The different spinal metastases of IMRT target development and efficacy evaluation / 中华骨科杂志

ABSTRACT

Objective To investigate the significance of intensity modulated radiation therapy(IMRT)for spinal metastases during different target areas setting and evaluate the efficacy of pain relief before and after radiotherapy. Methods Forty-four cases of spinal metastases were treated with intensity modulated radiation therapy, including 18 males and 26 females; aging from 40 to 68 years with a mean of 56 years.Frankel grade before treatment stage A in 2 patients, B in 2, C in 3, D in 3, E in 34. The target area was determined according to preoperative imaging, CT localization before radiotherapy and different anatomical characteristics of spinal cord segments. And then the intensity modulated radiation therapy was performed by means of 5-field irradiation. Prescription dose 30-56 Gy, the average 40.5 Gy, the median dose of 40 Gy, 2-3 Gy/times, 5 times/week. Before and after radiotherapy for pain relief in patients, neurological function of spinal cord were compared and comprehensively evaluated. Results Among 44 patients undergone pain intensity modulated radiation therapy, 21 patients achieved complete remission, 17 achieved partial remission and 6 achieved minor effect, with a relief rate of 86.4% (38/44). Pain rating before treatment was not correlative with the state of pain relief. Evaluation of the effect of radiotherapy showed complete remission in 4 cases and partial remission in 33, no change in 7, with an efficiency rate of 84.1%(37/44). There was no relationship between pain relief with implant nails and implant bone cement. Ten patients with different degrees of neurological impairment before treatment were improved in Frankel grade after treatment. Conclusion IMRT can improve pain in patients with metastatic spinal tumors, and nerve dysfunction and other symptoms, which was not easy to result in radioactivity spinal cord and nerve injury.