肺癌骨转移疼痛患者止痛治疗的效果评估

背景：应用以帕米膦酸盐为代表的破骨细胞活性抑制剂，是否可以缓解肺癌骨转移性疼痛，已成为治疗中值得探讨的问题。目的：评估抗癌治疗中帕米膦酸盐类药物对肺癌骨转移疼痛患止痛治疗的效果，以及治疗后生活质量。设计：随机实验对照。地点和对象：1996-01／1998-06暨南大学附属第二医院深圳市人民医院收治的肺癌骨转移患71例，分为综合疗法组(46例)和单一疗法组(25例)。综合疗法组分为3个小组：化疗 帕米膦酸钠组(18例)，放疗 帕米膦酸钠组(16例)，核素 帕米膦酸钠组(12例)。单一疗法组分为2个小组：化疗组(15例)，放疗组(10例)。方法：综合疗法组的3个小组和单一疗法组的2个小组分别采用帕米膦酸钠加化疗、放疗、核素的综合疗法和化疗、放疗的单一疗法。根据主诉疼痛分级法进行疗效评价。主要观察指标：各组的镇痛效果及不良反应。结果：综合疗法组镇痛总有效率为89％(41／46)，化疗 帕米膦酸钠组有效率为89％(16／18)，放疗 帕米膦酸钠组有效率为88％(14／16)。核素 帕米膦酸钠组有效率为92％(11／12)；单一疗法组镇痛总有效率为64％(16／25)，化疗组有效率为60％(9／15)，放疗组有效率为70％(7／10)。结论：采用抗癌和破骨细胞抑制剂帕米膦酸钠综合治疗肺癌骨转移引起的疼痛，疗效满意，不良反应无相加，可进一步改善患的生活质量。     

肺癌骨转移疼痛不同治疗方法的比较

目的:探讨肺癌骨转移伴疼痛的特点,骨转移的发生部位,骨损害的性质,疼痛的程度等。方法:福建省肿瘤医院1996-03/2003-03收治肺癌骨转移伴1级以上疼痛的患者176例。采用单纯化学治疗(简称化疗),化疗+骨膦,化疗+放射治疗(简称放疗),化疗+放疗+骨膦进行治疗。结果:化疗+放疗+骨膦对肺癌骨转移伴疼痛的治疗止痛疗效为79%。治疗后生存时间为12.5个月。与其他3组比较差异有显著性意义(χ2=7.609～11.347,P<0.00714)。结论:化疗+放疗+骨膦最能改善肺癌骨转移伴疼痛患者的生活质量及延长生存时间。     

全身热化疗联合唑来膦酸钠治疗多发性骨转移癌临床观察

目的观察全身热化疗联合唑来膦酸钠治疗多发性骨转移癌临床疗效及不良反应。方法将66例多发性骨转移癌病人随机分成3组,全身热化疗联合唑来膦酸钠组(A组),全身热化疗组(B组),单纯唑来膦酸钠组(C组),各22例。观察3组患者的疼痛缓解情况和全身体力评分(KPS评分)。结果疼痛缓解率A组95.4%,B组90.9%,C组77.3%;KPS评分提高有效率A组95.4%,B组81.8%,C组68.2%。全身热化疗有轻度不良反应。结论全身热化疗联合唑来膦酸钠治疗多发性骨转移癌能缓解患者疼痛,提高KPS评分,是一种安全、有效的新技术,值得推广应用。     

唑来膦酸合并放射治疗骨转移癌临床研究

目的:观察唑来膦酸联合放射治疗对骨转移癌疼痛的疗效及不良反应.方法:98例骨转移癌患者随机分成观察组(51例)和对照组(47例).观察组静滴唑来膦酸4 mg加局部放疗37.5GY/15F,之后再静滴唑来膦酸4 mg;对照组则单纯行放疗.结果:观察组与对照组止痛有效率分别为88.2%和74.5%(P＞0.05),多发骨转移癌疼痛病灶研究组与对照组止痛有效率分别为86.5%和67.6%(P＜0.05),随访2个月后观察组与对照组止痛有效率分别为86.3%和66.0%(P＜0.05).结论:唑来膦酸联合放射治疗骨转移癌疼痛疗效优于单纯放疗,唑来膦酸副作用轻.     

