不同剂量分割模式容积旋转调强放射治疗联合唑来膦酸治疗脊柱转移瘤疗效分析

发布时间：2018-02-28 03:30

本文关键词： 容积旋转调强放射治疗脊柱转移瘤分割模式唑来膦酸疗效　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1.分析容积旋转调强放射治疗联合唑来膦酸在脊柱转移瘤患者疼痛缓解及生活质量改善等方面的疗效。2.比较不同剂量分割模式容积旋转调强放射治疗联合唑来膦酸在脊柱转移瘤患者疼痛缓解、止痛维持时间、生活质量提高及功能状态(如行走功能及膀胱功能)改善等方面的不同疗效。方法40例符合入组条件的脊柱转移瘤患者均接受容积旋转调强放疗(VMAT)。剂量为(30~60)Gy/(10~30)f,(2~3.5)Gy/f,1f/d,生物等效剂量(BED)为(39~66.3)Gy。所有患者均规律注射唑来膦酸,4mg/次,1次/4周。进一步将所有患者分两组,低剂量分割组(A组)20例,(30~40)Gy/(10~15)f,(2.5~3.5)Gy/f,1f/d,生物等效剂量(BED)为(39~47)Gy;高剂量分割组(B组)20例,(45~60)Gy/(15~30)f,(2~3)Gy/f,1f/d,生物等效剂量(BED)为(58.5~66.3)Gy。采用数字评分法(NRS)、语言模拟疼痛评分法(VRS)、生活质量骨转移量表(EORTC QLQ-BM22)、一般功能状态评分(Tomita、KPS)、脊髓神经功能Frankel分级评价放疗后的疗效,用RTOG-EORTC急慢性放射性损伤标准评价放疗后副反应。40例患者放疗前后NRS评分等指标采用配对t检验比较差异。两组患者放疗前后NRS评分下降分值等指标独立样本t检验比较差异。两组患者疼痛复发率等指标采用卡方检验比较差异。结果放疗后40例患者疼痛总缓解率为90%。至随访结束,脊柱转移瘤患者无疼痛人数由放疗前0例/40例上升至10例/16例(c2=4.67,P0.05),差异有统计学意义。EORTC QLQ-BM22生活质量评分显示放疗后总分由放疗前(48.55±2.18)分下降至(39.25±1.48)分(t=32.42,P0.05),差异有统计学意义,生活质量改善主要体现在疼痛部位、程度和功能方面,而患者的社会心理方面无明显变化。患者放疗耐受性好,40例患者中,4例患者出现1-2级的吞咽困难反应,3例患者出现3级反流性食管炎,3例患者出现1-2级腹泻反应,1例患者出现3级腹泻反应。放疗后患者的骨髓抑制未加重(P0.05)。脊髓神经功能受损的患者放疗后脊髓神经功能得到一定程度的改善,仅一例患者出现脊髓神经放射性损伤。两组比较:A、B两组患者中位生存时间分别为8个月、10个月。放疗后A、B两组疼痛缓解率(85%vs 95%)、疼痛缓解起效时间(5.00±0.92 vs 4.90±1.25)、疼痛明显好转时间(7.60±1.93 vs 6.80±2.04)、止痛维持时间(5.15±4.21 vs7.05±5.25)均无明显统计学差异(P0.05),B组患者止痛较久,有实际临床意义。放疗后B组NRS疼痛评分降低分值、EORTC QLQ-BM22评分下降分值均显著高于A组(4.90±1.52 vs 3.85±1.09,10.10±2.17 vs 8.75±1.41),而B组疼痛复发率明显低于A组(10%vs 31.6%),差异均有显著统计学意义(P0.05)。A、B两组患者2~4级急性副反应发生率分别为17%和10%,无明显统计学差异(c2=1.67,P0.05)。仅一例高剂量分割模式组患者出现晚期放射性脊髓损伤。结论容积旋转调强放疗联合唑来膦酸治疗脊柱转移瘤患者,止痛迅速且维持时间较久,改善患者机体功能,提高患者生活质量;对两种不同剂量分割模式放疗疗效进行比较,高剂量分割模式因其低的疼痛复发率及较长止痛维持时间更适合于生存期长的患者。
[Abstract]:Effect of.2. objective analysis of 1. volume modulated arc radiotherapy combined with zoledronic acid in patients with spinal metastases pain in remission and improvement of quality of life and other aspects of the comparison of different dose fractionation volume modulated arc radiotherapy combined with zoledronic acid in patients with metastatic spinal tumor pain relief, pain duration, improve the quality of life status and function (such as walking function and bladder function) of different therapeutic improvement and so on. Methods 40 eligible patients with spinal metastases underwent volumetric modulated arc therapy (VMAT). The dose of (30~60) Gy/ (10~30) f, (2~3.5) Gy/f, 1f/d, biological equivalent dose (BED) for (39~66.3 Gy.) all patients were regular intravenous zoledronic acid, 4mg/ times, 1 times /4 weeks. All patients were further divided into two groups, low dose radiotherapy group (A group) 20 cases, (30~40) Gy/ (10~15) f, (2.5~3.5) Gy/f, 1f/d, biological equivalent dose (BED) for (39~47 Gy); high dose Segment group (B group) 20 cases, (45~60) Gy/ (15~30) f, (2~3) Gy/f, 1f/d, biological equivalent dose (BED) to (58.5~66.3) Gy. using digital pointrating method (NRS), language analogue scale (VRS), quality of life scale bone metastasis (EORTC QLQ-BM22) in general, functional status score (Tomita, KPS), spinal nerve function Frankel classification evaluation of curative effect after radiotherapy, with RTOG-EORTC acute side effects of.40 evaluation of chronic radiation injury after radiotherapy in patients before and after