骨转移癌58例放射治疗的临床分析

目的：观察放射治疗对骨转移癌疼痛的缓解效果。方法：58例患者83处骨转移灶均采用^60Co放射治疗。采用2种剂量方案：DT28—50Gy，14—25次；DT25—40Gy，6—10次。结果：分次方案对疼痛缓解率无明显影响，总有效率为94．8％，但常规分次放疗3—4次后疼痛缓解，而低分割放疗1—2次后疼痛缓解。结论：骨转移癌放射治疗止痛效果确切、迅速，副作用小，对大部份病例可采用低分割方案。     

骨转移癌疼痛的放射治疗

目的观察放射治疗对骨转移癌疼痛的缓解效果。方法59例患者83处骨转移灶均采用60Co放射治疗。采用2种方案:DT28~50 Gy,14~25次;DT25~40 Gy,6~10次。结果分次方案对疼痛缓解率无明显影响,总有效率为94.9%,但常规分次放疗3~4次后疼痛缓解,而低分割放疗1~2次后疼痛缓解。结论骨转移癌放射治疗止痛效果确切、迅速,副作用小,对大部份病例可采用低分割方案。     

骨转移癌58例放射治疗的临床分析

目的:观察放射治疗对骨转移癌疼痛的缓解效果.方法:58例患者83处骨转移灶均采用 60Co放射治疗. 采用2种剂量方案:DT28-50Gy,14-25次;DT 25-40Gy,6-10次.结果:分次方案对疼痛缓解率无明显影响,总有效率为94.8%, 但常规分次放疗 3-4 次后疼痛缓解,而低分割放疗1-2次后疼痛缓解.结论:骨转移癌放射治疗止痛效果确切、迅速,副作用小,对大部份病例可采用低分割方案.     

不同放疗分割方式对骨转移癌疼痛的疗效观察

目的 观察骨转移癌常规分割放疗组与低分割放疗组的止痛效果。方法 56例骨转移癌患者,30例采用常规分割照射,DT 2Gy／次,5次／周,总DT 40～50Gy;26例采用低分割照射,DT 4～5Gy／次,3～4次／周,总DT 25～30Gy。结果 56例总有效率为87．5％,常规分割照射组与低分割照射组止痛效果大致相似,差异无显著性（P〉0．05）。结论 放射治疗是骨转移癌止痛的有效方法,采用何种分割方式应根据病情及生存期长短来决定。     

骨转移癌放射治疗止痛疗效分析（附52例报告）

目的:观察不同分割放射治疗骨转移癌疼痛的疗效.方法:收集我院52例各种恶性肿瘤骨转移疼痛患者进行不同分割方式和剂量的体外放射治疗.200cGY/次,5次/周,总DT40GY/20次;300cGY/次,5次/周,总DT30GY/10次,;500cGY/次,3次/周,总DT30GY/6次.结果:不同分割方式的放射治疗骨转移癌疼痛缓解总有效率为96%.结论:不同分割放射治疗骨转移癌疼痛缓解疗效相似,治疗效果肯定.常规分割更安全、可靠.     

放射治疗50例骨转移癌疼痛的临床观察

[目的]探讨放射治疗不同分割方式对恶性肿瘤骨转移的止痛效果。[方法]50例骨转移癌患者，28例采用低分割照射，DT3Gy／次，4～5次／周．总DT30Gy：22例采用常规分割照射，DT2Gy／次，5次／周，总DT40Gy。[结果]68处骨转移灶放疗后止痛总有效率为94．1％（64／68），大剂量低分割组有效率为94．8％（37／39），常规分割剂量组有效率为93．1％（27／29）．两组止痛有效率比较差异无显著性（P〉0．05）。[结论]放射治疗对骨转移癌疼痛是一种好的止痛方法，大剂量低分割方式与常规分割方式放射治疗止痛疗效相近。     

39例骨转移癌放射治疗止痛疗效观察

目的:观察骨转移癌放射治疗止痛效果。方法:39例共65处骨转移癌,采用6MV蛳X线体外照射,模拟机结合CT、ECT或X线片定位,照射野病灶外放1cm~3cm。30处病灶采用2Gy/次,5次/周,总剂量30Gy~50Gy,22处采用3Gy/次,5次/周,总剂量27Gy~42Gy;13处采用4Gy/次,4次/周(周三、周六、周日休息),总剂量24Gy~36Gy。结果:65处病灶总有效率为87.69%,3个剂量组有效率分别为86.67%、86.36%、92.31%,放疗开始止痛的时间为放疗后2d~3周不等,无严重毒副反应和并发症。结论:放射治疗是骨转移癌止痛的有效方法。     