心理干预伊班膦酸钠联合放疗骨转移癌疼痛效果观察

目的　探讨伊班膦酸钠联合放疗治疗骨转移癌疼痛晚期癌症患者心理干预的影响,方法 50例住院骨转移癌患者,随机分为二组.干预组26例在采用伊班膦酸钠联合放疗治疗的同时加心理干预;对照组24例单纯采用伊班膦酸钠联合放疗治疗骨转移癌疼痛,效果评定采用抑部自评量表(SDS)和焦虑自评量表(SAS)进行统计学分析.均给予3个周期的用药后评价疗效.结果 干预组的抑郁及焦虑情绪明显低于对照组(P＜0.01),止痛效果明显高于对照组(P＜0.05).结论 心理干预可以显著缓解骨转移癌疼痛患者的抑郁及焦虑情绪,明显提高了伊班膦酸钠联合放疗治疗骨转移癌疼痛的治疗效果.     

伊班膦酸钠治疗乳腺癌骨转移的疗效分析

目的　探讨伊班膦酸钠 (艾本 )及其联合化疗对乳腺癌骨转移的疗效。方法　 2 3例单用伊班膦酸钠治疗 ,2 5例伊班膦酸钠联合化疗。比较两种方法的疗效。结果　单用伊班膦酸钠治疗 ,疼痛缓解率87% (2 0 / 2 3例 ) ,卡氏评分标准平均提高 10分 ;伊班膦酸钠加化疗组 ,疼痛缓解率 10 0 % (2 5 / 2 5例 ) ,卡氏评分标准平均提高 2 0分。结论　单用伊班膦酸钠或伊班膦酸钠加化疗对乳腺癌骨转移的疗效均好 ,可缓解疼痛 ,促进骨质修复。伊班膦酸钠加化疗效果更佳。     

帕米膦酸二钠联合同期化疗治疗乳腺癌骨转移临床疗效观察

目的观察帕米膦酸二钠(博宁)联合同期化疗治疗乳腺癌骨转移的疗效。方法将79例乳腺癌骨转移患者随机分为试验组(40例)和对照组(39例)。试验组静脉滴注帕米膦酸二钠90 mg联合同期化疗,对照组单纯行同期化疗。结果试验组与对照组止痛有效率、生活质量提高率和骨质修复有效率分别为90.0%,87.5%,75.50%和74.4%,64.1%,43.59%,两组比较差异具有统计学意义(P<0.05)。结论帕米膦酸二钠联合同期化疗对乳腺癌骨转移患者在止痛、生活质量改善和骨质修复方面疗效明显。     

肺癌骨转移单用化疗和配合伊班膦酸钠疗效分析

目的分析单用化疗或化疗联合伊班膦酸钠治疗肺癌骨转移的疗效。方法共68例患者,分两组治疗。34例单用NP方案化疗:诺维本25 mg/m2,第1、8天静脉推注,顺铂20 mg第1~5天静脉点滴,以21 d为一周期。34例化疗联合艾本治疗:NP方案化疗(方法同前),加艾本4 mg/次,21 d为一周期。均连用2周期。然后评价疗效。结果单用化疗组,疼痛缓解率82.3%(28.34),化疗联合艾本组,疼痛缓解率100%(34.34)。结论化疗联合艾本对肺癌骨转移疗效好,能缓解疼痛,延长生存期。艾本不良反应轻,是临床值得推广的新一代双膦酸盐药物。     

肺癌骨转移疼痛不同治疗方法的比较

目的：探讨肺癌骨转移伴疼痛的特点，骨转移的发生部位，骨损害的性质，疼痛的程度等。方法：福建省肿瘤医院1996-03／2003-03收治肺癌骨转移伴1级以上疼痛的患者176例。采用单纯化学治疗(简称化疗)，健疗 骨膦，化疗 放射治疗(简称放疗)，化疗 放疗 骨膦趔行治疗。结果：化疗 放疗 骨膦对肺癌骨转移伴疼痛的治疗止痛疗热为79％。治疗后生存时间为12．5个月。与其他3组比较差异有显著性意义(X^2=7．609-11．347，P＜O．00714)。结论：化疗 放疗 骨膦最能改善肺癌骨转移伴疼痛患者的生活质量及延长生存时间。     

唑来膦酸和帕米膦酸二钠治疗骨转移癌疼痛疗效比较的Meta分析

目的系统评价唑来膦酸和帕米膦酸二钠治疗实体瘤骨转移疼痛疗效的差异。方法通过PubMed和CNKI数据库检索所有符合检索条件的文献,末次检索日期2010年9月15日,根据纳入和排除标准进一步筛选。采用Meta分析方法比较唑来膦酸和帕米磷酸二钠用药后第7天或第14天治疗骨转移疼痛的疗效。两组用药方案:唑来膦酸组,4mg/次;帕米膦酸二钠组,60mg/次或90mg/次。疗效评价标准采用WHO癌痛分级及疗效评价标准。结果 29篇文献纳入Meta分析,唑来膦酸组和帕米膦酸二钠组病例数分别为1099例和1092例。唑来膦酸治疗骨转移疼痛总有效率显著高于帕米膦酸二钠,RR=0.93(95%CI:0.88～0.98),P=0.005,显效率也显著高于帕米膦酸二钠,RR=0.82(95%CI:0.69～0.97),P=0.02。结论唑来膦酸较帕米膦酸二钠治疗肿瘤骨转移疼痛疗效更好。     