standard radiotherapy with NRS score index compared with paired t test. Two groups of patients before and after radiotherapy NRS score decreased scores of indexes such as independent sample t test to compare differences. Two groups of patients with pain recurrence rate difference index by using the chi square test. Results the total remission rate of pain in 40 patients after radiotherapy for 90%. to the end of follow-up, in patients with metastatic spinal pain before radiotherapy in 0 cases of /40 by the number of cases rose to 10 cases of /16 patients (c2=4.67, P0.05) There was a significant difference between the.EORTC and QLQ-BM22 quality of life score showed that after radiotherapy by score before radiotherapy (48.55 + 2.18) decreased to (39.25 + 1.48) points (t=32.42, P0.05), the difference was statistically significant, the improvement of the quality of life is mainly reflected in the extent and location of the pain, function, and social psychological aspects of patients without obvious changes. Radiotherapy is well tolerated, in 40 patients, 4 cases of patients with dysphagia was 1-2, 3 patients had grade 3 reflux esophagitis, 3 cases of patients with grade 1-2 diarrhea, 1 cases of patients with grade 3 diarrhea reaction. After radiotherapy for patients with bone marrow suppression did not increase (P0.05). To a certain extent improve the neurological function of spinal cord by radiotherapy in patients with spinal cord function damaged, only one patient appeared radioactive spinal nerve injury. The comparison between the two groups: A, B two groups of patients with the median survival time was 8 months, 10 months after radiotherapy. A, B two The pain remission rate (85%vs 95%), the onset time of pain relief (5 + 0.92 vs 4.90 + 1.25), pain significantly improved time (7.60 + 1.93 vs 6.80 + 2.04), pain duration (5.15 + 4.21 + 5.25 vs7.05) were no significant difference (P0.05), B group of patients with pain for a long time a practical clinical significance. After radiotherapy group B NRS pain score decreased EORTC score, QLQ-BM22 score decreased scores were significantly higher than A group (4.90 + 1.52 vs 3.85 + 1.09,10.10 + 2.17 vs 8.75 + 1.41), B group pain recurrence rate was significantly lower than A group (10%vs 31.6%), the difference was statistically significant (P0.05).A, the incidence of acute adverse reaction in two groups of B patients with grade 2~4 were 17% and 10%, no statistically significant difference (c2=1.67, P0.05). Only one case of high dose group of patients with advanced segmentation model of radiation injury of spinal cord. Conclusion volume modulated arc radiotherapy combined with zoledronic acid in the treatment of patients with spinal metastases, check The pain is rapid and sustained for a long time, which improves the patient's body function and improves the quality of life of patients. Comparing the efficacy of two different doses of split mode radiotherapy, the high-dose segmentation mode is more suitable for patients with longer survival time because of its low pain recurrence rate and longer pain maintenance time.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.55

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