Micheletti E, Ippolito V, Tonoli S, Barbera F, Saccalani M
Centro di Oncologia Ortopedica, 1 Ortopedia, Ospedale Civile, Brescia.
Radiol Med. 1996 Oct;92(4):470-4.
The skeletal system is a frequent site of metastatic involvement from breast cancer, whose pattern of spread is such that cure becomes practically impossible. The best palliation with the minimum discomfort for the patient must therefore be the major objective. With an increasing number of reports about major surgical procedures for spinal metastases, we reviewed our series of patients submitted to radiotherapy. Of 2,189 breast cancer patients, we selected 28 who might have been potential candidates for surgical resection (with lesions only in the spine, only one or no more than three contiguous bodies involved and no other metastases). All these patients had been treated with 20 or 30 Gy plus systemic (chemo, hormone, or both) therapy. Follow-up revealed that all of them had developed new metastases outside the treated field within one year. Local control was achieved in 68% of patients and 75% of them had stable or better performance status at 3 months. Median survival was 36 months. From our analysis, even patients with a so called "solitary lesion" seem not to have a better prognosis than others. We conclude that radiotherapy is still the method of choice to treat vertebral metastases from breast cancer. The role of surgery should be limited to patients with neurologic compression or severe mechanical instability.
骨骼系统是乳腺癌转移的常见部位，其转移模式使得治愈几乎不可能。因此，以最小的患者不适感实现最佳姑息治疗必须是主要目标。随着关于脊柱转移瘤主要外科手术的报道越来越多，我们回顾了我们接受放疗的患者系列。在2189例乳腺癌患者中，我们选择了28例可能是手术切除潜在候选者的患者（病变仅在脊柱，仅累及一个或不超过三个相邻椎体且无其他转移）。所有这些患者均接受了20或30 Gy的放疗加全身治疗（化疗、激素治疗或两者兼有）。随访显示，所有患者在一年内均在治疗区域外出现了新的转移灶。68%的患者实现了局部控制，75%的患者在3个月时功能状态稳定或更好。中位生存期为36个月。从我们的分析来看，即使是所谓“孤立性病变”的患者，其预后似乎也并不比其他患者好。我们得出结论，放疗仍然是治疗乳腺癌椎体转移的首选方法。手术的作用应仅限于有神经压迫或严重机械性不稳定的患者。
