Retreatment of the spinal cord with palliative radiotherapy
Retreatment of the spinal cord with palliative radiotherapy
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DOI：
10.1016/s0360-3016(01)02780-8
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发表时间：
2002-04-01
影响因子：
7
通讯作者：
Molls, M
中科院分区：
文献类型：
--
作者：
Grosu, AL;Andratschke, N;Molls, M
目的：我们对脊髓接受过两次放射治疗的患者进行了回顾性研究，以评估其缓解效果和长期副作用。方法和材料：8例患者（4女4男，中位年龄：67岁）于1990年7月至1997年7月间接受过两次脊髓放射治疗，通常是为了治疗骨转移。所有患者均被随访至因疾病进展而死亡。再治疗时的Karnofsky表现评分为20% ~ 90%。首次治疗的总剂量为29至50戈瑞（中位数：38戈瑞），单次剂量为1.25至3戈瑞；再治疗总剂量为29 ~ 38 Gy（中位数为30 Gy），单次剂量为1.8 ~ 4 Gy。累积剂量范围为59至88戈瑞（中位数：67.5戈瑞）。重复治疗部位的重叠由1-3节段组成，而在1例患者中，2个单节段接受了两次治疗。回顾性评估了进展性疾病、姑息性效果和脊髓病发展的结果。结果：再照射的中位时间间隔为30个月（6-63个月），末次治疗后的中位随访时间为16个月（5-44个月）。再照射后，4/7患者疼痛完全缓解，2/7患者疼痛轻微缓解，仅有1例患者无变化。2例截瘫患者完全康复。所有患者都能很好地耐受再治疗。未见需要任何治疗的严重急性副作用。随访期间，没有患者出现治疗引起的影响运动和感觉功能的神经系统异常，所有患者均能行走，大小便通畅。结论：根据这有限数量的患者的研究结果，不可能给出明确和一般的建议，关于最佳总剂量和分数大小，将有最大的缓解作用和最小的副作用。然而，为了达到缓解的目的，考虑到患者的预期寿命和临床症状，应考虑在我们机构使用的剂量范围内进行再治疗。(C) 2002爱思唯尔科学有限公司
Purpose: We conducted this retrospective review of patients whose spinal cord was irradiated twice to evaluate the outcome in terms of palliation and long-term side effects.Methods and Materials: Eight patients (4 females, 4 males; median age: 67 years) were identified whose spinal cord had been irradiated twice between July 1990 and July 1997, usually for the management of bone metastases. All patients were followed up until their death from progressive disease. The Karnofsky performance score at the time of retreatment ranged from 20% to 90%. Total dose for the first treatment ranged from 29 to 50 Gy (median: 38 Gy) with single doses 1.25-3 Gy; the total dose for the retreatment ranged from 29 to 38 Gy (median: 30 Gy) with a single dose 1.8-4 Gy. The cumulative dose ranged from 59 to 88 Gy (median: 67.5 Gy). The overlap in the site of retreatment consisted of 1-3 segments, whereas in one patient, 2 single segments were treated twice. The outcome in terms of progressive disease, the palliative effects, and the development of myelopathy was assessed retrospectively.Results: The median interval to reirradiation was 30 months (range: 6-63 months), and the median follow-up after the last treatment was 16 months (range: 5-44 months). After reirradiation, 4/7 patients experienced complete pain relief, 2/7 patients experienced minor pain relief, and only 1 patient showed no change. Two patients with paraparesis experienced complete recovery. All patients tolerated retreatment very well. No serious acute side effects requiring any therapy were seen. During follow-up, no patient showed treatment-induced neurologic abnormalities affecting motor and sensory function, and all patients were able to walk and were continent for stool and urine.Conclusion: On the basis of the findings in this limited number of patients, it is not possible to give clear and general recommendations concerning the optimal total dose and fraction size that will have maximal palliative effects and minimal side effects. However, for the purpose of palliation, retreatment within the dose range used at our institution should be considered, taking the patient's expected life span and clinical symptoms into account. (C) 2002 Elsevier Science Inc.