放射治疗骨转移瘤疼痛的疗效分析(附53例)

目的　观察放射治疗及分割方式对骨转移瘤疼痛的治疗效果。方法　对 5 3例骨转移瘤患者进行常规分割和低分割放射治疗 ,观察放疗后疼痛缓解情况。结果　全组 5 3例中 ,总有效率为 86 8%(46 / 5 3) ,其中常规分割组有效率为 86 7%(2 6 / 30 ) ,低分割组有效率为 87 0 (2 0 / 2 3) ,两组之间无显著性差异 (P >0 0 5 )。结论　放射治疗骨转移引起的疼痛 ,效果较好。采用何种分割方式放疗应根据病情和预计生存期长短来决定。     

放疗联合复方苦参注射液治疗骨转移癌痛72例临床分析

72例初次入院骨转移癌痛患者给予常规或大分割放疗的同时加用复方苦参注射液,放疗的总剂量DT 30～50Gy/2～5周,2.0～3.0 Gy/d;复方苦参注射液20 ml加生理盐水500 ml静脉滴注,1次/d.连用10d.治疗结束时88.89％患者均有不同程度的疼痛缓解.     

115例骨转移癌放射止痛效果分析

目的：评价放射治疗对骨转移癌的止痛效果。方法：对115例骨转移癌患者，202处转移病灶进行单纯放射治疗，其中106处病灶2Gy，次，5次／周照射，总剂量36Gy-54Gy；67处病灶3Gy，次，5次／周照射，总剂量30Gy-42Gy；29处病灶4Gy／次，5次／周照射，总剂量20Gy-24Gy.结果：总有效率97.5％(197／202)，其中疼痛完全缓解率78．2％(158/202)；部分缓解率1913％(39／202)，不同剂量分割组间和原发灶控制与否，止痛疗效差异无显著性。结论：骨转移癌的放射治疗止痛效果确切，不仅大部分患者可以获得较持久的止痛疗效，而且保持满意的生活质量。     

45例骨转移疼痛不同分割剂量放疗疗效分析

[目的]探讨不同分割剂量放疗对骨转移癌止痛的疗效。[方法]45例骨转移癌病人采用三种不同分割剂量放疗,分别为DT40Gy/(20F·4w)、DT30Gy/(10F·2w)和DT20Gy/(5F·1w)。[结果]患者止痛有效率为88.89%(40/45),其中25例获得完全缓解。DT40Gy/(20F·4w)组、DT30Gy/(10F·2w)组及DT20Gy/(5F·1w)组的CR率分别为63.64%、57.14%、33.33%;PR率分别为36.36%、32.14%和33.33%,差异均无显著性(P>0.05)。[结论]不同分割剂量放疗对骨转移癌疼痛的缓解程度无影响。     

放射疗法对骨转移癌止痛疗效的观察

目的分析不同分割方式对转移性骨肿瘤放射治疗的止痛效果。方法将42例骨转移癌患者72处病灶分为两组,常规分割组31例44处病灶40～50Gy／4～5周,5次／周,2Gy／次;大分割组11例28处病灶采用大分割快速照射,30-39Gy／2～3周,5次／周,3Gy／次,照射10～13次的不同分割方式进行止痛治疗。结果全组病例有效率（CR＋PR）为91．7％;常规分割组完全缓解率（CR）72．7％、部分缓解率（PR）20．5％、总有效率（CR＋PR）93．2％;大分割组CR率60．7％、PR率28．6％、CR＋PR率89．3％。组间比较无显著性差异（P〉0．05）。结论骨转移癌进行局部止痛放疗是有效的治疗手段,两种分割方式止痛效果无明显差异。     

Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration

Purpose: In order to better define variables and factors that may influence the pain response to radiation, and to look for a radiation regimen that can assure the highest percentage and the longest duration of pain relief, we performed a prospective, although not randomized, study on patients with bone metastases from various primary sites.