食管鳞癌的放射治疗加TP方案化疗综合治疗86例分析

目的探讨紫杉醇与顺铂同步化疗联合放疗对食管癌的可行性和近期疗效。方法对126例食管鳞癌患者进行前瞻随机分组研究,其中单纯放疗组40例,放化同步治疗综合组86例。放疗采用常规分割方式,总剂量50~64 Gy,放化疗同步治疗组在上述放疗的同时加用化疗,化疗采用TP方案。计算2组总生存率、放化疗毒副反应,以及死亡原因分析。结果放化疗组和单纯放疗组的1年生存率分别为76.7%和71.8%。同期放化疗可提高KPS评分90、N1期亚组的1年生存率。放化疗同步治疗组Ⅲ~Ⅳ级骨髓抑制、食管炎发生率高于单纯放疗组,但差异无统计学意义,其他急性毒副反应、晚期副反应发生率相似。2组的局部复发率分别为48.8%、66.7%,远处转移率分别为16.3%、12.8%。结论同期放化疗可提高患者总生存率、KPS评分90和Nl期亚组的生存率,降低区域失败率,但未能降低远处转移率,且Ⅲ~Ⅳ级骨髓抑制、急性食管炎发生率增加。     

直肠癌的术前单独放疗与联合放疗、化疗的疗效比较

目的:分析直肠癌的临床病理变化特征,对术前放疗和联合放疗、化疗的疗效进行评价。方法:146例直肠癌患者分为术前放疗组(组1)31例,放、化疗组(组2)115例。放疗总剂量为45 Gy,每周5次,每次1.8 Gy。全身化疗共2个疗程,四氢叶酸静脉滴入,随后静脉给予5-氟尿嘧啶。辅助治疗完成后4～6周采取手术治疗。结果:治疗中出现的并发症,除了组2的皮肤红斑症较多以外,其它并发症无显著差异。术后并发症最多的是切口延迟愈合,其次为肠梗阻,两组患者术后并发症没有显著差异。腔内B超和CT显示肿瘤大小的减少在组1为45.1%,组2为75.6%。术后病理显示,淋巴结减少在两组中均有明显效果。总复发率在组1为35.4%,组2为20%,且两组患者都表现出远处转移的发生率比局部复发率高。结论:术前放、化疗与单独放疗相比较,治疗中和术后并发症无显著差异;而病理学治疗效果,前者明显优于后者。     

Orlistat, sibutramine, or combination therapy: which performs better on waist circumference in relation with body mass index in obese patients?

The aim of this study was to evaluate decrease in waist circumference in obese patients receiving different anti-obesity treatments. The study was designed as a short-term (12 weeks), open-label, and randomized trial. Eighty six patients (70 females, 81.4%; mean age 41.09+/-8.73 years, mean BMI 36.1+/-4.3 kg/m2) were randomized to four different therapy groups. The primary outcome parameters were waist circumference and body mass index (BMI). The therapy groups were a) diet+sibutramine 1 x 10 mg/d (n=22), b) diet+orlistat 3 x 120 mg/d (n=25), c) combination of diet+sibutramine+orlistat (n=20) and d) diet (n=19). Combination therapy was more effective than diet and orlistat mono-therapy (p<0.0001 for all), but not significantly superior to sibutramine mono-therapy (p=0.072) in decreasing BMI. Sibutramine mono-therapy was significantly more effective in inducing BMI decrease compared with orlistat mono-therapy (p=0.039). The association between change in BMI and change in waist circumference was strongest in the orlistat mono-therapy group (P interaction=0.003). This means that patients taking orlistat experienced more decrease in waist circumference (3.4 cm, R2=0.29) per unit decrease in BMI compared to patients under combination therapy (2.6 cm, R2=0.25, P interaction = 0.015) and patients taking sibutramine (1.8 cm, R2=0.19, P interaction=0.026). In the diet therapy group decline in waist circumference was independent of BMI (1.9 cm, R2=0.02, P interaction=0.076). Although combination therapy and sibutramine mono-therapy were more effective in decreasing BMI, reduction in waist circumference and BMI was most significantly associated with the orlistat mono-therapy group. This may hint at the possibility of orlistat inducing weight loss mainly in the abdominal area targeted to reduce cardiovascular risk.     

