Bashir F A, Parry J M, Windsor P M
Department of Clinical Oncology, Tayside Cancer Centre, Dundee, UK.
Clin Oncol (R Coll Radiol). 2008 Oct;20(8):591-8. doi: 10.1016/j.clon.2008.05.005. Epub 2008 Jun 17.
To determine whether patients receiving hemi-body irradiation required further treatment to painful bone sites out with the radiation field (skull or lower leg), whether patients required further treatment to areas within the treated radiation field for pain or new skeletal events, and whether the treatment outcome was successful in terms of pain control. Toxicities, the need for transfusions and survival were also analysed.
In our retrospective review, 103 men aged 50-87 years, with skeletal metastases from prostate cancer, received modified hemi-body irradiation (HBI) during a consecutive 10-year period, using the same radiotherapy technique and dose. The upper HBI field excluded the region above the ramus of the mandible and the lower HBI field excluded the lower limb below the knee. A successful outcome was determined by assessing the pain response in combination with a change in analgesic intake.
Twenty patients received upper HBI; 17/20 (85%) had a successful outcome at the 6-week review, sustained in 94.1% at the final follow-up with no need for radiotherapy to the skull. Thirty-eight patients received lower HBI; 26/38 (68.4%) had a successful outcome at the 6-week review, sustained in 80.8% at the final follow-up with no need for radiotherapy to the lower leg. Forty-five patients received sequential HBI; 33/45 (73.3%) had a successful outcome at the 6-week review, sustained in 87.9% at the final follow-up, with three patients requiring further radiotherapy to the skull (2/45) or lower leg (1/45). Only 5/103 patients (4.8%) developed new skeletal events in the treated area. Toxicity and transfusion requirements were minimal.
Modifying the field size for single-fraction HBI does not have a significant effect on the final outcome of treatment, namely pain control and a need for additional radiotherapy. In our experience, modified HBI should be considered in patients with multiple bone pain sites, especially if they will probably require several visits for localised radiotherapy to single painful bone sites within a short period of time.
确定接受半身照射的患者是否需要对放射野外（颅骨或小腿）的疼痛骨部位进行进一步治疗，患者是否需要对治疗放射野内的区域进行疼痛或新的骨骼事件的进一步治疗，以及就疼痛控制而言治疗结果是否成功。还分析了毒性、输血需求和生存率。
在我们的回顾性研究中，103名年龄在50 - 87岁之间、患有前列腺癌骨转移的男性，在连续10年期间接受了改良半身照射（HBI），采用相同的放疗技术和剂量。上半身HBI野排除下颌骨升支上方区域，下半身HBI野排除膝盖以下下肢。通过评估疼痛反应并结合镇痛药物摄入量的变化来确定成功的结果。
20名患者接受了上半身HBI；其中17/20（85%）在6周复查时结果成功，在最终随访时有94.1%保持成功，无需对颅骨进行放疗。38名患者接受了下半身HBI；其中26/38（68.4%）在6周复查时结果成功，在最终随访时有80.8%保持成功，无需对小腿进行放疗。45名患者接受了序贯HBI；其中33/45（73.3%）在6周复查时结果成功，在最终随访时有87.9%保持成功，有3名患者需要对颅骨（2/45）或小腿（1/45）进行进一步放疗；仅103名患者中的5名（4.8%）在治疗区域出现了新的骨骼事件。毒性和输血需求极小。
调整单次分割HBI的照射野大小对治疗的最终结果，即疼痛控制和额外放疗的需求，没有显著影响。根据我们的经验，对于有多处骨痛部位的患者，尤其是那些可能在短时间内需要多次对单个疼痛骨部位进行局部放疗的患者，应考虑采用改良HBI。
