van der Linden Yvette M, Steenland Elsbeth, van Houwelingen Hans C, Post Wendy J, Oei Bing, Marijnen Corrie A M, Leer Jan Willem H
Radiotherapeutic Institution Friesland, Leeuwarden, The Netherlands.
Radiother Oncol. 2006 Mar;78(3):245-53. doi: 10.1016/j.radonc.2006.02.007. Epub 2006 Mar 20.
In the prospectively, randomized Dutch Bone Metastasis Study on the effect of a single fraction of 8 Gy versus 24 Gy in six fractions on painful bone metastases, 28% of the patients survived for more than 1 year. Purpose of the present study was to analyze the palliative effect of radiotherapy in long-term surviving patients, and to identify prognostic factors for survival.
Response rates were compared in all patients surviving>52 weeks. The Cox proportional hazards model stratified by primary tumour was used for multivariate (MV) analyses of prognostic factors for survival.
In 320 patients surviving>52 weeks, responses were 87% after 8 Gy and 85% after 24 Gy (P=0.54). Duration of response and progression rates were similar. For all primary tumours, prognostic factors for survival were a good Karnofsky Performance Score, no visceral metastases, and non-opioid analgesics intake (all factors, MV P<0.001).
Single fraction radiotherapy should be the standard dose schedule for all patients with painful bone metastases, including patients with an expected favourable survival. General prognosticators as the Karnofsky Performance Score and metastatic tumour load are useful in predicting survival.
在一项前瞻性、随机的荷兰骨转移瘤研究中，比较了单次8 Gy与分6次给予24 Gy对疼痛性骨转移瘤的疗效，28%的患者存活超过1年。本研究的目的是分析放疗对长期存活患者的姑息效果，并确定生存的预后因素。
比较所有存活超过52周患者的缓解率。采用按原发肿瘤分层的Cox比例风险模型对生存预后因素进行多变量（MV）分析。
在320例存活超过52周的患者中，8 Gy放疗后的缓解率为87%，24 Gy放疗后的缓解率为85%（P = 0.54）。缓解持续时间和进展率相似。对于所有原发肿瘤，生存的预后因素包括良好的卡氏功能状态评分、无内脏转移和使用非阿片类镇痛药（所有因素，MV P < 0.001）。
单次分割放疗应作为所有疼痛性骨转移瘤患者的标准剂量方案，包括预期生存良好的患者。卡氏功能状态评分和转移瘤负荷等一般预后指标有助于预测生存。
