Hayashi Shinya, Hoshi Hiroaki, Iida Takayoshi
Department of Radiology, Gifu University School of Medicine, Japan.
Radiat Med. 2002 Sep-Oct;20(5):231-6.
The purpose of this study was to evaluate retrospectively the effectiveness, prognostic factors, and sequelae of the first course of local-field reirradiation for painful bone metastases.
From 1994 to 2000, a total of 30 patients were reirradiated for painful bone metastases. The most commonly used initial treatment regimen was 30 Gy/10 Fr/2 wk. An additional dose in the range from 10 Gy/5 Fr to 26 Gy/13 Fr was reirradiated.
Fifteen patients (50%) showed some type of pain relief after reirradiation. Patients with initial CR were more likely to respond than those with previous PR (100% vs. 41%). The median duration of pain relief was five months. The duration of response was longer in initial CR than initial PR. The median survival time of responders after retreatment was 11 months. No patient developed radiation myelopathy. Prognostic factors for pain relief were duration from initial treatment, performance status (PS), and status of bone metastases.
Reirradiation for patients with a long duration from initial treatment (> or = 4 months), good PS (ECOG: 1-2), or solitary bone metastases was effective for pain relief. The appropriate indications, optimal dose, fractions, and technique for reirradiation to painful bone metastases should be further explored in randomized study.
本研究旨在回顾性评估首次局部野再照射治疗疼痛性骨转移瘤的有效性、预后因素及后遗症。
1994年至2000年，共有30例患者接受了疼痛性骨转移瘤的再照射治疗。最常用的初始治疗方案为30Gy/10次/2周。另外再照射10Gy/5次至26Gy/13次的剂量。
15例患者（50%）再照射后出现某种程度的疼痛缓解。初始完全缓解（CR）的患者比之前部分缓解（PR）的患者更易出现反应（100%对41%）。疼痛缓解的中位持续时间为5个月。初始CR患者的反应持续时间比初始PR患者更长。再治疗后有反应患者的中位生存时间为11个月。无患者发生放射性脊髓病。疼痛缓解的预后因素为初始治疗后的持续时间、体能状态（PS）及骨转移状态。
对于初始治疗后间隔时间长（≥4个月）、PS良好（东部肿瘤协作组：1 - 2）或孤立性骨转移的患者，再照射对缓解疼痛有效。疼痛性骨转移瘤再照射的合适适应证、最佳剂量、分割次数及技术应在随机研究中进一步探索。
