Makris A, Kunkler I H
Weston Park Hospital, Sheffield, UK.
Clin Oncol (R Coll Radiol). 1995;7(2):82-6. doi: 10.1016/s0936-6555(05)80806-4.
A prospective study of functional assessment of response to palliative radiotherapy (RT) in malignant spinal cord compression (SCC) is reported. The relevant components of the Barthel Activities of Daily Living Index (ADLI: walking, transfer, and bladder and bowel control) were used to assess functional capacity, and compared with a standard neurological assessment. Fifty-one consecutive patients (38 men, 13 women; mean age 63.9 years) were assessed, all of whom were treated by primary or postoperative radiotherapy. Five of the 51 patients had had decompressive laminectomy prior to RT. Median survival was 34 days (range 2-570). Walking improved in only five of 12 patients who had an improvement in motor power. The ability to transfer from bed to chair improved in 11 patients. Ambulation at presentation was the single most important determinant of outcome. Of the eight patients ambulatory at presentation, all were alive at 1 month and seven remained ambulatory. Of the 43 non-ambulatory patients, only four were able to walk following treatment (all prostatic carcinomas). Only four patients regained urinary continence, and none regained bowel control after this was lost. Functional assessment using ADLI and standard neurological examination provide a more useful guide to outcome in malignant SCC than neurological examination alone.
本文报道了一项关于恶性脊髓压迫（SCC）患者姑息性放疗（RT）反应功能评估的前瞻性研究。采用巴氏日常生活活动指数（ADLI：行走、转移以及膀胱和肠道控制）的相关组成部分来评估功能能力，并与标准神经学评估进行比较。对51例连续患者（38例男性，13例女性；平均年龄63.9岁）进行了评估，所有患者均接受了原发性或术后放疗。51例患者中有5例在放疗前接受了减压性椎板切除术。中位生存期为34天（范围2 - 570天）。运动力量改善的12例患者中只有5例行走能力得到改善。11例患者从床上转移到椅子上的能力得到改善。就诊时的行走能力是结果的最重要单一决定因素。就诊时能够行走的8例患者中，所有患者在1个月时均存活，7例仍能行走。43例不能行走的患者中，治疗后只有4例能够行走（均为前列腺癌）。只有4例患者恢复了尿失禁，而在肠道控制丧失后无患者恢复。与单独的神经学检查相比，使用ADLI进行功能评估和标准神经学检查能为恶性SCC的结果提供更有用的指导。