免疫组织化学法与流式细胞术在非小细胞肺癌骨髓微转移检测中的效果

目的免疫组织化学法和流式细胞术检测非小细胞肺癌骨髓微转移状况的差异比较。方法选取2009年5月至2011年3月我院手术治疗的非小细胞肺癌160例,术前没有经历化疗及放疗,术中抽取肋骨骨髓,分别应用免疫组织化学法和流式细胞技术检测骨髓中阳性细胞表达率。结果160例非小细胞肺癌患者免疫组化检测骨髓转移阳性率为30．0％（48例）,流式细胞术检测骨髓转移阳性率为34．4％（55例）,112例免疫组化检查阴性的患者中,流式细胞术检测发现12例患者骨髓中存在微转移;而48例免疫组化检查阳性的患者中,有5例流式细胞术检测为阴性。结论流式细胞术和免疫组化技术都可检测非小细胞肺癌骨髓微转移,流式细胞技术有着更高的敏感性和检测效率。     

乳腺癌根治术后胸壁复发142例治疗分析

目的探讨乳腺根治术后单纯胸壁复发的治疗措施。方法对乳腺根治术后单纯胸壁复发142例患者的再次治疗方式作回顾性分析。单纯手术治疗25例,单纯化疗19例,单纯内分泌治疗3例,化疔＋放射治疗42例,手术后化疗＋放射治疗34例,化疗＋放射治疗后手术7例,手术后化疗十放射治疗＋内分泌治疗12例。结果单一方式治疗47例,27例胸壁再复发,35例出现远处转移,5年生存率25．5％;综合治疗方案95例,15例胸壁再复发,54例出现远处转移,5年生存率43．2％。结论乳腺癌根治术后的单纯胸壁复发患者疗效,综合治疗优于单一方法治疗。     

放疗和博宁治疗骨转移癌疼痛的疗效观察

目的 :对比观察骨转移癌疼痛行放疗止痛和博宁止痛的疗效。方法 :6 9例骨转移癌疼痛患者随机分为放疗组 (36例 ,局部放疗 DT 2 0 GY/5 F/1W)和博宁组 (33例 ,第 1天静滴博宁 90 mg,第 15天再静滴 6 0 mg)。结果 :放疗组与博宁组止痛有效率分别为 91.7%和 81.8% (P>0 .0 5 ) ;单发骨转移癌痛病灶放疗组与博宁组止痛有效率分别为 95 .7%和 73.3% (P<0 .0 5 ) ;多发骨转移癌痛病灶放疗组与博宁组止痛有效率分别为 84 .6 %和 88.9% (P>0 .0 5 )。结论 :放疗与博宁治疗骨转移癌疼痛都具有良好的止痛效果 ,但对单发骨转移癌痛病灶 ,应首选放疗。     

术前放疗和化疗联合手术治疗老年中晚期食管癌的疗效观察

目的分析术前放、化疗联合手术治疗老年中晚期食管癌的临床疗效。方法将60例老年食管癌患者随机分为术前放、化疗联合手术治疗组（联合治疗组）和单纯手术组,每组各30例。联合治疗组术前予以辅助放、化疗,放、化疗结束3～5周后行手术切除治疗;单纯手术组仅实施手术治疗。结果联合治疗组总有效率为76．67％,明显优于单纯手术组的30．00％（P〈0．05）,且联合治疗组患者术后骨髓抑制、恶心呕吐及放射性食管炎发生率均低于单纯手术组（P〈0．05）。患者总随访率为96．67％,随访结果显示联合治疗组总复发率低于单纯手术组,且除1年局部控制率两组间差异无统计学意义（P〉0．05）外,联合治疗组的肿瘤局部控制率、生存率均明显优于单纯手术组（P〈0．05）。结论术前辅助放、化疗能提高老年中、晚期食管癌手术疗效,提高肿瘤局部控制率和生存率,减少肿瘤复发和转移。     

恩度联合放化疗治疗晚期非小细胞肺癌患者的护理

目的 探讨肿瘤靶向治疗药物恩度联合放化疗治疗初诊晚期非小细胞肺癌的优势,寻找一种治疗晚期非小细胞肺癌有效的治疗组合模式,提高晚期肺癌患者的生存率及生存质量.方法 将2009年7月至2010年2月收住的18例初诊为晚期非小细胞肺癌患者随机分为实验组(含恩度)和对照组(不含恩度)各9例,采用诱导化疗并三维适形放疗,观察2组患者治疗的临床症状缓解率、疗效、不良反应,同时做好放化疗及靶向治疗的护理.结果 实验组及对照组的疗效分别为77.8%和66.7%,实验组的临床症状缓解率与对照组比较无显著差异,2组患者均有不同程度的不良反应,在护理人员的整体护理和系统健康教育下,均顺利完成治疗.结论 恩度联合放化疗治疗初诊晚期非小细胞肺癌,能提高疗效及生存率,改善生活质量,虽有一定的不良反应,但经对症处理及护理能缓解.

