| ObjectiveRadiotherapy is an important treatment for bone metastasis of malignant tumor. In the past, conventional dose fractionation radiotherapy was usually adopted in clinic. However, there is some insufficiency of conventional dose fractionation radiotherapy such as longer treatment time and higher cost of treatment. In order to solve these problems, this study will employ intensity modulated radiation therapy (IMRT) to investigate and evaluate the clinical curative effect of large dose fractionation for the patients with bone metastases compared with the method of conventional dose fractionation radiotherapy. The aim of this study would be to explore a more effective radiotherapy, improve the treatment effect for cancer patients with bone metastases, reduce radiation-induced side-effects, shorten treatment time and decrease the cost of treatment.Methods130 malignant tumor’s patients with bone metastasis in Affiliated Hospital of Binzhou Medical College from 2013.12 to 2014.12 were chosen and studied; the entire clinical data about all of the patients in this study were collected. Bone metastases in the patients were diagnosed by ECT (Computed Tomography Emission), CT (Tomography Computed), MRI (Nucler Magnetic Resonance Imaging) or PET-CT (Positron emission tomography-CT). According to the method of random number table, the patients were divided into two groups of large dose and conventional dose fractionated methods for radiotheropy. The cases in large dose and conventional dose groups included 66 and 64, respectively.Before the radiotherapy to the patients, the specialized body phantom was made at first, followed by a scanning and locating with spiral CT, and 3D IMRT treatment plan for the patients was designed by 3D treatment planning system based on CT scanning images. The target area includes three parts:the tumor, the plan and the clinic.6MV-X linear accelerator was used for IMRT. For the large dose fractionation group, the dose was 300cGy in each time, once a day,5 times a week, and the total dose was up to 3000cGy. For the conventional dose fractionation group, the dose was given 200cGy in each time, once a day,5 times a week, and the total radiation dose was 5000cGy. The classification of the pain level for patient was evaluated according to 0-10 digital rating scale, and the score for general condition of patients was estamited using Karnofsky scoring method. The side effect of radiotherapy was assessed by WHO standard evaluation. The comparative stydy between two groups of large dose and conventional dose fractionation to treat bone metastasis patients was conduced via following indicator:pain intensity, general physical condition, remission of bone pain, radiotherapy-induced side-effects, treatment time and the cost of treatment.The data were analysed by SPSS 17.0 software. The comparation of measurement data was analyzed by t test (a= 0.05), the comparation of count data were carried out with the chi square test (P< 0.05).Results1. Basic information for the patients with bone metastasesAmong 130 patients with bone metastases,66 patients (50.8%) were male and 64 were female (49.2%), respectively. The ratio of male to female was 1.03:1, the age of onset was 38 years old, the median age was 64 years old, and the mean age was 59 ±12 years old. There were 53 cases of the patients over 60 years old (44.8%) and 77 cases lower 60 years old (59.2%). There were 24 cases with single bone metastasis (18.5%), and 106 cases with multiple bone metastasis (86.2%).25 cases with simple bone metastasis were 19.2%,105 cases with mixed bone and other organ metastases were 80.8%.The pathological types of the 130 cases of the patients:57 cases with lung cancer contained 32 cases with adenocarcinoma,16 cases with squamous cell carcinoma,5 cases with small cell lung cancer and 4 cases with large cell carcinoma; The 5 cases wilh renal cell carcinoma included clear cell carcinoma (4 cases) and granular cell tumor (1 cases); all of liver cancer, colorectal cancer, breast cancer, gastric cancer, ovarian cancer, prostate cancer and thyroid carcinoma were adenocarcinoma. The pathological type of nasopharyngeal carcinoma patients was squamous cell carcinoma.The diagnosis of bone metastasis was determined by a variety of imaging examinations, such as ECT for 122 cases (93.8%), CT examination for 115 cases (88.5%), MRI for 85 cases (65.4%), PET-CT for 19 cases (16.4%), and X-ray examination for 15 cases (11.5%).For the primary malignant tumors among the 130 cases of the patients with bone metastasis, lung cancer was the most common with 57 cases (43.8%), and the second one was breast cancer with 38 cases (29.2%), and colorectal cancer in 10 cases (7.7%),6 cases of gastric cancer (4.6%), ovarian carcinoma in 5 cases (3.8%), renal cell carcinoma in 5cases (3.8%). But the cases with prostate cancer, liver cancer, nasopharyngeal carcinoma was relatively rare.The skeletal regions of bone metastases in 130 cases were:vertebral region in 83 patients (63.8%), pelvic area in 62 cases (47.7%),44 cases with thoracic region (33.8%),36 cases with limbs (27.7%), and 12 cases with cranial region (9.2%). The results showed that the distributions of 130 patients with bone metastases were mainly found in the spine and pelvis; the bone metastases were discovered in 237 different skeletal regions in 130 patients, and the number of bone metastases was an average of 1.82 regions in each patient.2. Comparison of treatment outcome of bone metastases between two groups2.1 The treatment effect of radiationtherapy on the pain of the tumor patients with bone metastasesFor the evaluation of curative effect to 130 cases of the patients, a total of 119 cases got pain relief and total pain relief rate was 91.5%, and the complete remission appeared in 86 cases (66.2%),25 cases with partial remission (accounting for 19.2.