本文關(guān)鍵詞： 容積旋轉(zhuǎn)調(diào)強(qiáng)放射治療 脊柱轉(zhuǎn)移瘤 分割模式 唑來(lái)膦酸 療效　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的1.分析容積旋轉(zhuǎn)調(diào)強(qiáng)放射治療聯(lián)合唑來(lái)膦酸在脊柱轉(zhuǎn)移瘤患者疼痛緩解及生活質(zhì)量改善等方面的療效。2.比較不同劑量分割模式容積旋轉(zhuǎn)調(diào)強(qiáng)放射治療聯(lián)合唑來(lái)膦酸在脊柱轉(zhuǎn)移瘤患者疼痛緩解、止痛維持時(shí)間、生活質(zhì)量提高及功能狀態(tài)(如行走功能及膀胱功能)改善等方面的不同療效。方法40例符合入組條件的脊柱轉(zhuǎn)移瘤患者均接受容積旋轉(zhuǎn)調(diào)強(qiáng)放療(VMAT)。劑量為(30~60)Gy/(10~30)f,(2~3.5)Gy/f,1f/d,生物等效劑量(BED)為(39~66.3)Gy。所有患者均規(guī)律注射唑來(lái)膦酸,4mg/次,1次/4周。進(jìn)一步將所有患者分兩組,低劑量分割組(A組)20例,(30~40)Gy/(10~15)f,(2.5~3.5)Gy/f,1f/d,生物等效劑量(BED)為(39~47)Gy;高劑量分割組(B組)20例,(45~60)Gy/(15~30)f,(2~3)Gy/f,1f/d,生物等效劑量(BED)為(58.5~66.3)Gy。采用數(shù)字評(píng)分法(NRS)、語(yǔ)言模擬疼痛評(píng)分法(VRS)、生活質(zhì)量骨轉(zhuǎn)移量表(EORTC QLQ-BM22)、一般功能狀態(tài)評(píng)分(Tomita、KPS)、脊髓神經(jīng)功能Frankel分級(jí)評(píng)價(jià)放療后的療效,用RTOG-EORTC急慢性放射性損傷標(biāo)準(zhǔn)評(píng)價(jià)放療后副反應(yīng)。40例患者放療前后NRS評(píng)分等指標(biāo)采用配對(duì)t檢驗(yàn)比較差異。兩組患者放療前后NRS評(píng)分下降分值等指標(biāo)獨(dú)立樣本t檢驗(yàn)比較差異。兩組患者疼痛復(fù)發(fā)率等指標(biāo)采用卡方檢驗(yàn)比較差異。結(jié)果放療后40例患者疼痛總緩解率為90%。至隨訪結(jié)束,脊柱轉(zhuǎn)移瘤患者無(wú)疼痛人數(shù)由放療前0例/40例上升至10例/16例(c2=4.67,P0.05),差異有統(tǒng)計(jì)學(xué)意義。EORTC QLQ-BM22生活質(zhì)量評(píng)分顯示放療后總分由放療前(48.55±2.18)分下降至(39.25±1.48)分(t=32.42,P0.05),差異有統(tǒng)計(jì)學(xué)意義,生活質(zhì)量改善主要體現(xiàn)在疼痛部位、程度和功能方面,而患者的社會(huì)心理方面無(wú)明顯變化�；颊叻暖熌褪苄院�,40例患者中,4例患者出現(xiàn)1-2級(jí)的吞咽困難反應(yīng),3例患者出現(xiàn)3級(jí)反流性食管炎,3例患者出現(xiàn)1-2級(jí)腹瀉反應(yīng),1例患者出現(xiàn)3級(jí)腹瀉反應(yīng)。放療后患者的骨髓抑制未加重(P0.05)。脊髓神經(jīng)功能受損的患者放療后脊髓神經(jīng)功能得到一定程度的改善,僅一例患者出現(xiàn)脊髓神經(jīng)放射性損傷。兩組比較:A、B兩組患者中位生存時(shí)間分別為8個(gè)月、10個(gè)月。放療后A、B兩組疼痛緩解率(85%vs 95%)、疼痛緩解起效時(shí)間(5.00±0.92 vs 4.90±1.25)、疼痛明顯好轉(zhuǎn)時(shí)間(7.60±1.93 vs 6.80±2.04)、止痛維持時(shí)間(5.15±4.21 vs7.05±5.25)均無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),B組患者止痛較久,有實(shí)際臨床意義。放療后B組NRS疼痛評(píng)分降低分值、EORTC QLQ-BM22評(píng)分下降分值均顯著高于A組(4.90±1.52 vs 3.85±1.09,10.10±2.17 vs 8.75±1.41),而B組疼痛復(fù)發(fā)率明顯低于A組(10%vs 31.6%),差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。A、B兩組患者2~4級(jí)急性副反應(yīng)發(fā)生率分別為17%和10%,無(wú)明顯統(tǒng)計(jì)學(xué)差異(c2=1.67,P0.05)。僅一例高劑量分割模式組患者出現(xiàn)晚期放射性脊髓損傷。結(jié)論容積旋轉(zhuǎn)調(diào)強(qiáng)放療聯(lián)合唑來(lái)膦酸治療脊柱轉(zhuǎn)移瘤患者,止痛迅速且維持時(shí)間較久,改善患者機(jī)體功能,提高患者生活質(zhì)量;對(duì)兩種不同劑量分割模式放療療效進(jìn)行比較,高劑量分割模式因其低的疼痛復(fù)發(fā)率及較長(zhǎng)止痛維持時(shí)間更適合于生存期長(zhǎng)的患者。
[Abstract]:Effect of.2. objective analysis of 1. volume modulated arc radiotherapy combined with zoledronic acid in patients with spinal metastases pain in remission and improvement of quality of life and other aspects of the comparison of different dose fractionation volume modulated arc radiotherapy combined with zoledronic acid in patients with metastatic spinal tumor pain relief, pain duration, improve the quality of life status and function (such as walking function and bladder function) of different therapeutic improvement and so on. Methods 40 eligible patients with spinal metastases underwent volumetric modulated arc therapy (VMAT). The dose of (30~60) Gy/ (10~30) f, (2~3.5) Gy/f, 1f/d, biological equivalent dose (BED) for (39~66.3 Gy.) all patients were regular intravenous zoledronic acid, 4mg/ times, 1 times /4 weeks. All patients were further divided into two groups, low dose radiotherapy group (A group) 20 cases, (30~40) Gy/ (10~15) f, (2.5~3.5) Gy/f, 1f/d, biological equivalent dose (BED) for (39~47 Gy); high dose Segment group (B group) 20 cases, (45~60) Gy/ (15~30) f, (2~3) Gy/f, 1f/d, biological equivalent dose (BED) to (58.5~66.3) Gy. using digital pointrating method (NRS), language