NSCLC溶骨型脊柱转移瘤21例放疗前后CT影像对比
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摘要
目的探讨NSCLC溶骨型脊柱转移瘤放射治疗前后在CT表现的变化特点。方法回顾性分析21例NSCLC溶骨型脊柱转移瘤患者的放射治疗及影像学资料,观察溶骨型脊柱转移瘤CT影像特点及其放疗后1月、3月、6月的椎体转移瘤CT值及体积值变化,总结其特征。结果所有患者均顺利完成治疗及影像学CT检查,溶骨型椎体转移病灶放疗后1个月病灶内未见明显钙化,CT值变化差异无统计学意义(P> 0. 05); 3个月、6个月后病灶同部位CT值与放疗前相比显著升高(P=0. 04,P=0. 017)。本组中所有病灶在放疗6个月后CT检查评价为CR 2例,PR 9例,NR 8例,PD 2例,总有效率52. 3%,38. 1%的患者病灶表现稳定。结论在NSCLC溶骨型脊柱转移病灶的治疗中,放射治疗可以有效杀灭肿瘤细胞、促进溶骨性病灶钙化修复,对患者具有相当肯定的疗效; CT检查是一种观察骨转移灶放疗后影像学变化的安全有效的常规检查手段。
Objective To explore the characteristics of the CT images before and after the radiotherapy of NSCLC osteolytic spinal metastases. Methods The radiotherapy and imaging data of 21 patients with NSCLC osteolytic spinal metastases were retrospectively analyzed. The CT values and volume changes in 1 month,3 months,and 6 months after radiotherap were employed to assess the radiotherapy effect. Results All patients successfully completed the treatment and imaging CT examination. On 1 month after the radiotherapy,there was no significant calcification at the lesion site,and there was no significant change of the CT values(P > 0. 05). On 3 months or 6 months after the radiotherapy,the CT value of the same site was higher than that before radiotherapy(P = 0. 04,P = 0. 017). The CT images of all lesions were evaluated 6 months after the radiotherapy,with results showing 2 cases of CR,9 cases of PR,8 cases of NR,and 2 cases of PD. The total efficiency was 52. 3%,while 38. 1% of the patients showed no change. Conclusion Radiotherapy can effectively kill tumor cells and promote the calcification repair of osteolytic lesions in the treatment of NSCLC osteolytic spinal metastases patients. CT is a safe and effective routine examination method for revealing imaging changes in bone metastases after radiotherapy.
Objective To explore the characteristics of the CT images before and after the radiotherapy of NSCLC osteolytic spinal metastases. Methods The radiotherapy and imaging data of 21 patients with NSCLC osteolytic spinal metastases were retrospectively analyzed. The CT values and volume changes in 1 month,3 months,and 6 months after radiotherap were employed to assess the radiotherapy effect. Results All patients successfully completed the treatment and imaging CT examination. On 1 month after the radiotherapy,there was no significant calcification at the lesion site,and there was no significant change of the CT values(P > 0. 05). On 3 months or 6 months after the radiotherapy,the CT value of the same site was higher than that before radiotherapy(P = 0. 04,P = 0. 017). The CT images of all lesions were evaluated 6 months after the radiotherapy,with results showing 2 cases of CR,9 cases of PR,8 cases of NR,and 2 cases of PD. The total efficiency was 52. 3%,while 38. 1% of the patients showed no change. Conclusion Radiotherapy can effectively kill tumor cells and promote the calcification repair of osteolytic lesions in the treatment of NSCLC osteolytic spinal metastases patients. CT is a safe and effective routine examination method for revealing imaging changes in bone metastases after radiotherapy.
引文
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[20]Aoyagi T,Morii T,Ohtsuka K,et al. Lung cancer cell line sensitivity to zoledronic acid is BAX-dependent[J]. Anticancer Research,2013,33(12):5357-5363.
[21]曾少容,凌钦杰,曾维亮.唑来膦酸联合放射治疗对非小细胞肺癌骨转移患者癌痛的疗效观察[J].临床肿瘤学杂志,2017,22(2):152-156.
[22]代军强.放疗联合唑来膦酸治疗恶性肿瘤骨转移的临床分析[J].现代诊断与治疗,2017,28(3):451-452.
[23]Siker ML,ToméWA,Mehta MP,et al. Tumor volume changes on serial imaging with megavoltage CT for non-small-cell lung cancer during intensity-modulated radio-therapy:how reliable,consistent,and meaningful is the effect[J]. International Journal of Radiation Oncology Biology Physics,2006,66(1):135-141.
