唑来膦酸或帕米膦酸二钠联合阿那曲唑治疗绝经后乳腺癌骨转移的疗效观察

目的 比较唑来膦酸和帕米膦酸二钠分别联合阿那曲唑治疗绝经后乳腺癌骨转移的临床疗效及不良反应。方法 收集2010年1月至2014年6月我院肿瘤科收治的绝经后乳腺癌骨转移患者51例，以随机数字表法分为对照组（n=27）和治疗组（n=24）。治疗组口服阿那曲唑（1 mg/d）联合唑来膦酸4 mg静滴；对照组口服阿那曲唑（1 mg/d）联合帕米膦酸二钠60 mg静滴，28 d为1个周期。观察两组骨痛缓解情况、骨转移灶清退情况、无骨相关事件（skeletal related evend，SRE）生存时间、总生存时间及不良反应。结果 治疗14　d后对照组和治疗组疼痛控制总有效率分别为66.7%和87.5%，差异有统计学意义（P＜0.05）；治疗56 d后对照组疼痛控制总有效率为77.8%，治疗组为91.7%，差异无统计学意义（P＞0.05）。治疗组的骨转移灶清退情况显著优于对照组，差异有统计学意义（P＜0.05）。对照组与治疗组中位无SRE生存时间为17.4个月和22.4个月，中位总生存时间为25.8个月和35.1个月，差异均有统计学意义（P＜0.05）。不良反应主要为发热、肌肉及骨酸痛等，给予对症治疗后缓解。结论 唑来膦酸联合阿那曲唑治疗绝经后乳腺癌骨转移疗效较好，不良反应可耐受，安全性良好，值得临床推广应用。

Efficacy of Anastrozole combined with Zoledronic acid or Pamidronate in postmenopausal breast cancer patients with bone metastases

Objective To compare the clinical efficacy and adverse effects of anastrozole therapy involving either zoledronic acid or pamidronate disodium for reducing skeletal complications in patients with postmenopausal breast cancer involving bone metastases. Methods This study involved 51 patients diagnosed with postmenopausal breast cancer with bone metastases based on pathology and imaging between January 2010 and June 2014. Patients were randomly allocated into a control group that received anastrozole and pamidronate disodium（n=27） or a group that received anastrozole and zoledronic acid （n=24）. Drugs were administered on a 28-day cycle as follows：anastrozole，1 mg，qd，po； zoledronic acid，4 mg， ivgtt；pamidronate disodium，60 mg，ivgtt. Survival time based on skeletal-related events（SREs） and overall survival were evaluated strictly. Bone pain，bone metastasis remission and adverse reactions were also recorded. Results On day 14 of treatment， the total effective rate of pain relief was significantly higher in the anastrozole and zoledronic acid group（87.5%） than in the control group （66.7%，P<0.05）. On day 56，the respective rates were similar （91.7% vs 77.8%，P>0.05）. Anastrozole and zoledronic acid treatment led to significantly greater bone metastasis remission （P<0.05），longer median survival time without SREs （22.4  vs 17.4 months，P<0.05） and longer median overall survival time（35.1 vs 25.8 months， P<0.05）. Frequent adverse effects included fever as well as muscle and bone pain；these effects　were relieved after symptomatic treatment. Conclusion Using zoledronic acid in combination with anastrozole  shows good efficacy and tolerable toxicity in patients with postmenopausal breast cancer involving bone metastasis. This therapy merits further clinical studies.