椎体转移瘤椎体成形术与放射治疗的临床研究

目的 对椎体转移性肿瘤患者行经皮穿刺椎体成形术(PVP)序贯放射治疗并进行疗效分析. 方法 天津医科大学附属肿瘤医院介入治疗科2001年9月至2007年10月收治颈、胸、腰椎体转移瘤患者65例,行PVP治疗后1周开始放射治疗,并与同期接受单纯PVP治疗患者87例,单纯放射治疗者111例进行比较,评价并分别记录各组治疗后6 h、24 h、3 d、2周、1个月、3个月、6个月、1年疼痛和生活质量变化;每3个月行椎体CT或联合MR检查. 结果 与治疗前比较,PVP组及联合组治疗6 h后NRS评分即明显降低(P<0.01),治疗后疼痛迅速缓解,而单纯放疗组治疗1个月后数字分级法(NRS)评分较治疗前明显降低(P<0.01),疗效发生缓慢.各组治疗后欧洲癌症研究与治疗组织(EORTC)评分较治疗前均降低,术后生活质量较术前提高(P<0.01),治疗后相同时间点不同分组之间比较,以PVP组和联合组变化显著(P<0.01). 结论 放疗与PVP联合应用治疗椎体转移瘤,安全有效,优势互补.

Percutaneous verterbreplasty combined with radiotherapy treating malignant vertebrate metastasis

Objective To evaluate retrospectively the treatment effects and side effects of malignant vertebrate metastasis who had received radiotherapy or percutaneous verterbreplasty (PVP) or PVP combined with radiotherapy. Methods Two hundred and sixty-three patients who had been diagnosed as malignant tumor with vertebrate metastasis received PVP (87 paitents)or radiotherapy(111 paitents) or PVP combined with radiotherapy (65 paitents). Radiotherapy was done one week after PVP procedure in PVP combined with radiotherapy group. All patients received regular follow-up. The changes of pain scale were analyzed by NRS. The improvement of quality of life was evaluated by inquiry questionnaire of EORTC QLQ-C30. The side effects were also observed. Results All defects in vertebrate metastasis in PVP treating were fully filled by polymethylmethacrylate (PMMA) under CT examination. The NRS number decreased significantly after 6 hours after treating in PVP Group and PVP combined with radiotherapy Group (P < 0.01), which shows easement of pain was rapid. The NRS number decreased significantly after one month after treating in radiotherapy Group (P < 0.01), which shows easement of pain was slow. The score of EORTC QLQ-C30 inquiry questionnaire in three Groups reduced ,which indicated that the quality of life had been improved. In PVP Group and PVP combined with radiotherapy Group, the score of EORTC QLQ-C30 changed most significantly(P < 0.01). There were no severe clinical complications. Conclusions It is safe and effective to treat malignant tumor patients with vertebrate metastasis by PVP combined with radiotherapy and quality of life had been improved significantly with long catabasis.