%), mild response in 8 patients (6.2%), and 11 cases were invalid (8.4%). Total pain relief rate have significant difference before and after radiotherapy through statistical analysis (p<0.001). The results from the pain score (NRS) was decreased from 7.71 before radiotheropy to 2.47 after radiotheropy, and the difference between before and after radiotherapy was significant (p< 0.001); the pain relief rate in large dose fractionation group or onventional dose fractionation was 90% or 89.4%, respectively, the difference between the two groups had no statistically significant in the treatment of pain(p >0.05), indicating two different radiation therapy methods had the same analgesic effect, and the pain degree of the patients was significantly reduced and the pain was relived after radiotherapy through the analysis by the NRS pain score.2.2 The onset time to relieve pain after radiotherapyThe average onset time to relieve pain after radiotheropy for the treatments by conventional fractionated dose or large fractionated dose was 7.7 days or 5.5 days, respectively. The onset time of two groups had statistical significance (p<0.05), suggesting that the radiotherapy by large fractionated dose had quicker onset time to stop pain for the patents.2.3 The improvement of physical condition for the patentsFor the conventional dose fractionation radiotherapy group, the average KPS scores were singnificantly increased from 68.02 ±16.46 before radiotherapy to 84.57±1.14 after radiotherapy (p<0.001); and for the large dose fractionation radiotherapy group, KPS scores averaged were also singnificantly increased from 67.19±15.49 before radiotherapy to 85.63±13.67 after radiotherapy (p<0.001). However, the average KPS scores in two groups had no statistical difference (p=0.44, p>0.05), implying that both radiotherapies can improve the physical condation of the patients and there was no difference between two groups.2.4 The radiotherapy-induced side effectsThere were 27 cases (42.2%) with the side effect of digestive system caused by radiotherapy in the conventional dose fractionated group and 48 cases (72.7%) in the large dose fractionated group, and the difference between two groups was significant (p<0.01), suggesting that the large dose fractionated radiotherapy has more severe reaction. However, further analysis showed that the damage level in all of two groups was the relatively mild degree I and II, and the damage recovered soon after symptomatic treatment, serious irreversible damage was not found.There were 13 cases (20.3%) with the decrease of number of white blood cells in conventional dose fractionation group and 15 cases (22.7%) in large dose fractionation group, there was no significant difference between two groups (p>0.05). The level of the decrease of white blood cells in both groups was degree I and II, and no infection occurred during radiotherapy.In conventional dose fractionation group there were only two patients with thrombocytopenia (3.1%) and large dose fractionation group had 3 cases (4.8%), there was no statistically significant difference between the two groups (p>0.05). The level of radiotherapy-induced thrombocytopenia was light degree I, which had no effect on radiation therapy, and the patients had no bleeding.Radioactive skin injury is also a common side effects induced by radiotherapy. There were 53 cases with radioactive skin injury in conventional dose fractionation group (80.3%), and 56 cases in large dose fractionation group (84.8%), there was no statistical significance between the two groups in the degree of skin injury (p>0.05). The level of radiation-induced skin injury was mainly degree I and II but no skin damage of degree III and IV.2.5 The cost and time of radiationtherapy for the cancer patientsConventional dose fractionation radiotherapy for cancer patients required 25 times in a treatment process but large dose fractionation treatment was 10 times; radiotherapy fee was 900 CNY every time, total radiation fee for the treatment in conventional dose fractionated group was 22,500 CNY, then for large doses fractionated group the total fee costed only 9,000 CNY, the ratio between two radiotherapes was 2.5:1. The treatment time for conventional dose fractionated radiotherapy lasts for 33 days but only 10 days for large dose fractionated radiotherapy.Conclusions1. In this study, among the 130 patients, it was found that the patients with lung cancer, breast cancer and colorectal cancer would be prone to have bone metastases. Metastatic bone cancer often occurs in many parts of the skeletal system, and is more common in the spine, thorax, pelvis, and so on.2. Radiotherapy has better effect for relieving pain of bone cancer. And large dose fractionated radiotherapy not only has the same analgesic effect as conventional dose fractionated radiotherapy, but also has the characteristics of rapid onset of pain.3. The patient’s general condition was improved obviously after radiation therapy, large dose fractionation and conventional dose radiation therapy had the same effect to improve the general situation of the patients.4. Although the digestive tract side effects caused by large dose fractionated treatment were more severe than that of the conventional dose group, the side effects in both groups were mild and no severe irreversible damage was found. There were no differences between the two radiotherapies in the terms of white blood cell decline, thrombocytopenia, and radiation skin reactions.5. Compared with conventional dose fractionated radiotherapy, large dose fractionated radiotherapy is more effective in reducing the cost of medical treatment and reducing the time of radiation therapy. |
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