脊柱转移瘤分离手术联合立体定向放疗的研究进展

随着癌症治疗水平的不断提升,脊柱转移瘤患者的生存期得到显著延长。当前脊柱转移瘤的治疗呈现多模式趋势,临床采用的手术方式包括椎体肿瘤切除椎管减压重建内固定术、分离手术、微创手术和经皮消融技术等,放疗技术包括传统外照射治疗、立体定向放疗和近距离放疗等。椎体肿瘤切除椎管减压重建内固定术的手术风险较大,术中和术后并发症的发生率较高,术后恢复期的延长可能造成后续放疗和其他内科治疗的延误,对患者的生存期和治疗信心都造成严重影响。而传统外照射治疗的精准度不高,脊髓耐受性的限制使得放疗剂量常难以达到控制放疗不敏感肿瘤的目的。随着放疗和手术技术的发展,精准性更高的立体定向放疗和手术创伤更小的分离手术脱颖而出,成为目前临床医生关注的焦点。本文就分离手术联合立体定向放疗的Hybrid治疗的研究进展作一综述。

Research progress in separation surgery combined with stereotactic radiotherapy of spinal metastases

With the continuous improvement of cancer treatment,the survival of patients with spinal metastases has been significantly prolonged. Currently,the treatment of spinal metastases presents a trend of multi-mode. Clinical surgical methods include vertebral tumor resecting spinal canal decompression and internal fixation surgery,separation surgery,minimally invasive surgery and percutaneous ablation technology,etc. Radiotherapy techniques include traditional external radiation therapy,stereotactic radiotherapy and brachytherapy,etc. The risk of vertebral tumor resecting spinal canal decompression and internal fixation surgery,and the incidence of intraoperative and postoperative complications is high. The extension of postoperative recovery period may lead to delay of follow-up radiotherapy and other medical treatment,which has a serious impact on patients'' survival and treatment confidence. However,the precision of traditional external radiation therapy is not high,and the limitation of tolerance of spinal cord makes it difficult to achieve the goal of controlling insensitive tumor. With the development of radiotherapy and surgical technology,stereotactic radiotherapy with higher accuracy and separation surgery with smaller surgical strike have become the focus of many clinical experts at present. This article reviews the progress of Hybrid treatment of separation surgery combined with stereotactic radiotherapy.