Lee Ik Jae, Seong Jinsil, Lee Chang Geol, Kim Yong Bae, Keum Ki Chang, Suh Chang Ok, Kim Gwi Eon, Cho Jaeho
Department of Radiation Oncology, Yonsei University Health System, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1517-24. doi: 10.1016/j.ijrobp.2008.07.035. Epub 2008 Dec 10.
To evaluate the feasibility of synchronous treatment of multiple metastatic lesions by helical tomotherapy.
Forty-two patients with multiple metastatic lesions were treated by helical tomotherapy from April 2006 to February 2007. Among these patients, 21 had metastatic bone disease. Subjective pain response was assessed using the visual analogue scales, and morbidity was evaluated by Common Terminology Criteria for Adverse Events v3.0. The correlation between the percentage of red bone marrow in the radiation field and the severity of leukocytopenia was analyzed.
The median age was 57 years. Radiation dose to the gross tumor volume was 30-84 Gy, with a median fractional size of 3 Gy. Mean treatment time was 16 min and 1 sec. Treatment time and fraction size were modified because of poor performance status or hematologic toxicity in two patients. With regard to palliative effects for bone metastasis, 16 patients (76.2%) experienced positive pain relief. Four patients had Grade III leukocytopenia, and three had Grade IV leukocytopenia. In the multivariate logistic regression, red marrow percentage was the independent risk factor most associated with Grade III/IV leukocytopenia (p = 0.014). The tolerance cutoff point of red bone marrow was 26.8%, with a sensitivity and specificity of 85.7% and 85.7%, respectively.
Helical tomotherapy was effective for symptom palliation and was feasible for patients with multiple metastatic diseases. The volume of red bone marrow, as well as performance status, must be taken into account to determine optimal treatment.
评估螺旋断层放射治疗同步治疗多个转移病灶的可行性。
2006年4月至2007年2月期间，42例有多个转移病灶的患者接受了螺旋断层放射治疗。其中，21例有骨转移疾病。使用视觉模拟量表评估主观疼痛反应，并根据不良事件通用术语标准v3.0评估发病率。分析了放射野内红骨髓百分比与白细胞减少严重程度之间的相关性。
中位年龄为57岁。对大体肿瘤体积的放射剂量为30 - 84 Gy，中位分次剂量为3 Gy。平均治疗时间为16分1秒。两名患者因身体状况差或血液学毒性而调整了治疗时间和分次剂量。对于骨转移的姑息治疗效果，16例患者（76.2%）疼痛得到缓解。4例患者出现III级白细胞减少，3例出现IV级白细胞减少。在多因素逻辑回归分析中，红骨髓百分比是与III/IV级白细胞减少最相关的独立危险因素（p = 0.014）。红骨髓的耐受临界点为26.8%，敏感性和特异性分别为85.7%和85.7%。
螺旋断层放射治疗对症状缓解有效，对有多个转移病灶的患者可行。确定最佳治疗方案时必须考虑红骨髓体积以及身体状况。
