[Radiotherapy for vertebral metastases: analysis of symptoms and clinical effects by MR imaging].
Fifty patients with 63 symptomatic vertebral metastases (18 sites: pain only, 28 sites: radiculopathy with pain, 17 sites: myelopathy) were treated by radiotherapy. Primary lesions were located in the lung (9 cases), breast (9 cases) colorectal area (9 cases), prostate (7 cases) and so on. We correlated the radiologic findings, symptoms and clinical effects with metastatic features which were classified into 4 types by MR imaging: non-deformity, expanding, vertebral collapse, and destructive mass. Each type of metastasis was accompanied with or without epidural tumor. Osteolytic metastases were apt to create features of deformity (expanding type: 18 vertebrae, vertebral collapse type: 17 vertebrae, destructive mass type: 9 vertebrae). The features of osteoblastic metastases were no deformity (18 vertebrae) and expanding type (2 vertebrae). The symptom of pain only occurred most frequently in the lumbosacral spine. The vertebral body deformity of symptomatic sites was relatively slight (non-deformity type: 6 sites, expanding type: 6 sites, vertebral collapse type: 6 sites), and epidural tumors were seen at only 2 sites. The effect of radiotherapy was excellent (complete pain relief: 64.7%, partial pain relief: 29.4%). Radiculopathy occurred most frequently in the lumbar spine. Vertebral body deformity was noted in most symptomatic sites (expanding type: 9 sites, vertebral collapse type: 10 sites, destructive mass type: 2 sites). Complete relief was obtained in 6 sites (22. 2%), partial relief in 18 (63.0%). Myelopathy occurred most often in the thoracic spine, followed by the lumbar spine. The vertebral body deformity was severe (expanding type: 3 cases, vertebral collapse type: 3 cases, destructive mass type: 6 cases). Epidural tumors were also present in all but one case. Six of 13 patients treated with radiation alone improved. These 6 patients had non-deformity or expanding types with epidural tumor. No improvement was seen in the vertebral collapse type with epidural tumor or destructive mass type.
Sugiyama
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Department of Radiology, Shizuoka Saiseikai General Hospital.
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary*; D013131:Spine / Q000473:pathology*