脊柱转移恶性肿瘤诊治进展.ppt

Subaxial cervical spine Burst frcature Fracture of unilateral facet cervical kyphosis hold the head Thoracic spine Often initiated when a flat position Comfortable when walking Sleeping upright in a chair Radiography: burst fracture with posterior elements Lumbar spine Burst fracture with extension of tumor into neural foramen Standing resulting in severe leg and back pain Systemic medical comorbidities Predicated on the ability of patients tolerate the proposed treatment Drug development Immunotherapy and Hormonal therapy Non-small cell lung carcinoma(Pancoast tumors) Neoadjuvant chemotherapy(etoposide鬼臼乙叉甙 cisplatin顺铂) followed by resection Bisphosphonate二碳磷酸盐化合物 osteoclast inhibitor decrease the risk of skelectal events pamidronate zolendronate Radiotherapy IMRT (Intensity –Modulated RT) CyberKnife (Accuray) BUT, 2-mm margin need a full tumoral dose (100% isodose) risking progressive myelopathy 脊柱转移恶性肿瘤治疗进展New Therapeutics in Spine Metastases 张 琥 Epidemiology 5% to 10% of all cancer patients Traditional: Corticosteroids Radiotherapy(RT) Epidemiology Epidemiology Metastatic Epidural Spinal Cord Compression (MESCC) Oligometastatic disease : involvement of three or fewer vertebrae and lack of other bone or visceral metastases Presentation of the disease Biologic pain Radiculopathy Myelopathy Pain reflective of mechanical instability Imaging MRI T1WI: hypointense (dark) T2-fat-suppressed :hyperintense(bright) Diffusion and perfusion sequence(experiment) CT : assess bony quality for spinal implant placement the placement of pedicle screws navigating from images that CT and fluoroscopic CAP :chest,abdomen and pelvis PET (positron emission tomography) radiolabeled glucose molecule FDG radion