Li Yi, Qing Yi, Zhang Zhimin, Li Mengxia, Xie Jiaying, Wang Ge, Wang Dong
Department of Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China ; Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, People's Republic of China.
Department of Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China.
Onco Targets Ther. 2015 Aug 19;8:2139-45. doi: 10.2147/OTT.S86270. eCollection 2015.
This study aimed to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) combined with intensity-modulated radiotherapy (IMRT) for metastatic lesions of patients with non-small-cell lung cancer (NSCLC) at centrum vertebrae.
A total of 39 patients with spinal metastatic NSCLC (stage IV) were treated with PVP followed by IMRT (30 Gy/10F/2 W) for metastatic lesion at centrum vertebrae under local anesthesia. Retrospective analysis was done with medical records and radiological data. The change of visual analog scale (VAS), activities of daily living, and kyphotic angle was measured preoperatively. The presence of complications was assessed preoperatively (baseline) at 24 hours, 1 week, and 1, 3, 6, 12, and 24 months postoperatively, or until the patient died or was lost to follow-up. Survival was assessed in the group.
A total of 39 consecutive patients were successfully treated with PVP via a translateral approach and IMRT. Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure. The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05). Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05). No severe complications were observed. Mild complications included two cases (5.13%) of asymptomatic cement leakage into the epidural space and one case (2.56%) of paravertebral leakage. Median survival time was extended to 13 months.
The safety and efficacy of PVP combined with IMRT in patients with NSCLC with metastatic lesions at centrum vertebrae and the ability to prevent the diseased vertebrae from further deformation and tumor infiltration into the vertebral body were demonstrated. PVP combined with IMRT should be the optimal technique for treatment of vertebral compression pain resulting from spinal metastatic NSCLC.
本研究旨在评估经皮椎体成形术（PVP）联合调强放射治疗（IMRT）对非小细胞肺癌（NSCLC）椎体转移瘤患者的安全性和疗效。
39例脊柱转移的NSCLC（IV期）患者在局部麻醉下接受PVP治疗，随后对椎体转移瘤进行IMRT（30 Gy/10F/2周）。对病历和放射学数据进行回顾性分析。术前测量视觉模拟量表（VAS）、日常生活活动能力和后凸角的变化。在术前（基线）、术后24小时、1周、1、3、6、12和24个月评估并发症的发生情况，或直至患者死亡或失访。对该组患者的生存情况进行评估。
39例患者通过经侧方入路成功接受了PVP联合IMRT治疗。其平均VAS评分从术前的7.93±1.09降至术后24小时的4.14±1.15，术后1周为3.92±1.23，1个月为4.27±1.93，3个月为3.24±1.35，6个月为2.27±0.96，12个月为2.59±1.55。术后各时间点的平均VAS评分均较术前基线评分显著降低（P<0.05）。日常生活活动能力评估显示，联合治疗后患者的生活质量显著提高（50.9±11.7对82.3±9.9，P<0.05）。未观察到严重并发症。轻度并发症包括2例（5.13%）无症状的骨水泥渗漏至硬膜外间隙和1例（2.56%）椎旁渗漏。中位生存时间延长至13个月。
证明了PVP联合IMRT治疗NSCLC椎体转移瘤患者的安全性和疗效，以及防止病椎进一步变形和肿瘤浸润椎体的能力。PVP联合IMRT应是治疗脊柱转移NSCLC所致椎体压缩性疼痛的最佳技术。
