Ippolito V, Micheletti E, Saccalani M, Barbera F, Tonoli S, Motta C
Centro di Oncologia Ortopedica, 1a Ortopedia, Ospedale Civile, Brescia.
Chir Organi Mov. 1998 Jan-Jun;83(1-2):177-83.
In metastatic breast cancer the goal to reach must be the best possible palliation with minimum discomfort for the patient. We reviewed our experience with radiotherapy (20 or 30 Gy), systemic therapy and brace. Among 2200 breast cancer patients, we extracted 28 potential candidates for resection. All of them developed new metastases outside the treated field within one year. Local control was achieved in 68%, and 80% of them had stable or better performance status at 3 months. From our analysis, even patients with a so called "solitary lesion" do not seem to have a better prognosis than others. We conclude that radiotherapy (with systemic therapy and a brace) is still first-choice treatment for vertebral metastases; CT-guided percutaneous biopsy can avoid worthless major operations. The role of surgery should be limited to neurological compression, severe mechanical instability and to salvage the failures of conservative treatment.
在转移性乳腺癌中，必须实现的目标是在给患者带来最小不适的情况下尽可能达到最佳的姑息治疗效果。我们回顾了我们在放疗（20或30 Gy）、全身治疗和支具方面的经验。在2200例乳腺癌患者中，我们筛选出28例可能适合手术切除的患者。他们所有人在一年内都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，其中80%的患者在3个月时病情稳定或状况更好。通过我们的分析，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更好。我们得出结论，放疗（联合全身治疗和支具）仍然是脊柱转移瘤的首选治疗方法；CT引导下经皮活检可以避免无意义的大手术。手术的作用应限于神经压迫、严重机械性不稳定以及挽救保守治疗失败的情况。
