Control Study Of Curative Effect Of Spinal Metastases Treated With Target In Target Radiotherapy And Conventional Radiotherapy

The study is to analyze the effect of dose-escalated Target in Targetradiotherapy compare to conventional radiotherapy for spinal metastasesand to assess its safety.Retrospective study was carried out on90patients with spinalmetastasis received radiotherapy in the people’s liberation army air forcegeneral hospital between January2010and December2012, controlledclinical research method. The patients were divided into two groups,52cases in target in the target radiation group (63lesions) and38cases inconventional radiotherapy group38cases (55lesions). All patientsreceived linear accelerator6MV-X radiotherapy or tomotherapy. Theywere in prone position, fixed vacuum bag or thermoplastic net. GTV andPTV were defined on the CT scans at the spontaneous breathing. The TITradiotherapy: PTV (planning target volume)30-40Gy, GTV (gross targetvolume)40～60Gy/15-25f. Conventional radiotherapy:38patients with55lesions. PTV30-40Gy/10-20f,5f/w.1f/d. All patients were evaluated inpain relief every week, local control and survival with Kaplan-Meiermethod, difference comparing with the Log-rank test, the comparison ofthe recent treatment effect between the two groups and complicationsgrades were classified according to RTOG evaluation criteria during andafter radiotherapy.90patients with spinal metastasis finished radiotherapy. The overallresponse of TIT radiotherapy, conventional radiotherapy were90.4%and81.6%respectively, but no significant difference(P＞0.05). Theimprovement of TIT radiotherapy31Lesions (49.2%), steady28lesions (44.4%), worsening4lesions (6.35%), conventional radiotherapy groupimproved25lesions (45.5%), steady20lesions(36.3%), deterioration10lesions (18.1%). Following up to May2013,6-months,1-year local controlrate were86.8%,71%,84.7%,68.6%and1-year survival rate were49.4%,32.2%respectively. There were significant difference in local control andsurvival rates (P<0.05). Average survival time were13.1and8.7months,and the median survival time was12,7months respectively. Acute adversereactions are mainly hematologic toxicity, no difference in the adversereactions (P＞0.05),Exposure area of skin damage and radiationmyelitis,did not emerge in two groups.Dose-escalated TIT radiotherapy for spinal metastases is a safer andmore effective local treatment, with better efficacy and minor toxicity. Itcan be used as the preferred treatment for spinal metastases.