Tatar Zuzana, Soubrier Martin, Dillies Anne Françoise, Verrelle Pierre, Boisgard Stéphane, Lapeyre Michel
Medical Oncology Department, Centre Jean Perrin, Centre de Lutte contre le Cancer de la Région Auvergne, 58 Rue Montalembert, BP 392, Clermont-Ferrand, 63011, France.
Rheumatology Department, CHU Gabriel Montpied, 58 Rue Montalembert, BP 69, Clermont-Ferrand, 63003, France.
Radiat Oncol. 2014 Oct 16;9:227. doi: 10.1186/s13014-014-0227-1.
Radiotherapy for long bone metastases (RTLB) can be complicated by fractures, which considerably increase morbidity and mortality. The aim of this study was to analyze the risk factors for impending fractures following radiotherapy for long bone metastases (RTLB) using CT scan-based virtual simulation.
Forty-seven (47) patients were treated with RTLB (18 lung, 11 breast, 10 prostate and 8 other cancers) for a period of 18 months. Two doctors analyzed the CT images prior to radiation therapy. The impending fractures were then monitored and the correlation between bone scan parameters and fracture occurrence was analyzed.
The male gender ratio was 0.57 and the mean age 62.8 (33-93) years. The average size of the metastatic lesions was 32 (8-87) x 2 (6-81) x 52 (7-408) mm with cortical involvement (CI) in 66% of cases. The site was in the upper third of the bone in 92% of cases (28 femoral, 17 humeral and two tibial). Ten fractures occurred: two during RTLB, seven after one month and one after 6.6 months. The fractured lesions measured 48 (17-87) x 34 (12-66) x 76 (38-408) mm. The predictive parameters for fracture were osteolytic (39% vs. 10%; p=0.02) and permeative lesions (42% vs. 0%; p<0.0005), a Mirels score ≥9 (42% vs. 0%; p<0.0005), circumferential CI ≥30% (71% vs. 0%, p < 0.00001), CI ≥45 mm in height (67% vs. 0%, p<0.00001) and CI in thickness =100% (40% vs. 0%; p=0.0008). In the multivariate analysis, circumferential CI ≥30% was the only predictive parameter for fracture (p=0.00035; OR=62; CI 95%: 6.5-595). Overall survival was 91% and 40% at one month and twelve months respectively.
Prophylactic primary fixation surgery should always be considered when the circumferential CI ≥30%.
长骨转移瘤放疗（RTLB）可能并发骨折，这会显著增加发病率和死亡率。本研究的目的是使用基于CT扫描的虚拟模拟分析长骨转移瘤放疗（RTLB）后即将发生骨折的危险因素。
47例患者接受了为期18个月的长骨转移瘤放疗（18例肺癌、11例乳腺癌、10例前列腺癌和8例其他癌症）。两名医生在放疗前分析CT图像。然后监测即将发生的骨折情况，并分析骨扫描参数与骨折发生之间的相关性。
男性性别比为0.57，平均年龄62.8（33 - 93）岁。转移瘤平均大小为32（8 - 87）×2（6 - 81）×52（7 - 408）mm，66%的病例有皮质受累（CI）。92%的病例病变位于骨的上三分之一处（28例股骨、17例肱骨和2例胫骨）。发生了10例骨折：2例在放疗期间，7例在放疗后1个月，1例在放疗后6.6个月。骨折病变大小为48（17 - 87）×34（12 - 66）×76（38 - 408）mm。骨折的预测参数为溶骨性病变（39%对10%；p = 0.02）和浸润性病变（42%对0%；p < 0.0005）、Mirels评分≥9（42%对0%；p < 0.0005）、周向CI≥30%（71%对0%，p < 0.00001）、高度CI≥45 mm（67%对0%，p < 0.00001）以及厚度CI = 100%（40%对0%；p = 0.0008）。在多变量分析中，周向CI≥30%是骨折的唯一预测参数（p = 0.00035；OR = 62；95%CI：6.5 - 595）。1个月和12个月时的总生存率分别为91%和40%。
当周向CI≥30%时，应始终考虑进行预防性初次内固定手术。
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