[2]Siegel R,Naishadham D,Jemal A. Cancer statistics,2012[J].CA Cancer J Clin,2012,62(1):10-29.
[3]Morgensztern D,Ng SH,Gao F,et al. Trends in stage distribution for patients with non-small cell lung cancer:a national cancer database survey[J]. Journal of Thoracic Oncology,2010,5(1):29-33.
[4]Uoyang WW,Su SF,Ma Z,et al. Prognosis of non-small cell lung cancer patients with boneoligometastases treated concurrently with throcic three-dimensional radiotherapy and chemotherapy[J]. Radiat Oncol,2014,9(1):147.
[5]徐辉,肖嵩华,刘郑生,等.胸腰椎转移瘤的外科治疗策略和效果分析[J].中国骨伤,2014,27(1):25-28.
[6]蒋伟刚,刘耀升,刘蜀彬.脊柱转移瘤的外科治疗进展[J].中国矫形外科杂志,2015,23(1):55-59.
[7]Ma Y,Li L,Niu Z,et al. Effect of recombinant plasminogen activator timing on thrombolysis in a novel rat embolic stroke model[J]. Pharmacol Res,2016,107(2):291-299.
[8]Ikeda T,Oomura M,Sato C,et al. Cerebral infarction due to cardiac myxoma developed with the loss of consciousness immediately after defecation-a case report[J]. Rinsho Shinkeigaku,2016,56(5):328-333.
[9]徐宏明,邵宝尔,潘洁,等.经皮椎体成形术联合放射粒子植入术对脊柱转移瘤的镇痛研究[J].中国疼痛医学杂志,2016,22(4):308-311.
[10]薛建喜,刘新黎,毕大卫.经皮椎体成形术在治疗椎体转移瘤中疼痛效果的临床意义[J].浙江临床医学,2015,13(6):874-875.
[11]丁婕,戴旭,孟宪运,等.实体瘤疗效评价标准的研究进展[J].中国肿瘤临床与康复,2015,22(9):1150-1152.
[12]刘荣伟,徐小虎,刘月军,等.胸部CT与纤维支气管镜对肺癌的临床诊断分析[J].医学影像学杂志,2017,27(10):2022-2025.
[13]张鼎,陈刚.骨关节结核影像学检查临床对比分析[J].医学影像学杂志,2017,27(4):786-788.
[14]Guise T. Examining the metastaticniche:targeting the microenvironment[J]. Swminars in Oncology,2010,37(5):2-14.
[15]孙燕,管忠霞,廖美琳,等.肺癌骨转移诊疗专家共识(2014版)[J].中国肺癌杂志2014,17(2):57-72.
[16]Lutz S,Berk L,Chang E,et al. Palliative radiotherapy for bone metastases:an ASTRO evidence-based guideline[J]. International Journal of Radiation Oncology Biology Physics,2011,79(4):965-976.
[17]Ikeda T,Oomura M,Sato C,et al. Cerebral infarction due to cardiac myxoma developed with the loss of consciousness immediately after defecation-a case report[J]. Rinsho Shinkeigaku,2016,56(5):328-333.
[18]肖智志,刘晖,李俐,等.椎体放射治疗脊柱转移瘤的临床疗效观察[J].临床肿瘤学杂志,2016,21(9):818-821.
[19]薛建喜,刘新黎,毕大卫.经皮椎体成形术在治疗椎体转移瘤中疼痛效果的临床意义[J].浙江临床医学,2015,13(6):874-875.
[20]Aoyagi T,Morii T,Ohtsuka K,et al. Lung cancer cell line sensitivity to zoledronic acid is BAX-dependent[J]. Anticancer Research,2013,33(12):5357-5363.
[21]曾少容,凌钦杰,曾维亮.唑来膦酸联合放射治疗对非小细胞肺癌骨转移患者癌痛的疗效观察[J].临床肿瘤学杂志,2017,22(2):152-156.
[22]代军强.放疗联合唑来膦酸治疗恶性肿瘤骨转移的临床分析[J].现代诊断与治疗,2017,28(3):451-452.
[23]Siker ML,ToméWA,Mehta MP,et al. Tumor volume changes on serial imaging with megavoltage CT for non-small-cell lung cancer during intensity-modulated radio-therapy:how reliable,consistent,and meaningful is the effect[J]. International Journal of Radiation Oncology Biology Physics,2006,66(1):135-141.