| Objective: To analyze the clinical features of bone metastases, toevaluate the effect of palliative radiotherapy for painful bone metastases andto observe myelosuppression after radiotherapy.Methods: We totally followed up40patients with painful bonemetastases receiving palliative radiotherapy from April2010to December2011in the Fourth Hospital of Hebei Medical University, including30malesand10females. Age ranged from18to81years old with a median age58years old and mean age59±12years old. There were125sites of bonemetastases totally diagnosed by ECT, CT or MRI etc. and67painful sitesreceived radiotherapy. Twenty-one cases received a treatment schedule of2Gyeach, and19cases received3Gy each. Total dose ranged from22Gy to68Gy,and biological effective dose was25Gy to68Gy. Verbal rating scale (VRS)and numeric rating scale (NRS) were used to assess degree of pain, KarnofskyPerformance Score (KPS) was used to assess patients' performance status, andRTOG Acute Radiation Injury Grading Standard was used to assessmyelosuppression. The clinical features of each patient such as sex, age,primary tumors, pathological types, treatment condition, other metastases,causes of finding bone metastases, bone metastatic sites, occurrence time andnumbers of sites were analyzed retrospectively. Then we evaluated the effectand influencing factors of palliative radiotherapy for painful bone metastasesand observed myelosuppression after radiotherapy.Results:(1) In the40cases of bone metastases, the primary tumors werelung cancer (19cases,47.5%), esophageal carcinoma (8cases,20.0%),nasopharyngeal carcinoma (3cases,7.5%), prostate cancer (2cases,5.0%),rectal cancer (2cases,5.0%), cardia cancer (2cases,5.0%), breast cancer (1case,2.5%), bladder cancer (1case,2.5%), ureteral carcinoma (1case,2.5%) and malignant pleural mesothelioma (1case,2.5%). Twenty-four cases hadmultiple sites of bone metastases and16cases had isolated lesions, account for60.0%and40.0%respectively. The bone metastatic sites included: vertebrate(26cases,65.0%), ribs (17cases,42.5%), pelvic bone (16cases,40.0%), limbbone (10cases,25.0%), scapula (4cases,10.0%), skull (1case,2.5%) andsternum (1case,2.5%). The mean occurrence time of bone metastases in28cases of squamous cell carcinoma and of adenocarcinoma were10.22±6.37and33.93±30.12months respectively, the difference was statisticallysignificant (t=2.555, P=0.019). The mean occurrence time of bone metastasesin patients receiving chemotherapy and not receiving chemotherapy were25.75±22.69and4.76±2.63months respectively, the difference wasstatistically significant (t=2.411, P=0.023).(2) After radiotherapy, VRS, NRSand scale of analgesic usage decreased significantly (P<0.05). The effectiverate (CR+PR) of palliative radiotherapy for painful bone metastases was87.5%. The clinical benefit rate (CR+PR+MR) was90.0%. The effect of painrelief was not statistically correlative to primary tumors, pathological types,treatment, radiation total dose, single dose, fractions and radiotherapytechnique (P>0.05).(3) The mean times of pain relief in the treatmentschedule of2Gy each and3Gy each were7.86±2.63and5.95±2.07fractionsrespectively, the difference was statistically significant (t=2.564, P=0.015).(4)The duration of pain relief in patients receiving chemotherapy after bonemetastases for <4cycles and≥4cycles were4.65±2.38and8.63±2.93monthsrespectively, the difference was statistically significant (t=3.497, P=0.002).The duration of pain relief in patients receiving bisphosphonates after bonemetastases for <4cycles and≥4cycles were5.67±2.81and8.99±4.31monthsrespectively, the difference was statistically significant (t=2.559, P=0.018).The duration of pain relief was not statistically correlative to radiation totaldose, BED, and fractions (P>0.05).(5) The mean KPS before and afterradiotherapy were68.00±16.20and84.00±10.33respectively, the differencewas statistically significant (t=6.092, P=0.000).(6) Myelosuppressionoccurred in14cases of vertebrate and pelvic radiotherapy, myelosuppression rate was60.9%, and none of limbs or scapula radiotherapy, the difference wasstatistically significant (χ2=11.243, P=0.001).Conclusions:(1) The common primary tumors metastasizing to bone arelung cancer, esophageal carcinoma, nasopharyngeal carcinoma, et al. Morebone metastases are multiple lesions. The common metastatic sites include:vertebrate, ribs and pelvic bone. Active treatment can delay the occurrence ofbone metastases.(2) Palliative radiotherapy is effective for painful bonemetastases. A treatment schedule of3Gy each led to shorter response timethan that of2Gy each. More than4cycles of chemotherapy orbisphosphonates can prolong the duration of pain relief after radiotherapy.(3)Myelosuppression occur frequently in vertebrate and pelvic radiotherapy. |
PDF Full Text Request