Maranzano E, Latini P, Beneventi S, Perruci E, Panizza B M, Aristei C, Lupattelli M, Tonato M
Department of Radiation Oncology, Policlinico Monteluce, Perugia, Italy.
Am J Clin Oncol. 1996 Apr;19(2):179-83. doi: 10.1097/00000421-199604000-00018.
A phase II trial was planned to investigate the feasibility of radiotherapy (RT) without steroids in 20 consecutive patients with metastatic spinal cord compression (MSCC), no neurologic deficits, or only radiculopathy, and no massive invasion of the spine at magnetic resonance imaging (MRI) or computed tomography (CT). Aiming at an early diagnosis, MRI or CT was prescribed for all cancer patients with back pain and osteolysis, even when there were no signs of neurologic spinal compression. All patients were given 30 Gy in 10 fractions over 2 weeks with no steroids. Back pain and motor capacity were the parameters adopted to verify response to RT. Sixteen of 20 patients (80%) were able to walk without support, and 14 (70%) had no radiculopathy. Seventeen of 20 cases (85%) achieved relief from back pain. Regarding motor function, all patients (100%) responded to RT because the 16 patients able to walk without support at diagnosis did not deteriorate and the other 4, who needed support, became ambulatory without motor impairment. Median survival time was 14 months. Eight of 20 (40%) treated patients are still alive (14 to 36 months after end of RT), fully ambulatory, and free from relapse in the treated spine. Acute side effects were documented in only 2 patients (10%) and were managed without steroids. The results of this study suggest that RT without steroids is a feasible regimen for MSCC patients with good motor function. Elimination of steroids from the standard treatment for MSCC avoids cortisone side effects above all in those patients with diabetes, hypertension, peptic ulcer, and other steroid-sensitive medical problems.
一项II期试验计划调查对20例连续的转移性脊髓压迫（MSCC）患者不使用类固醇进行放射治疗（RT）的可行性，这些患者无神经功能缺损，或仅有神经根病，且在磁共振成像（MRI）或计算机断层扫描（CT）检查中无脊柱的广泛侵犯。为了实现早期诊断，对于所有有背痛和骨质溶解的癌症患者，即使没有神经脊髓压迫的迹象，也会开具MRI或CT检查。所有患者在2周内分10次给予30 Gy照射，不使用类固醇。背痛和运动能力是用于验证放疗反应的参数。20例患者中有16例（80%）能够独立行走，14例（70%）无神经根病。20例中有17例（85%）背痛得到缓解。关于运动功能，所有患者（100%）对放疗有反应，因为诊断时能够独立行走的16例患者病情未恶化，另外4例需要辅助行走的患者在无运动障碍的情况下能够行走。中位生存时间为14个月。20例接受治疗的患者中有8例（40%）仍然存活（放疗结束后14至36个月），能够完全独立行走，且治疗的脊柱未复发。仅2例患者（10%）记录有急性副作用，且无需使用类固醇进行处理。本研究结果表明，对于运动功能良好的MSCC患者，不使用类固醇的放疗是一种可行的治疗方案。在MSCC的标准治疗中去除类固醇可避免皮质激素的副作用，尤其是对于患有糖尿病、高血压、消化性溃疡和其他对类固醇敏感的内科疾病的患者。
