| Chen Fang,Ren Ye,Su Xiaoming,Shan Gaixain,Dai Zhuojie,Cui Di,Wang Zongye.Analysis on volume modulated arc therapy for spinal metastases[J].Chinese Journal of Radiological Medicine and Protection,2017,37(1):35-39 |
| Analysis on volume modulated arc therapy for spinal metastases |
| Received:August 06, 2016 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.01.007 |
| KeyWords:Volume modulated arc therapy Spinal metastases Pain Quality of life |
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| Abstract:: |
| Objective To evaluate clinical effect of volume modulated arc therapy(VMAT) for spinal metastases.Methods Twenty patients with spinal metastases who had been treated with VMAT were chosen to participate in the study. The prescribed dose varied from 45 to 60 Gy within 15-20 fractions, 3 Gy per fraction, and one fraction per day of VMAT. Pain and quality of life were measured before VMAT and at several time points up to 6 months after treatment, by the numerical rating scale (NRS) and verbal rating scale (VRS) and the quality of life scale for bone metastases (EORTC QLQ-BM22) questionnaire. In addition, Frankel grading was used to evaluate the neurological function of spinal cord. The primary endpoint was frequency and duration of complete pain relief, and the secondary endpoint was death. Results 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 20 before VMAT to 10 of 14 (t=20.24, P<0.05). NRS-reported pain reduction from baseline to 1 weeks and 4 weeks after VMAT were clinically meaningful with NRS score (6.50±0.51) at baseline,(4.30±0.47) at 1 week and(2.50±0.50)at 4 weeks (t=15.98, 27.57, P<0.05). The pain reduction maintained until the end of the follow-up. These improvements were accompanied by significant reduction in opioid use during the first 6 months after VMAT (16 of 20 patients with strong opioid use at baseline vs. 6 of 18 at 6 months; t=8.46, P<0.05). According to EORTC QLQ-BM22 questionnaire, patients obtained significant improvement in pain location, severity, and function with the score (46.50±1.50)at baseline, (38.35±0.98) at 4 weeks(t=21.51, P<0.05). However,no significant alleviation in social psychology was reported(P>0.05). After VMAT, the patients who suffered from nerve function impairment recovered to different extent. No one had radiation-induced injury, such as radiation myelitis, radiation pneumonitis, etc. Median survival time was 10 month. Conclusions VMAT is a safe and effective treatment method for spinal metastases. Significant reductions in patient-reported pain were observed, along with nerve dysfunction improved. The patients' quality of life was significantly improved. VMAT has no late spinal cord toxicities. |
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