大分割同步加量放疗对肿瘤非成骨性脊柱转移疗效的研究  

Efficacy of hypofractionated radiotherapy with simultaneous integrated boost for non-osteogenic spinal metastases

作　　者：尹法东 高玉艳 南贤秀 刘璇 郑先斌 石鑫珏 原静 刘其腾 Yin Fadong;Gao Yuyan;Nan Xianxiu;Liu Xuan;Zheng Xianbin;Shi Xinjue;Yuan Jing;Liu Qiteng(Department of Radiation Oncology,Beijing Luhe Hospital Capital Medicine University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院放疗科,北京101100

出　　处：《中华放射肿瘤学杂志》2024年第10期928-934,共7页Chinese Journal of Radiation Oncology

摘　　要：目的:评估大分割同步加量放疗(HFRT-SIB)治疗不适合立体定向放疗(SBRT)的肿瘤非成骨性脊柱骨转移患者的可行性与有效性。方法:回顾性分析2020年3月至2023年4月于首都医科大学附属北京潞河医院接受治疗的24例肿瘤非成骨性脊柱骨转移患者的26处骨转移灶。患者的放疗采用临床靶区(CTV)3 Gy/次×10次(每周5次,每日1次),大体肿瘤体积(GTV)同步加量区(SIB)4 Gy/次×10次(每周5次,每日1次)的剂量分割模式。主要研究终点为放疗结束12周和24周的疼痛总体缓解(OR)率,次要研究终点为疼痛缓解起效时间、疼痛缓解维持时间、放疗后不良事件发生率和1年总生存(OS)率。采用Wilcoxon符号秩和检验分析治疗前后数据差异性。采用标准Kaplan-Meier法评估OS。结果:中位随访11.7(8.0,17.0)个月。放疗结束12周时,92%(22/24)的患者实现OR;放疗结束24周时,81%(17/21)的患者实现OR。中位疼痛缓解起效时间为4(3,5)d。截至末次随访,42%(10/24)的患者疼痛缓解维持时间超过1年,所有患者中位疼痛缓解维持时间为11.0(6.0,16.9)个月。全组患者1年OS率为66.3%,所有患者均未出现3级以上急性或慢性不良事件。结论:HFRT-SIB可以有效地减轻疼痛,实现持久的疼痛控制,没有出现严重不良反应。ObjectiveTo assess the feasibility and efficacy of hypofractionated radiotherapy with simultaneous integrated boost(HFRT-SIB)for patients with non-osteogenic spinal metastases who were not suitable for stereotactic body radiotherapy(SBRT).MethodsA totoal of 26 spinal metastatic lesions in 24 patients with non-osteogenic spinal metastases admitted to Beijing Luhe Hospital affiliated to Capital Medical University from March 2020 to April 2023 were retrospectively analyzed.In our institution,a higher-dose fractionated regimen for spinal metastases was introduced,at a dose of 3 Gy/f×10 times(5 times a week,once a day)to the clinical target volume(CTV),and simultaneous integrated boost(SIB)of 4 Gy/f×10 times(5 times a week,once a day)to the gross tumor volume(GTV).The primary endpoint was the overall relief(OR)rates of pain at 12 and 24 weeks post-radiotherapy,while secondary endpoints included the pain response time and duration of pain relief,the incidence of adverse events post-radiotherapy,and the 1-year overall survival(OS)rate.The differences before and after treatment were analyzed by Wilcoxon signed-rank test.OS was assessed using Kaplan-Meier method.ResultsThe median follow-up was 11.7(8.0,17.0)months.At 12 weeks post-radiotherapy,92%(22/24)of patients achieved OR,and 81%(17/21)obtained OR at 24 weeks post-radiotherapy.The median pain response time was 4(3,5)d.At the last follow-up,42%(10/24)of patients maintained pain relief for over 1 year,with a median duration of pain relief up to 11.0(6.0,16.9)months.The 1-year OS rate was 66.3%,and no patients experienced grade 3 or higher acute or chronic adverse events.ConclusionHFRT-SIB can effectively alleviate pain,and achieve sustained pain control,and does not lead to severe adverse effects in patients with non-osteogenic spinal metastases.

关 键 词：肿瘤转移 骨转移 脊柱转移 体部立体定向放射疗法 大分割放射疗法 同步加量放射疗法 

分 类 号：R738.1[医药卫生—肿瘤]