Abstract：

Objective To study in targeted therapy of cancer drug endostar combined with radiotherapy and chemotherapy in the treatment of newly diagnosed patients with advanced non-small cell lung cancer, and find an effective combined treatment mode of advanced non-small cell lung cancer, so as to improve the survival rate and quality of life of patients with advanced lung cancer. Methods 18 patients with newly diagnosed advanced non- small cell lung cancer admitted to our hospital from July 2009 to February 2010 were randomly divided into 2 groups and treated with induction chemotherapy and 3D-CRT,9 cases in the experimental group (including Endostar), 9 cases in the control group, All of the patients'clinical symptoms, efficacy and toxicity in the two groups were observed. At the same time, nursing of radiotherapy, chemotherapy and targeted therapy was given to paients. Results The efficacy of the experimental group and the control group were 77.8% and 66.7%, the clinical remission rates of the experimental group and the control group showed no significant difference, both of the patients in the two groups had varying degrees of toxicity, but all of the them completed the treatment well under the holistic nursing and systematical health education by nurses. Conclusions Endostar combined with induction chemotherapy and three-dimensional conformal radiotherapy (3D-CRT) in the treatment of advanced non-small cell lung cancer can improve the efficacy and survival rate, and the quality of life, although there are some side effects, but can be alleviated by symptomatic treatment and care.     

内镜下微波治疗联合局部放疗对晚期肺癌疗效及免疫指标的影响

目的 观察经纤维支气管镜介导微波热凝固疗法加局部放疗治疗晚期中心型肺癌疗效及相关免疫指标的影响。方法 将58例晚期中心型肺癌患者随机分为治疗组和对照组。治疗组采用纤维支气管镜介导微波热凝固疗法加局部放疗；对照组采用单纯局部放疗。于治疗前后观察疗效及相关免疫指标变化。结果 与对照组相比，治疗组在治疗后1、2周内外用血树突状细胞数量、T淋巴细胞亚群、淋巴细胞转化率明显提高，癌胚抗原、肿瘤相关生长因子明显下降；治疗组30例，1周内气道阻塞完全缓解18例，部分缓解12例，有效率95％．明显高于对照组（P〈0．05）。结论 纤维支气管镜介导微波热凝固疗法加局部放疗治疗晚期中心型肺癌能快速解除气道阻塞，并有效改善患者机体细胞的免疫功能。     

The role of disodium pamidronate in the management of bone pain due to malignancy

A number of controlled studies have recently demonstrated the role of disodium pamidronate in the prevention of skeletal complications in patients with metastatic bone disease due to breast cancer and multiple myeloma. They have also shown that it relieves pain and is well tolerated. The aim of this open prospective study was to evaluate the acceptability of a new schedule of pamidronate infusion and to assess pain, analgesic consumption and the Karnofsky Performance Status (KPS) in patients with metastatic bone pain treated with pamidronate in association or not with chemotherapy, radiotherapy, and hormone therapy. Patients with different types of cancer and at least one painful bone metastasis were treated with two cycles of 60 mg intravenous (iv) pamidronate weekly for three consecutive doses, with a 3-week interval between the two cycles (six infusions over 7 weeks), followed by one infusion every 3 weeks for a total of 24 infusions. Two hundred patients were enrolled in the study, of whom 94 received at least the first six infusions; 25 patients received all 24 infusions. Pamidronate was well tolerated in the majority of the patients both during the first six infusions and during the whole study period. In the patients under study, pain intensity decreased compared with T0 after the first two infusions (second week of treatment). The mean equivalent daily dose of oral morphine required ranged from 21.5 to 41.5 mg/day and was low and stable during the study. For the patients who remained in the study, the KPS remained around 70 during the whole treatment period and intrasubject analysis showed a substantial stability of the KPS within each subject. A first fracture occurred within 321 days in 25% of the whole population under study. Pamidronate represents a further valid therapy to add to an already consolidated list of therapies such as radiotherapy, chemotherapy, hormone therapy and orthopaedic intervention in the pain management of patients with bone metastases. Future studies are necessary to evaluate the role of pamidronate and the appropriate schedule in patients with advanced or terminal cancer who are no longer being treated with oncological therapies.