT的治疗方式分别对五组比格犬T9-T10椎体给予0、40、50、60和70Gy剂量的放疗。放疗3个月后处死取材,取相同位置的T9-T10节段椎体骨进行HE染色、电镜观察,并用免疫组织化学法定量检测椎体中Caspase-3蛋白的表达,TUNEL法定量检测椎体骨中凋亡骨细胞。结果随着IMRT剂量的增大,比格犬椎体骨空骨陷窝率明显减少(P<0.05),骨小梁断裂程度增加,但面积未见明显下降(P>0.05);放疗后50、60和70Gy组的比格犬椎体骨细胞凋亡指数及椎体骨细胞凋亡蛋白Caspase-3表达高于40Gy组(P<0.05)。结论椎体IMRT对椎体转移瘤有很好的治疗效果;50Gy可作为临床选择治疗总剂量的参考标准。Objective To investigate the efficacy of different doses of intensity modulated radiation therapy（IMRT） on the metastatic tumor of the spine. Methods Thirty purebred beagles were equally randomized into 5 groups. After mimicking a beagle clinical model of metastatic tumor in the vertebrae T9-T10 ,IMRT of T9-T10 was performed in the doses of 0 Gy（group A）, 40 Gy（group B）,50 Gy（group C）, 60 Gy（group D） and 70 Gy（group E）, respectively. The vertebrae was taken out three months later for the histological observation by electron microscope, detecting the Caspase-3 protein expression by immunohistochemistry and vertebral osteoblasts apoptosis by TUNEL- quantitative method. Results As the dose of IMRT was increased, the empty lacunae rate of beagle vertebral bones was significantly reduced （P〈0. 05）with an increased degree of trabecular bone fracture, but not the area （P〉0. 05）. The apoptosis index and Caspase-3 protein expression were higher in groups of C,D and E than those in group B（P〈0. 05）. Conclusion The vertebral IMRT is effective in the treatment of vertebral metastases, for which a total dose of 50 Gy may be taken as a reference standard.

关 键 词：适形调强放疗 椎体 

分 类 号：R739[医药卫生—肿瘤]