analogue scale (VRS), quality of life scale bone metastasis (EORTC QLQ-BM22) in general, functional status score (Tomita, KPS), spinal nerve function Frankel classification evaluation of curative effect after radiotherapy, with RTOG-EORTC acute side effects of.40 evaluation of chronic radiation injury after radiotherapy in patients before and after standard radiotherapy with NRS score index compared with paired t test. Two groups of patients before and after radiotherapy NRS score decreased scores of indexes such as independent sample t test to compare differences. Two groups of patients with pain recurrence rate difference index by using the chi square test. Results the total remission rate of pain in 40 patients after radiotherapy for 90%. to the end of follow-up, in patients with metastatic spinal pain before radiotherapy in 0 cases of /40 by the number of cases rose to 10 cases of /16 patients (c2=4.67, P0.05) There was a significant difference between the.EORTC and QLQ-BM22 quality of life score showed that after radiotherapy by score before radiotherapy (48.55 + 2.18) decreased to (39.25 + 1.48) points (t=32.42, P0.05), the difference was statistically significant, the improvement of the quality of life is mainly reflected in the extent and location of the pain, function, and social psychological aspects of patients without obvious changes. Radiotherapy is well tolerated, in 40 patients, 4 cases of patients with dysphagia was 1-2, 3 patients had grade 3 reflux esophagitis, 3 cases of patients with grade 1-2 diarrhea, 1 cases of patients with grade 3 diarrhea reaction. After radiotherapy for patients with bone marrow suppression did not increase (P0.05). To a certain extent improve the neurological function of spinal cord by radiotherapy in patients with spinal cord function damaged, only one patient appeared radioactive spinal nerve injury. The comparison between the two groups: A, B two groups of patients with the median survival time was 8 months, 10 months after radiotherapy. A, B two The pain remission rate (85%vs 95%), the onset time of pain relief (5 + 0.92 vs 4.90 + 1.25), pain significantly improved time (7.60 + 1.93 vs 6.80 + 2.04), pain duration (5.15 + 4.21 + 5.25 vs7.05) were no significant difference (P0.05), B group of patients with pain for a long time a practical clinical significance. After radiotherapy group B NRS pain score decreased EORTC score, QLQ-BM22 score decreased scores were significantly higher than A group (4.90 + 1.52 vs 3.85 + 1.09,10.10 + 2.17 vs 8.75 + 1.41), B group pain recurrence rate was significantly lower than A group (10%vs 31.6%), the difference was statistically significant (P0.05).A, the incidence of acute adverse reaction in two groups of B patients with grade 2~4 were 17% and 10%, no statistically significant difference (c2=1.67, P0.05). Only one case of high dose group of patients with advanced segmentation model of radiation injury of spinal cord. Conclusion volume modulated arc radiotherapy combined with zoledronic acid in the treatment of patients with spinal metastases, check The pain is rapid and sustained for a long time, which improves the patient's body function and improves the quality of life of patients. Comparing the efficacy of two different doses of split mode radiotherapy, the high-dose segmentation mode is more suitable for patients with longer survival time because of its low pain recurrence rate and longer pain maintenance time.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R730.55

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