Methods and Materials: From December 1988 to March 1994, 205 patients with a total of 255 solitary or multiple bone metastases from several primary tumors were treated in our radiotherapy center with palliative intent. Irradiation fields were treated with three main fractionation schedules: (1) Conventional fractionation: 40–46 Gy/20–23 fractions in 5–5.5 weeks; (2) Short course: 30–36 Gy/10–12 fractions in 2–2.3 weeks; (3) Fast course: 8–28 Gy/1–4 consecutive fractions. Pain intensity was self-assessed by patients using a visual analogic scale graduated from 0 (no pain) to 10 (the strongest pain one can experience). Analgesic requirement was assessed by using a five-point scale, scoring both analgesic strength and frequency (0 = no drug or occasional nonopioids; 1 = Nonopioids once daily; 2 = Nonopioids more than once daily; 3 = Mild opioids (oral codeine, pentazocine, etc.), once daily; 4 = Mild opioids more than once daily; 5 = Strong opioids (morphine, meperidine, etc.). Complete pain relief meant the achievement of a score ≤ 2 in the pain scale or 0 in the analgesic requirement scale. Partial pain relief indicated a score of 3 to 4 or of 1 to 2 on the former and latter scale, respectively.

Results: Total pain relief (complete + partial) was observed in 195 (76%) sites, in 158 of which (62%) a complete response was obtained. Metastases from NSC lung tumors appeared to be the least responsive among all primary tumors, with 46% complete pain relief in comparison to 65% and 83% complete relief in breast (p = 0.04) and in prostate metastases (p = 0.002), respectively. A significant difference in pain relief was detected among the several ranges of total dose delivered to the painful metastases, with 81%, 65%, and 46% complete relief rates in the 40–46 Gy, 30–36 Gy (p = 0.03), and 8–28 Gy (p = 0.0001) dose ranges respectively. A straight correlation between total dose and complete pain relief was confirmed by the curve calculated by the logistic model which shows that doses of 30 Gy or more are necessary to achieve complete pain relief in 70% or more of bone metastases. This correlation holds also for the duration of pain control, as shown by the actuarial analysis of time to pain progression. Multivariate analyses, with complete pain relief and time to pain progression as endpoints show a highly significant effect of radiation dose (p = 0.0007) and performance status (p = 0.003), with lower rates of complete pain relief and shorter time to pain progression observed after smaller radiation total doses or higher Eastern Cooperative Oncology Group (ECOG) scores.

Conclusion: Although single-dose or short course irradiation is an attractive treatment in reducing the number of multiple visits to radiotherapy departments for patients with painful bone metastases, it is nevertheless clear that aggressive protracted treatments seem to offer significant advantages especially for patients in whom the expected life span is not short.     

Palliative fractionated radiotherapy for bone metastases clinical and biological assessment of single versus multiple fractions

Background: Radiotherapy is effective in controlling pain from bone metastases which is a direct result of bone resorption. The urine resorption marker DPD proved important in assessing effectiveness of palliative radiotherapy to bone metastases. There is still controversy about the optimum adopted fractionation regimen. The aim of this study is to compare single fraction 8Gy with the standard treatment course of 30Gy/10 fractions/ 2weeks and to a third regimen of 20Gy/5 fractions/ 1week regarding factors impacting on QoL in terms of improved pain, mobility, analgesia scores, PS. The decrease of urine DPD was included as an objective parameter of response. Patients and Methods: A prospective phase lll controlled study of palliative radiotherapy was conducted on 60 patients with bone metastases from known primary sites divided into 3 groups each of 20 patients balanced in age, sex, and type of malignancy, to be treated with one of three RT regimens. Assessment was done before and 6 weeks after treatment completion according to an established scoring system. Results: Pain and analgesia scores were improved in the group receiving 30Gy/10 fr. regimen (p = 0.002 = 0.003) with no significant improvement of mobility (p=0.16) or PS (p=0.08). Urine DPD was decreased in this group by 43% in 9/20 patients. The group receiving single fraction of 8 Gy showed a significant improvement of scores of pain (p=0.008), analgesia (p=0.01), mobility (p=0.001), PS (p=0.01) and decrease in urine DPD by 33% in 7/20 patients. The group receiving 20Gy/5 fr. protocol achieved improved scores of pain (p=0.002), analgesia (p=0.008), mobility (p=0.03), and a decrease of ,-DPD by 56% in13/20 patients which was significantly better than the group receiving single 8Gy fraction,(p=0.03). There was a trend towards an increased number of reirradiations in patients receiving single fraction 8Gy, though not significant, whereas reirradiation was significantly correlated with the high initial ,-DPD level within all groups. Conclusion: The 20Gy/5fr. regimen seems to be superior to both the standard 30Gy/10fr. and the single fraction 8Gy as it achieved significant improvement of three clinical criteria, pain, analgesia and mobility concomitantly with significant decrease in urine DPD. Urine resorption markers confer subjective evaluation of radiotherapy response in patients with bone metastases. The high initial ,-DPD level was significantly correlated with the need to reirradiation. Key Words: Fractionated radiotherapy , Bone metastases , Bone resorption markers.     

