孙建业,伦俊杰,胡效坤,赵俊玲,吴文亮,殷好治.椎体成形术联合调强放射治疗脊柱转移瘤疗效[J].中国介入影像与治疗学,2019,16(11):676-681
椎体成形术联合调强放射治疗脊柱转移瘤疗效
Therapeutic effect of percutaneous vertebroplasty combined with intensity-modulated radiation therapy for spinal metastases
投稿时间:2019-03-21  修订日期:2019-09-02
DOI:10.13929/j.1672-8475.201903035
中文关键词:  脊柱  肿瘤转移  放射治疗  经皮椎体成形术  骨水泥
英文关键词:spine  neoplasm metastasis  radiotherapy  percutaneous vertebroplasty  bone cement
基金项目:潍坊市科技局项目(2016YX145)。
作者单位E-mail
孙建业 昌乐县人民医院肿瘤科, 山东 潍坊 262400  
伦俊杰 昌乐县人民医院肿瘤科, 山东 潍坊 262400 lunjunjie001@163.com 
胡效坤 青岛大学附属医院介入医学中心, 山东 青岛 266011  
赵俊玲 昌乐县人民医院肿瘤科, 山东 潍坊 262400  
吴文亮 昌乐县人民医院肿瘤科, 山东 潍坊 262400  
殷好治 昌乐县人民医院肿瘤科, 山东 潍坊 262400  
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中文摘要:
      目的 探讨经皮椎体成形术(PVP)联合调强放射治疗(IMRT)对脊柱转移瘤的临床疗效。方法 回顾性分析106例脊柱转移瘤患者,其中38例接受PVP联合IMRT(PVP+IMRT组),38例接受单纯PVP(PVP组),30例接受单纯IMRT(IMRT组)。采用疼痛视觉模拟评分(VAS)、脊柱肿瘤不稳定评分(SINS)及Karnofsky功能状态评分(KPS)评估3组患者疼痛、脊柱稳定性和功能状态,观察治疗不良反应及局部进展情况,以Kaplan-Meier法进行生存状况分析,Cox模型评估各临床因素对预后的影响。结果 治疗后6个月3组局部进展率差异无统计学意义(χ2=5.890,P=0.061);治疗后1、3、6、12个月,3组VAS比较差异有统计学意义(P均<0.05),且PVP+IMRT组疼痛较IMRT组改善明显(P<0.016 7),各组组内治疗前与治疗后VAS比较差异均有统计学意义(P均<0.016 7);PVP+IMRT组及PVP组组内治疗前和治疗后KPS总体差异有统计学意义(P=0.007、0.033),治疗前与治疗后3个月比较差异均有统计学意义(P均<0.016 7);治疗后1、3个月3组间SINS总体比较差异有统计学意义,且PVP+IMRT组与PVP组间差异有统计学意义(P<0.016 7)。3组生存率差异无统计学意义(P>0.05)。Cox回归模型分析显示脑或内脏转移、KPS、内科治疗为独立预后影响因素。结论 PVP+IMRT治疗脊柱转移瘤能更好缓解疼痛,维持椎体稳定,改善功能状态。
英文摘要:
      Objective To investigate the efficacy of percutaneous vertebroplasty (PVP) combined with intensity modulated radiation therapy (IMRT) for spinal vertebra metastases. Methods Data of 106 patients with spinal metastases were retrospectively analyzed, including 38 patients underwent PVP combined with IMRT(PVP+IMRT group), 38 received PVP (PVP group) and 30 received IMRT (IMRT group). The pain visual analogue scale (VAS), tumors of spine instability score (SINS) and Karnofsky performance status score (KPS) were used to evaluate pain, spinal stability improvement and functional status. The adverse reaction and local progression were also observed. Kaplan-Meier was used to analyze the survival analysis, while Cox proportional hazard model was used to evaluate the correlations of survival and clinical factors. Results There was no significant difference of local tumor progression among 3 groups 6 months after treatment (χ2=5.890, P=0.061). VAS were significant different among 3 groups 1 month, 3 months, 6 months and 12 months after treatment (all P<0.05), which in PVP+IMRT group was significantly lower than in IMRT group (both P<0.016 7). Significant intragroup differences after and before treatment were observed in all 3 groups (all P<0.016 7). Intragroup differences of KPS scores were noticed in PVP+IMRT and PVP groups before and after treatment (P=0.007, 0.033), also before and 3 months after treatment (both P<0.016 7). There were statistically significant differences of SINS among 3 groups 1 and 3 months after treatment, also between PVP+IMRT and PVP group (P<0.016 7). There was no significant difference of overall survival rate among 3 groups (P>0.05). Brain or visceral metastasis, KPS and the medical treatment were independent factors affecting prognosis. Conclusion PVP combined with IMRT for spinal metastases is good at relieving pain, maintaining the stability of vertebral body and improving the functional status.
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