罗青竹 丁广成 时昌立 陈家富 雷艳文

[摘要]目的探討立体定向放疗联合唑来膦酸治疗非小细胞肺癌脊柱转移的临床疗效。方法回顾性分析郑州大学第五附属医院伽马刀治疗中心2017年1月至2018年12月治疗的64例非小细胞肺癌脊柱转移患者的临床资料。对64例患者实施立体定向放射治疗，处方剂量30～42 Gy，3.0～4.2 Gy/次，治疗10～14次，同时给予唑来膦酸静脉滴注。观察其近期疗效、治疗前后疼痛视觉模拟评分（VAS）、卡氏评分（KPS）及 Frankel 分级情况，随访1年，观察生存率、局部骨相关事件及不良反应。结果治疗3个月复查时，完全缓解7例，部分缓解40例，稳定13例，进展4例，有效率为73.44%。治疗后1个月、3个月时 VAS 评分较治疗前降低，KPS 评分较治疗前提高，差异均有统计学意义（ P <0.05）;治疗后 Frankel 分级较治疗前明显改善，差异有统计学意义（ P <0.05）;1年生存率为79.69%，1年后存活患者无骨相关事件发生率为68.63%;治疗后不良反应轻微，未观察到3级以上毒性。结论立体定向放疗联合唑来膦酸治疗非小细胞肺癌脊柱转移可以显著减轻疼痛，改善神经功能，减少骨相关不良事件，且不良反应少。

[关键词]立体定向放射治疗;唑来膦酸;骨相关事件;不良反应

[中图分类号] R734.2 [文献标识码] A  [文章编号]2095-0616（2021）22-0173-04

Efficacy of stereotactic radiotherapy combined with zoledronic acid in the treatment of patients with spinal metastasis from non-small cell lung cancer

LUO  Qingzhu   DING  Guangcheng   SHI  Changli   CHEN  Jiafu   LEI  Yanwen

Gamma Knife Treatment Center， the Fifth Affiliated Hospital of Zhengzhou University， He'nan， Zhengzhou 450000，China

[Abstract] Objective To explore the clinical efficacy of stereotactic radiotherapy combined with zoledronic acid in the treatment of patients with spinal metastasis from non-small cell lung cancer （NSCLC）. Methods The clinical data of 64 patients with spinal metastasis from NSCLC treated in Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were analyzed retrospectively.64 patients were treated with stereotactic radiotherapy. The prescription dose was 30～42 Gy，3.0～4.2 Gy/time with 10～14 times for treatment. The zoledronic acid was given intravenously as the same time. The short-term curative effect， visual analogue scale （VAS） score， karnofsky performance status （KPS） score and Frankel grading before and after treatment were observed， and the survival rate， local skeletal-related events （SREs） and adverse reactions were observed after 1 year follow-up. Results At the reexamination after 3 months of treatment， 7 cases were completely relieved， 40 cases were partially relieved， 13 cases were stable and 4 cases were advanced， with the effective rate of 73.44%. One month after treatment and three months after treatment， the VAS score decreased and the KPS score increased， with statistically significant differences （P <0.05）. After treatment， Frankel grade was improved compared with that before treatment， with statistically significant difference （P <0.05）. The 1-year survival rate was 79.69%， and the incidence of SRE-free in patients who survived after 1 year was 68.63%. After treatment， the adverse reactions were mild， and no toxicity above grade 3 was observed. Conclusion Stereotactic radiotherapy combined with zoledronic acid in the treatment of patients with spinal metastasis from NSCLC can significantly relieve pain， improve neurological function， and reduce skeletal-related adverse events with less adverse reactions.

[Key words] Stereotactic radiotherapy; Zoledronic acid; Skeletal-related events; Adverse reactions

非小细胞肺癌（non-small cell lung cancer，NSCLC）占所有肺癌的80%～90%[1-2]，随着现代系统治疗的不断进展，晚期肺癌患者生存期得以延长，肺癌骨转移发生率随之增高，相关研究报道 NSCLC 骨转移的发生率为30%～55%[3]，最常见的部位是脊柱，占骨转移的28.2%～70.0%[4]。由于椎体与脊髓、神经根的解剖关系，除了疼痛之外，脊柱转移瘤也会造成脊柱的畸形、神经或脊髓受压甚至导致瘫痪。放射治疗在骨转移瘤治疗中占有重要地位，不仅能有效控制肿瘤局部进展，而且在缓解疼痛、减轻症状和改善生活质量等方面发挥着显著作用[5]。立体定向放射治疗（stereotactic body radiotherapy， SBRT）因高精准性及靶区适形性，保证肿瘤周围正常组织受到相对少的剂量照射，更好地保护脊髓等危及器官[6]，唑来膦酸是治疗骨转移瘤的金标准，能有效缓解疼痛以及预防骨相关事件的发生[7]，研究发现[8]，唑来膦酸可增加放疗的抗肿瘤疗效，减轻患者临床症状。……