| Objective Analyse the pain relief and improvement of quality of life with volume modulated arc therapy combined with zoledronic acid for 40 spinal metastase patients.Compare pain relief rate,lasting time of pain relief,quality of life,and motor function of different dose-fraction regimes with volume modulated arc therapy(VMAT)combined with zoledronic acid for spinal metastase.Methods40 patients with spinal metastases who fit specific inclusion and exclusion criteria,who undergo treatment with volume modulated arc therapy combined with zoledronic acid were chosen to participate in the study.The prescribe dose and fraction were 30~60Gy/10~30f,2~3.5Gy per-fraction,5 fraction per-week,BED:39~66.3Gy.Further divided all patients into two groups: group A,20 patients treated with lower dose-fraction regimen 30 ~ 40Gy/10 ~ 15 f,BED:39 ~ 47Gy;group B,20 patients treated with higher dose-fraction regimen 45~60Gy/15~30f,BED:58.5~66.3Gy.All patients were injected with zoledronic acid regularly,4mg zoledronic acid intravenous injection,once every 4 weeks.Pain and quality of life were measured by the Numerical Rating Scale(NRS),Verbal Rating Scale(VRS)and The quality of life scale for bone metastases(EORTC QLQ-BM22)questionnaire respectively.Also,We used Karnofsky(KPS),Tomita and Frankel grading to assess functional status and The neurological function of spinal cord of patients respectively.Adverse effects were estimated by Radiation Therapy Oncology Group(RTOG)Acute/ Late Morbidity Criteria.Paired t-test method was used to test the difference of NRS scores of 40 patients before and after treatment.The decreased NRS scores and the pain recurrence rate differences between the arms were tested by using independent T-test and Chi-squared test respectively.Results The overall following-up were 97.5%,at the end of the follow-up,the number of patients reporting no pain from spinal metastases,as measured by the NRS,increased from 0 of 40 to 10 of 16(c 2=4.67,P<0.05).According to EORTC QLQ-BM22 questionnaire,patients obtained significant improvement after treatment(48.55±2.18,39.25±1.48;t=32.4,P<0.05),mainly the pain site,severity,and function.However,no significant alleviation in social psychology was reported.After VMAT,the patients who complicated with nerve function impairment recovered to different extent.Only one case had radiation myelitis.Comparison of two groups: Median survival time was 8 months and 10 months between group A and group B.There were no significant differences in the pain relief rate(5.00±0.92 vs 4.90±1.25),the pain relief time(7.60±1.93 vs 6.80±2.04),and the lasting time of pain relief(5.15±4.21 vs 7.05±5.25)between the two groups,the average lasting time of pain relief of group B was longer than that of group A,with clinical significance.Howere,the decreased degree of pain relief,and the decreased QLQ-scores(4.90±1.52 vs 3.85±1.09,10.10±2.17 vs 8.75±1.41)in group B were superior to group A,the pain recurrence rate of group B lower than group A(10% vs31.6%),the differences were statistically significance(P<0.05).There were no significant differences of adverse effect between two groups after treatment.Grade 2~4acute toxicity was more frequent in group B(17%)than in group A(10%),the differences were no statistically significance(P>0.05).Conclusion Volume modulated arc therapy(VMAT)combined with zoledronic acid for spinal metastases is safe and effective,gives a better and longer lasting reduction of pain,better improvement of body function,and therefore a better quality of life without an increase of treatment-related side effects.To compare the efficacy of two groups,howere,high dose-fraction due to lower the recurrence rate is more suitable for patients with a long life expectancy. |
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