Løhre Erik Torbjørn, Lund Jo-Åsmund, Kaasa Stein
Department of Medical Oncology and Radiotherapy, St Olavs University Hospital, Trondheim, Norway.
BMJ Support Palliat Care. 2012 Mar;2(1):51-6. doi: 10.1136/bmjspcare-2011-000154. Epub 2012 Jan 23.
Malignant spinal cord compression (MSCC) in patients with short life expectancy is most frequently treated with radiotherapy and/or corticosteroids. Hypofractionation has been proven to be efficient in metastatic bone pain, but the level of evidence for hypofractionation in MSCC is limited. Searches were performed in PubMed, Embase and the Cochrane Library for all relevant articles. Two randomised controlled trials (RCTs) were identified. The first RCT compared hypofractionation (8 gray (Gy)×2) with a more fractionated regimen. No differences in symptom control, duration of response or survival were detected. The second RCT compared 8 Gy×2 with 8 Gy×1. No significant differences in symptom control, duration of response or survival were detected. Five prospective non-randomised studies identified no differences in post-treatment motor function. Of 17 identified retrospective studies the largest included 1304 patients, treated with five different regimens ranging from 8 Gy×1 to 2 Gy×20, and found similar post-treatment ambulatory status. A Cochrane review based on the first published RCT concluded that short courses of radiotherapy appear to be justified in patients with a poor prognosis.
预期寿命较短的患者发生恶性脊髓压迫（MSCC）时，最常采用放疗和/或皮质类固醇进行治疗。已证实大分割放疗对转移性骨痛有效，但MSCC采用大分割放疗的证据水平有限。我们在PubMed、Embase和Cochrane图书馆中检索了所有相关文章。共识别出两项随机对照试验（RCT）。第一项RCT将大分割放疗（8格雷（Gy）×2）与分割更细的方案进行了比较。在症状控制、缓解持续时间或生存率方面未检测到差异。第二项RCT将8 Gy×2与8 Gy×1进行了比较。在症状控制、缓解持续时间或生存率方面未检测到显著差异。五项前瞻性非随机研究未发现治疗后运动功能存在差异。在17项已识别的回顾性研究中，规模最大的一项纳入了1304例患者，采用了从8 Gy×1到2 Gy×20的五种不同方案进行治疗，结果发现治疗后的行走状态相似。基于首次发表的RCT进行的Cochrane综述得出结论，对于预后较差的患者，短疗程放疗似乎是合理的。