放射治疗71例骨转移癌止痛效果分析

目的观察低于常规剂量的2种分割方式治疗骨转移性疼痛的疗效。方法71例恶性肿瘤晚期骨转移患者,总计93处骨转移灶,根据疼痛程度及行动受限程度,采取2种均低于常规剂量的分割方式进行放射治疗,分别为Dm30Gy/10f/2W,Dm30Gy/6f/2W。观察疼痛缓解情况。结果2种分割方式止痛有效率分别为88%、95%。两组间无显著差异性(P>0.05)。与国内多数文献报告的结果接近。结论低于常规剂量的分割方式对转移性骨痛疗效与常规剂量的分割方式的疗效相当,且简便易行。     

Randomized prospective clinical study of small, large and twice-a-day fraction radiotherapy for painful bone metastases

A prospective randomized clinical trial comparing small, large and twice-a-day fraction for the relief of painful bone metastases was performed from 1981 to 1986 at Tokyo Women's Medical College Hospital. Eighty patients with painful bone metastases (92 sites) were divided into three radiation methods which were conventional fraction scheme of 5 times/week at 2 Gy/day for a total of 30 Gy/15 fractions (Group I, TDF: 49), 2 times/week at 4.5 Gy/day for a total of 22.5 Gy/5 fractions (Group II, TDF: 50) and 3 times/week at 2 Gy/day twice a day at a minimum interval of 6 h for a total of 20 Gy/10 fractions (Group III). Pain was assessed using a score and response rate was 76% in Group I, 75% in Group II and 78% in Group III which were not statistically significant mutually. Group II and III regimes were found to have an earlier shorter onset of pain relief than Group I, but the dose of onset of pain relief was almost the same. Our data suggested that individualization of radiotherapy schedules based on to assess the patient's condition and the expected quality of life and to consider radiation site and size of field, was more important than the fractionation regime in the treatment of painful bone metastases.     

放射治疗骨转移癌疼痛63例临床分析

目的:观察放射治疗对骨转移癌的止痛效果。方法:63例97处骨转移灶采用6MV-X线放射治疗。A组DT36~50GY/18~25次/28~33天;B组DT30~39GY/10~13次/12~17天;C组DT30~40GY/6~10次/10~22天。结果:全组总有效率95.8%,A、B、C三组总有效率分别为88.6%、96.9%、100%,各组有效率差异无显著性。结论:放射治疗骨转移癌疼痛临床疗效肯定、迅速、安全、经济、方便,采用DT30~39GY/10~13次/12~17天的放射治疗模式较为理想。     

Altered Fractionation of Hemithorax Irradiation for Pleural Mesothelioma and Failure Patterns After Treatment

Malignant pleural mesothelioma is a rare malignancy with a bleak prognosis. The role of radiotherapy has not yet been clarified. Our aim was to study the effect of altered fractionation on mesothelioma. We have treated 57 patients, 41 males and 16 females, with hemithorax irradiation with six different fractionation schedules. All the patients have been included in a combined modality program consisting of surgery followed by chemotherapy and finally by hemithorax irradiation. The radiotherapy schedules used were: I. Conventional fractionation of 20 Gy in 10 fractions over 12 days. lI, Split-course radiotherapy 55 Gy in 25 fractions of 2.2 Gy over 7 weeks (a two weeks rest halfways) followed by a boost dose of 15 Gy over 8 days to the major tumour area. III. Hyperfractionation of 70 Gy over 7 weeks, 1.25 Gy BID with a 6-h interval and a 10-day rest halfways. IV. Combined hyperfractionation and hypofractionation, 35 Gy hyperfractionation in 28 fractions (1.25 Gy BID with a 6-h interval) over three weeks followed by 36 Gy hypofractionation 9 fractions of 4 Gy given every other day over 3 weeks to the major tumour areas only. V. Hypofractionation of 38.5 Gy over 15 days (9 × 3.5 Gy). VI. Combined conventional radiotherapy and hypofractionation with 20 Gy given conventionally in 10 fractions followed by 10 fractions of 3 Gy over two weeks, overall time 4 weeks. The 2-year survival rate of all patients was 21% and the 5-year survival rate 9%. Two patients are still alive more than 6 and 9 years after radiotherapy. Progression occurred after surgery in four patients, during and after chemotherapy in 22 patients and after completed radiotherapy in 29 patients. The pattern of progression was similar in each treatment group.