Bone metastasis is one of the most common manifestations of advanced malignant tumor, clinical symptoms are pain, hypercalcemia, spinal cord
Bone metastasis is one of the most common manifestations of advanced malignant tumor, clinical symptoms are pain, hypercalcemia, spinal cord compression, pathological fracture, seriously affect the life quality of patients, and even disabled. Radiotherapy is an important treatment of bone metastasis, can make 50% ~ 80% of patients with pain symptoms can be alleviated rapidly, about 1/3 patients with symptoms completely disappear. Recently, the American Society for radiation oncology (ASTRO) published the "palliative radiotherapy guide" (Int J Radiat Oncol Biol Phys 2011, 79: 96), in addition, Europe and the United States more tumor radiology organization updates "palliative radiotherapy research" (published in the international consensus end point Int J Radiat Oncol Biol Phys Online April 12, 2011).
Dose fractionation of radiotherapy for bone metastases of malignant tumors
9 large prospective randomized controlled clinical studies show that, for the initial treatment of bone metastasis, radiotherapy can get different segmentation schemes similar to the pain relief effect, including 30 Gy/10 F, 24 Gy/6 F, 20 Gy/5 F and 8 Gy/f. These randomized controlled studies did not specifically address the differences in pain relief between the vertebral body and other bone metastases. The incidence of long-term side effects after single fractionated irradiation was 1% to 7%, and there was no difference between the two groups. Guidelines recommend: 30 Gy/10 F, 24 Gy/6 F, 20 Gy/5 F and 8 Gy/f split program in the relief of pain no significant difference. Single fractionated irradiation is more convenient for treatment, but the risk of re irradiation is greater than that of fractionated irradiation. Single fractionated irradiation has a very small risk of serious long-term adverse effects, and there is no significant difference with fractionated irradiation.
Radiotherapy for bone metastases
Although no studies have focused on the recurrence of pain after bone metastases, the majority of studies have included these patients. The first course of radiotherapy for fractionation scheme for pain recurrence risk again irradiation was 8%, and the risk of a single dose of re treatment was 20%. For vertebral recurrent lesions, adopt external irradiation (EBRT) of Reradiotheraphy can effectively relieve pain, pain relief rate was 44% ~ 87%. Guidelines recommend: the current evidence does not identify a suitable re irradiation dose and fractionation scheme. But when re irradiation must be more careful when including the spinal cord, should estimate the risk of radiation myelopathy occurred.
Indication of stereotactic body radiotherapy (SBRT)
The increase of radiation dose of vertebral metastatic lesions by SBRT technology, and the dose gradient suddenly fall, to better protect the adjacent neural structure. Currently published data on the safety and effectiveness of SBRT are from a retrospective single center study. Guidelines recommend: SBRT is limited to clinical studies, bone metastases in patients with spinal cord compression symptoms can not be used as the first choice. SBRT is still limited to clinical research in the treatment of recurrent lesions after radiotherapy. Can other treatments replace EBRT?
Surgical decompression and postoperative radiotherapy for spinal cord compression
For spinal cord compression symptoms, radiotherapy must be after decompression. Different disciplines of clinical decision of surgical decompression should be included, neurosurgeons to determine, at the same time should be considered in general, patients with primary tumor site, metastasis and distribution as well as the expected survival time. Based on the available evidence, it is impossible to determine the dose of EBRT after operation. The most commonly used method is 30 Gy/10 F, which can be used to kill microscopic residual disease. There is no experience of single split EBRT after surgery. The study of radiation dose and fractionation should be considered in patients with spinal cord compression.
Radionuclide and EBRT
Radionuclide therapy of multifocal bone metastases is an important palliative treatment, which can be used as an indication of some special pathological types of bone metastases and EBRT tumors.
Bisphosphonates and EBRT
Patients with pain symptoms significantly and no complications of bone metastases, and bisphosphonates can't replace EBRT. Using EBRT and using bisphosphonates can re ossification successfully relieve bone pain, accelerate the destruction of bone, and the side effects were acceptable, but there is no evidence that EBRT combined with bisphosphonate effect better than that of pure EBRT.
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