基于容积弧形调强放疗的立体定向放疗治疗脊柱转移瘤的临床研究  

Clinical Study on Stereotactic Body Radiotherapy for Spinal Metastasis Based on Volume Arc Intensity Modulated Radiation Therapy

作　　者：刘苗苗 陈晓亮 穆振诺 Liu Miaomiao;Chen Xiaoliang;Mu Zhennuo(Radiotherapy Department,Pingmeishenma Medical Group General Hospital,Pingdingshan,Henan,467000,China)

机构地区：[1]平煤神马医疗集团总医院放射治疗科,河南平顶山467000 [2]烟台市烟台山医院放射治疗科,山东烟台264000

出　　处：《黑龙江医学》2025年第7期816-819,共4页Heilongjiang Medical Journal

基　　金：2023年度河南省医学科技攻关计划联合共建项目(LHGJ20230850)。

摘　　要：目的:探讨基于容积弧形调强放疗(VMAT)的立体定向放疗(SBRT)治疗脊柱转移瘤的临床效果。方法:回顾性分析2020年10月—2023年10月样本医院收治的119例脊髓转移瘤患者的临床资料,根据治疗方案的不同将应用基于调强放疗(IMRT)技术行SBRT治疗的患者设为对照组(n=59),应用基于VMAT技术行SBRT治疗的患者设为研究组(n=60)。比较两组患者脊柱疼痛程度[数字等级评分法(NRS)]、脊髓损伤程度(Frankle分级)、毒副反应、生活质量[骨转移患者生存质量调查问卷(EORTC QLQ-BM22)]及生存情况。结果:两组患者放疗前至放疗后3个月的NRS评分呈逐渐下降趋势。两组患者NRS评分时点比较,差异有统计学意义(F=630.174,P<0.001)。放疗结束,两组患者Frankle分级均较放疗前有所改善,差异均有统计学意义(Z=5.385、5.831,P<0.05)。研究组患者放射性肺炎、骨髓抑制发生率低于对照组,差异均有统计学意义(χ^(2)=4.555、4.627,P<0.05)。放疗结束时,两组患者EORTC QLQ-BM22评分均较放疗前降低,差异均有统计学意义(t=17.477、18.303,P<0.001)。结论:基于VMAT技术的SBRT治疗计划在缓解脊柱转移瘤患者脊柱疼痛、改善脊髓损伤、提高生活质量及远期生存方面与IMRT技术相当,但VMAT技术的毒副反应少。Objective:To explore the clinical efficacy of stereotactic body radiotherapy(SBRT)based on volume arc intensity modulated radiation therapy(VMAT)in the treatment of spinal metastases.Methods:A retrospective analysis was conducted on the clinical data of 119 patients with spinal metastasis in hospitals from October 2019 to October 2022.They were divided into two groups based on different treatment plans.Among them,59 patients treated with intensity modulated radiation therapy(IMRT)and 60 patients treated with VMAT were used as the control group and the study group,respectively.The degree of spinal pain(NRS),degree of spinal cord injury(Frankle grade),toxic side effects,and quality of life(EORTC QLQ-BM22)were compared between two groups,and the survival status of the two groups were calculated.Results:The NRS scores of both groups showed a gradual downward trend from before radiotherapy to 3 months after radiotherapy.There was significant difference in NRS score between the two groups(F=630.174,P<0.001).At the end of radiotherapy,Frankle grades of both groups were improved compared with those before radiotherapy,with statistical significance(Z=5.385,5.831;P<0.05).The incidence of radiation pneumonia and myelosuppression in the study group was significantly lower than that in the control group(χ^(2)=4.555,4.627;P<0.05).After radiotherapy,the EORTC QLQ-BM22 scores of both groups were lower than those before radiotherapy,and the difference was statistically significant(t=17.477,18.303;P<0.001).Conclusion:The SBRT treatment plan based on VMAT technology is equivalent to IMRT technology in alleviating spinal pain,improving spinal cord injury,improving quality of life,and long-term survival in patients with spinal metastases,but VMAT technology has fewer toxic side effects.

关 键 词：脊柱转移瘤 容积弧形调强放疗 立体定向放疗 毒副反应 

分 类 号：R738.1[医药卫生—肿瘤]