Related Factors For Skeletal Related Events In Non-small Cell Lung Cancer Patients With Bone Metastases

ObjectiveTo identify the related factors for skeletal related events (SREs) in non-small cell lungcancer (NSCLC) patients with bone metastases.MethodsThe clinical data of203NSCLC patients with bone metastases at Shanghai Jiao TongUniversity affiliated Sixth People’s Hospital between January2007and December2012were retrospectively analyzed.ResultAmong203NSCLC patients with bone metastases,107patients (52.71%) occurredSREs including83patients with one type of SREs,16patients with two types of SREs, and8patients with three or four types of SREs. Radiotherapy of bone metastases was the mainpattern of SREs, and then the pathological fracture. The character and quantity of bonemetastases were not relative factors to SREs. Soft-tissue mass adjacent to bone metastasessite was the risk factor of SREs(P=0.038). Percutaneous Vertebroplasty(PVP) coulddecrease the occurrence of bone metastases, compression of spine and surgery of bone(P=0.045). Twenty-six patients had SREs in87patients who were given Zoledronic Acid（29.89%）and81patients had SREs in116patients without Zoledronic Acid therapy（69.83%）.The result was statistically siganificant（P=0.000）.The incidence of SREs ofpatients who were given Zoledronic Acid in1month after they were identified bone metastases has no difference to those who were given Zoledronic Acid1month later(P=0.675). The same result was observed in patients who were given Zoledronic Acid in2month after they were identified bone metastases and those who were given ZoledronicAcid2month later (P=0.580). The patients with Zoledronic Acid therapy had longermedian time to first SREs than those without Zoledronic Acid therapy (11months vs5months, P<0.05).ConclusionsSoft-tissue mass adjacent to bone metastases site was the risk factor of SREs. PVPcould decrease the occurrence of bone metastases, compression of spine and surgery ofbone.Zoledronic acid reduced the risk SREs and delayed the median time to first SREs.It isnot clear what is the best time to treat the patients diagnosed bone metastasis withZoledronic. ObjectiveTo assess the efficacy and safety of percutaneous vertebroplasty(PVP) combined withradiotherapy(RT) to relieve pain and improve the activity ability in non-small cell lungcancer patients with vertebral metastasis.MethodsIn this retrospective study, the clinical data of non-small cell lung cancer(NSCLC)patients with vertebral metastasis receiving percutaneous vertebroplasty（PVP）and/orradiotherapy（RT）at Shanghai Jiao Tong University affiliated Sixth People’s Hospital fromJanuary2007to June2013were analyzed. According to different treatment modes, thepatients were divided into three groups: simple PVP group, simple RT group and PVPcombined with RT group. The changes of visual analogue score (VAS) and activity levelbefore and after treatment were measured respectively in these three groups. We comparedthe efficacy of combination treatment group with simple treatment group in painalleviation and activities ability improvement. We also investigated whether there is anydifference in the efficacy between the combination treatment modes of PVP first and thatof RT first. At the same time, we compared the effect of the three treatment modes onpatients survival.ResultsThe patients are divided into three groups: the simple PVP group (n=75), the simpleRT group(n=64) and the PVP combined with RT group (n=33).VAS of simple PVP group was6.77±1.760(before treatment),3.59±1.771(one day after treatment),1.94±1.652(onemonth after treatment)and2.30±1.818(three month after treatment).Compared with theVAS before treatment, there is a significant decrease in the VAS after treatment in thesimple PVP group (p<0.05). For the patients with activities obstacles in the simple PVPgroup (n=30), their activities ability scores were2.89±0.747(before treatment) and1.44±0.651(three months after treatment),whereby the difference was statisticallysignificant(P<0.05).VAS of simple RT group was6.91±1.716(before treatment),4.23±1.697(one dayafter treatment),2.79±1.862(one month after treatment)and2.02±1.867(three months aftertreatment). For the patients with activities obstacles in the simple RT group (n=26), theiractivities ability scores were2.85±0.818(before treatment) and1.67±0.840(three monthsafter treatment), whereby the difference was statistically significant (P<0.05).VAS of the combined treatment group6.82±1.424(before treatment),2.76±1.437(one day after treatment),1.96±1.800(one month after treatment)and1.68±1.701(threemonths after treatment).For the patients with activities obstacles in the combined treatmentgroup (n=10), their activities ability scores were2.90±0.876(before treatment) and1.44±0.726(three months after treatment),whereby the difference was statistically significant (P<0.05).When comparingcombination group with simple treatment group three months after operation, there was nodifference in terms of pain relief and activities improvement.However, the proportion of patients whose pain improvement level was excellent inthe combined treatment group was obviously higher than that of the RT group (one monthafter treatment, P=0.013), and that of the PVP group (three months after treatment, P=0.022).There was no difference in the efficacy of pain relief or activities improvementbetween the patients receiving PVP first and those receiving RT first in the combinationgroup. Two patients in the simple PVP group developed vascular embolization with bonecement (4%), while the incidence of the combination group is0. There was no differencein patients survival among the three groups.ConclusionsSimple PVP, simple RT and PVP combined with RT all had significant efficacy inlocal pain alleviation and activities ability improvement. In terms of pain relief, combination therapy was slightly better than simple treatment. PVP combined with RT donot increase the risk of vascular leakage, and it is a safe and reliable treatment mode.