Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine.The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are m...Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine.The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are mostly seen in older patients.Primary musculoskeletal system sarcomas involving the spinal column are rare.Benign tumors and tumor-like lesions of the musculoskeletal system are mostly seen in young patients and often cause instability and canal compromise.Optimal diagnosis and treatment of spine tumors require a multidisciplinary approach and thorough knowledge of both spine surgery and musculoskeletal tumor surgery.Either primary or metastatic tumors involving the spine are demanding problems in terms of diagnosis and treatment.Spinal instability and neurological compromise are the main and critical problems in patients with tumors of the spinal column.In the past,only a few treatment options aiming short-term control were available for treatment of primary and metastatic spine tumors.Spine surgeons adapted their approach for spine tumors according to orthopaedic oncologic principles in the last 20 years.Advances in imaging,surgical techniques and implant technology resulted in better diagnosis and surgical treatment options,especially for primary tumors.Also,modern chemotherapy drugs and regimens with new radiotherapy and radiosurgery options caused moderate to long-term local and systemic control for even primary sarcomas involving the spinal column.展开更多
文摘Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine.The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are mostly seen in older patients.Primary musculoskeletal system sarcomas involving the spinal column are rare.Benign tumors and tumor-like lesions of the musculoskeletal system are mostly seen in young patients and often cause instability and canal compromise.Optimal diagnosis and treatment of spine tumors require a multidisciplinary approach and thorough knowledge of both spine surgery and musculoskeletal tumor surgery.Either primary or metastatic tumors involving the spine are demanding problems in terms of diagnosis and treatment.Spinal instability and neurological compromise are the main and critical problems in patients with tumors of the spinal column.In the past,only a few treatment options aiming short-term control were available for treatment of primary and metastatic spine tumors.Spine surgeons adapted their approach for spine tumors according to orthopaedic oncologic principles in the last 20 years.Advances in imaging,surgical techniques and implant technology resulted in better diagnosis and surgical treatment options,especially for primary tumors.Also,modern chemotherapy drugs and regimens with new radiotherapy and radiosurgery options caused moderate to long-term local and systemic control for even primary sarcomas involving the spinal column.
文摘目的:探讨颈椎、胸椎及腰椎肿瘤在锥形束CT(cone beam CT,CBCT)影像引导下的调强放射治疗(image guided radiation therapy,IGRT)六自由度摆位误差分析。方法:收集2013年5月至2014年6月在北京大学第三医院行脊柱恶性肿瘤放疗的患者30例,其中颈椎肿瘤10例,胸椎肿瘤10例,腰椎肿瘤10例。采用瑞典医科达(ELEKTA)公司AXESSE直线加速器CBCT引导,用Hexa PODTMevoRT床从平移和旋转六自由度方向在线校正摆位误差,CT模拟定位获取治疗计划参考图像(层厚3 mm,120 k V,200 m As)。每次治疗前行千伏级(k V级)CBCT扫描(100 k V,36.6 m As,s20射野准直器),CBCT图像采用骨窗模式与计划参考图像自动匹配,并经高资质医师和物理师共同确认,误差校正后再次行CBCT扫描,将两次图像与计划参考图像分别进行匹配验证。本研究共收集838次摆位校正前、后匹配结果,分别记录患者平移摆位误差左右方向X(lateral)、进出方向Y(lngitudinal)、升降方向Z(vertical)、旋转误差俯仰方向RX(pitch)、滚动方向RY(roll)及左右旋转方向RZ(yaw)匹配结果。应用SPSS13.0统计软件,对Hexa PODTMevoRT床校正前后位移误差数据行配对t检验。结果:椎体肿瘤摆位误差(绝对值)中,3个平移X、Y和Z方向摆位误差结果分别为颈椎(1.71±0.10)mm、(1.81±0.11)mm和(1.94±0.09)mm;胸椎(3.17±0.19)mm、(4.26±0.28)mm和(2.18±0.12)mm;腰椎(2.69±0.24)mm、(3.33±0.26)mm和(2.86±0.21)mm。患者摆位后首次CBCT获得摆位误差数据与误差纠正后(动床后)再次CBCT验证后获得残余误差数据3个平移X、Y和Z方向分别为颈椎(0.5±2.4)mm、(0.01±2.4)mm和(2.4±1.4)mm,胸椎(1.17±0.11)mm、(0.26±0.30)mm和(0.08±0.12)mm,腰椎(1.09±0.24)mm、(2.03±1.26)mm和(0.06±0.51)mm。进行配对t检验结果:颈椎及胸椎平移3个方向误差纠正前后差异均有统计学意义;腰椎仅是升降Z方向平移误差纠正前后差异统计学有意义(t=-3.518,P<0.001)。3个旋转RX、RY和RZ方向摆�
