核素89SrCl2治疗骨转移瘤患者的临床观察

目的探讨核素89SrCl2对骨转移瘤患者的治疗效果。方法 75例肿瘤患者经全身骨扫描显像证实存在多发性骨转移瘤,使用核素89SrCl2治疗后,通过统计分析比较治疗前后骨痛的缓解程度、外周血象的改变及骨转移灶变化情况。结果核素89SrCl2治疗骨转移瘤疗效明确,75例患者中60例疼痛出现不同程度的缓解,缓解率达80%（P〈0.01）,其中19例患者疼痛完全消失;而治疗前后外周血象无明显改变;患者骨转移灶缓解率达89%（P〈0.01）。结论核素89SrCl2对骨转移瘤患者的止痛效果好,毒副反应小,且骨转移灶缓解率高,是一种有效的治疗手段。     

125I粒永久植入及89SrCl2治疗雄激素非依赖型伴骨转移前列腺癌

目的探讨125I粒永久植入及氯化锶[89SrCl2]静脉注射治疗雄激素非依赖型伴骨转移前列腺癌的疗效.方法在直肠B超引导下,经会阴穿刺将125I粒子植入到前列腺组织中进行组织间放疗, 静脉注射89SrCl2 111～148MBq/次,治疗前列腺癌伴骨转移患者11例.结果随访3～12个月,8例前列腺体积缩小,PSA 3例降至正常、5例不同程度下降、2例无变化,1例上升;骨痛完全缓解3例,部分缓解5例,2～6个月后X线片及骨扫描显示病灶部分消失、变淡5例;治疗一周后4例出现白细胞及血小板计数下降,但4～5周后渐恢复治疗前水平;术后未出现严重放射并发症.结论 125I粒永久植入及89SrCl2治疗骨转移前列腺癌是比较有效而且安全.     

~(125)I粒永久植入及~(89)SrCl_2治疗雄激素非依赖型伴骨转移前列腺癌

目的　探讨12 5I粒永久植入及氯化锶 [89SrCl2 ]静脉注射治疗雄激素非依赖型伴骨转移前列腺癌的疗效 .方法　在直肠B超引导下 ,经会阴穿刺将12 5I粒子植入到前列腺组织中进行组织间放疗 ,静脉注射89SrCl2 111～14 8MBq/次 ,治疗前列腺癌伴骨转移患者 11例 .结果　随访 3～ 12个月 ,8例前列腺体积缩小 ,PSA 3例降至正常、5例不同程度下降、2例无变化 ,1例上升 ;骨痛完全缓解 3例 ,部分缓解 5例 ,2～ 6个月后X线片及骨扫描显示病灶部分消失、变淡 5例 ;治疗一周后 4例出现白细胞及血小板计数下降 ,但 4～ 5周后渐恢复治疗前水平 ;术后未出现严重放射并发症 .结论　12 5I粒永久植入及89SrCl2 治疗骨转移前列腺癌是比较有效而且安全     

^125Ⅰ粒永久植入及^89SrCl2治疗雄激素非依赖型伴骨转移前列腺癌

目的探讨^125Ⅰ粒永久植入及氯化锶[^89SrCl2]静脉注射治疗雄激素非依赖型伴骨转移前列腺癌的疗效．方法在直肠B超引导下，经会阴穿刺将^125Ⅰ粒子植入到前列腺组织中进行组织间放疗，静脉注射^89SrCl2 111～148MBq／次．治疗前列腺癌伴骨转移患者11例．结果随访3～12个月，8例前列腺体积缩小，PSA3例降至正常、5例不同程度下降、2例无变化．1例上升；骨痛完全缓解3例，部分缓解5例，2～6个月后X线片及骨扫描显示病灶部分消失、变淡5例；治疗一周后4例出现白细胞及血小板计数下降，但4．5周后渐恢复治疗前水平；术后未出现严重放射并发症结论^125Ⅰ粒永久植入及^89SrCl2治疗骨转移前列腺癌是比较有效而且安全．     

核素^89Sr治疗前列腺癌骨转移临床价值及血清tPSA变化的研究

目的：探讨^89锶（^89Sr）治疗前列腺癌多发骨转移的效果。方法：经病理证实31例前列腺癌多发骨转移的患者共行50次^89Sr内照射治疗。治疗后随访患者的血常规、肝功能、肾功能、tPSA、骨痛评分及99mTc-MDP全身骨显像。根据骨痛的缓解情况分为4级：Ⅰ级（无反应）,Ⅱ级（有反应）,Ⅲ级（缓解）,Ⅳ级（完全缓解）。结果：31例患者中,总有效率为74.2%。其中Ⅳ级5例,Ⅲ级18例,Ⅱ级6例,Ⅰ级2例。副作用轻微、一过性的骨髓抑制,^89Sr治疗后,患者的PSA下降。结论：^89Sr有非常高的骨痛缓解率和非常小的副作用,前列腺癌多发骨转移应采取^89Sr治疗。     

89SrCl2治疗前列腺癌骨转移疗效分析

前列腺癌是老年男性常见恶性肿瘤之一,骨转移的发生率较高,国外报道为70%[1].约60%～70%出现剧烈疼痛,严重影响患者生活质量,氯化锶(89SrCl2)是一种用于转移性骨肿瘤所致疼痛的姑息治疗的放射性药物,1941年首次被用于前列腺癌骨转移患者,获得较好疗效.大量临床应用是在20世纪70年代中后期开始的.我们自2003年1月～2005年3月采用89SrCl2治疗27例前列腺癌骨转移患者,现报告如下.     

PSA、SPECT骨显像在前列腺癌诊断和治疗中的临床价值

目的:探讨PSA、SPECT骨显像在前列腺癌诊断及治疗中的临床应用.方法:对72例经临床确诊的前列腺癌患者全部行血清PSA测定及全身骨显像,并对部分患者治疗后进行了随访.结果:前列腺癌组PSA明显高于正常对照组、良性前列腺疾病组;前列腺癌骨转移组PSA明显高于非骨转移组;72例前列腺癌初诊患者骨显像发现24例骨转移瘤,阳性率33.3%.结论:血清PSA与骨显像联检对前列腺癌临床诊断、疗效观察及预后判定具有重要的指导意义.     

89Sr联合99Tc-MDP内照射治疗肺癌骨转移疼痛的临床观察

目的观察锶(89Sr)联合锝(99Tc-MDP)治疗肺癌骨转移临床疗效。方法将63例肺癌骨转移患者随机分为实验组(30例)与对照组(33例)。实验组应用89Sr联合99Tc-MDP治疗,对照组应用89Sr治疗。随访3个月,主要观察两组患者治疗前后的疼痛、生活质量、血象、骨显像所示骨转移灶数目的改善情况。计数资料采用卡方检验。结果经统计分析,实验组与对照组的止痛有效率分别为80.00%与54.54%;实验组与对照组治疗后骨痛缓解有效率(χ2=4.582)、生活质量改善率(83.33%与57.58%,χ2=4.950)和骨转移病灶治疗有效率(83.33%与60.61%,χ2=3.977)间比较差异有统计学意义(P均0.05),而毒副反应实验组没有明显叠加(χ2=1.880,P0.05)。结论89Sr联合99Tc-MDP的治疗方法较单独使用89Sr能显著提高肺癌骨转移疼痛的临床疗效。     

PSA、cPSA检测和骨显像对前列腺癌早期骨转移的诊断价值

目的:分析前列腺特异性抗原(PSA)、复合前列腺特异性抗原(cPSA)联检和核素全身骨显像对前列腺癌早期骨转移的诊断价值.方法:选择152例患者(其中74例为临床确诊的前列腺癌患者,78例为良性前列腺疾病患者),全部进行血清PSA、cPSA检测,并同时对74例临床确诊的前列腺癌患者进行核素全身骨显像.另选择正常健康查体男性90例检测血清PSA、cPSA结果作为对照组.并计算cPSA/PSA比值.结果:前列腺癌患者血清PSA、cPSA检测结果及cPSA/PSA比值显著高于良性前列腺疾病患者及正常健康男性.其中,骨转移阳性显像组血清PSA、cPSA水平及cPSA/PSA比值显著高于非骨转移显像组,检测存在显著性差异(P＜0.05).结论:当PSA＞20μg/L、cPSA＞10μg/L、cPSA/PSA＞0.80时,发生前列腺癌骨转移的可能性较大,应常规做核素全身骨显像,可早期、全面地发现前列腺癌骨转移.     

血清PSA、ALP检测和核素骨显像诊断前列腺癌早期骨转移

目的:探讨早期明确前列腺癌骨转移的有效方法。方法:选择45例前列腺增生患者作为对照组,用化学发光免疫分析法检测PSA;酶法检测单脂磷酸水解酶(ALP即AKP);用SPECT对38例前列腺癌患者进行全身核素骨显像的同时,测定血清PSA、ALP。结果:有骨转移的Pca患者的血清PSA和ALP浓度明显高于无骨转移及前列腺增生(BHP)患者;骨显像阳性组和骨显像阴性组分别与前列腺增生组比较,PSA有极显著性意义(P<0. 001);ALP测定阳性组与增生组比较有显著性意义(P<0. 001),阴性组与增生组比较无显著性意义(P>0. 05)。结论:同时测定血清PSA和ALP有助于明确前列腺癌患者核素骨显像异常表现的病变性质。     

89^Sr联合内分泌疗法治疗前列腺癌骨转移的疗效观察

目的：探讨89^锶（89^Sr）联合内分泌疗法治疗前列腺癌骨转移性疼痛的疗效。方法：将45例确诊为前列腺癌且具有骨转移病灶并伴有疼痛的患者随机分为两组：89^Sr联合内分泌疗法治疗的治疗组23例,单纯采用内分泌治疗的对照组22例,观察治疗后两组的止痛疗效、血清PSA水平的变化、血象及生化指标的变化。结果：治疗前两组患者的疼痛级数间差异无显著性意义（P〉0.05）。治疗后治疗组患者疼痛级数及血清PSA水平较对照组显著降低（P〈0.01;P〈0.05）;治疗后治疗组患者骨转移病灶治疗有效率较对照组显著升高（P〈0.01）。结论：89^Sr联合内分泌疗法能迅速有效地缓解前列腺癌骨转移疼痛,使骨转移病灶缩小或消失,副作用小,其疗效明显优于单纯内分泌疗法。     

放射性核素89Sr治疗前列腺癌骨转移

目的:探讨利用89Sr治疗前列腺癌骨转移的临床效果.方法:选取47例前列腺癌骨转移病人,采用静脉滴注89Sr的方法进行治疗,每6个月注射一次.结果:89Sr治疗前列腺癌骨转移患者不但可使骨转移疼痛缓解(91.7%),而且对骨转移肿瘤灶有显著的治疗作用(85.11%).结论:放射性核素治疗方法简单,副作用较小,治疗效果较...     

Strontium 89 in the treatment of pain due to diffuse osseous metastases: a university hospital experience

More than two-thirds of the patients with osseous metastases experience debilitating bone pain, requiring some form of pain relief. Analgesics are limited in their efficacy. Palliative application of hemi-body external beam radiation therapy in the treatment of multiple osseous metastases also is limited due to toxicity associated with large treatment ports. Intravenous injections of bone seeking radioisotopes are effective in the palliation of pain with fewer side effects. Forty-one patients with multiple osseous metastases due to prostate and breast cancer were treated with strontium chloride 89 (89Sr) at the department of radiation oncology, in a university hospital. A retrospective analysis of these patients indicated that all subjects had severe pain that diminished their quality of life. Most of these patients had multiple co-morbid factors. Many were on opioids leading to adverse effects such as nausea, constipation, and drowsiness that required additional medication. Objective findings and evaluation of the responses were not always available for all patients. Following treatmentwith 89Sr, over two-thirds of the patients responded favorably and required lower doses of opioids.     

Bone histology at autopsy and matched bone scintigraphy findings in patients with hormone refractory prostate cancer: the effect of bisphosphonate therapy on bone scintigraphy results

Bisphosphonates (BisP) are non-metabolized compounds with high bone affinity used in bone metastasis diagnosis and treatment. Currently, BisP are used to treat hypercalcemia of malignancy as well as to prevent, minimize, or delay skeletal morbidity. These compounds have a long half-life in bone. Thus long-term BisP treatment might saturate bone and interfere with a single-dose scanning agent used for bone scintigraphy when visualizing bone metastases. In an effort to answer this question, this study evaluated the concordance of histology and Technetium⁹⁹ methylene diophosphonate (Tc⁹⁹ MDP) bone scintigraphy in the diagnosis of bone metastases in prostate cancer patients. We assessed the concordance of findings between bone scintigraphy and histology using 188 bone biopsies from 11 autopsied patients who died with metastatic prostate cancer, 5 of whom were treated with pamidronate for 2 to 13 months before death. Overall agreement between histology and bone scintigraphy was 84%, 86% in non-pamidronate-treated patients and 82% in pamidronate-treated patients. Scintigraphic bone metastases without histological metastasis (false negatives = 12.7%) were observed in 24 anatomic locations; half of these were in one patient who had been treated with pamidronate and had no histological bone response to the carcinoma. There were only 4 sites where a positive bone scan was not associated with histologic metastasis (false positives = 2.21%). There was no statistical difference between the treated and non-treated group for concordance, specificity, sensitivity, positive and negative predictive values of bone scintigraphy and prevalence of histological abnormality. Long-term pamidronate treatment of prostate cancer bone metastases does not generally affect the ability to detect bone metastases with Tc⁹⁹ MDP bone scintigraphy. This revised version was published online in July 2006 with corrections to the Cover Date.     

Strontium 89 for palliation of bone metastases

At the University of Kansas Medical Center, systemic use of strontium 89 (⁸⁹Sr), a betaemitting radioisotope, was evaluated in the treatment of metastatic carcinoma to bone for relief of bone pain. Eighty-five patients were treated with systemic ⁸⁹Sr in the dosage of 30 to 40 μCi/kg. All patients had multiple bone metastases, the majority with primary breast or prostatic cancer. The response to treatment was evaluated by daily diary entries, changes in the amount of pain medication, periodic bone scans, and other laboratory values.     

大剂量和常规分割剂量调强适形放疗联合89SrCl2静脉注射治疗肺 癌骨转移的效果

目的:分析大剂量和常规分割剂量调强适形放疗分别联合89SrCl2静脉注射治疗肺癌骨转移的效果,为骨转移的临 床治疗提供试验数据。方法:将80例肺癌骨转移患者按自愿原则分大剂量调强适形放疗组（A组, n=35）和常规分割剂量 调强适形放疗组（B组, n=45）。比较两组近期疗效、远期疗效、疼痛及不良反应发生情况。结果:（1）两组近期疗效等级比 较差异无统计学意义（P>0.05）,A组局部控制率略高于B组（91.43% vs 84.44%）,但差异无统计学意义（P>0.05）;（2）A组 累积生存率为84.00%,高于B组的66.50%,差异无统计学意义（P>0.05）;（3）治疗后两组NRS评分均较治疗前下降,但A 组治疗后NRS评分低于B组,且疼痛缓解开始时间较B组短,差异有统计学意义（P<0.05）;（4）两组白细胞减少、血小板减 少、消化道副反应、神经毒性、放射性皮肤损伤等Ⅲ~Ⅳ级不良反应发生率比较差异无统计学意义（P>0.05）。结论:大剂量 或常规分割剂量调强适形放疗联合89SrCl2静脉注射治疗肺癌骨转移在近远期疗效上获益相当,但前者对疼痛的改善更显 著更迅速,且大剂量调强适形放疗并未增加Ⅲ~Ⅳ级不良反应发生率。     

Tartrate-resistant acid phosphatase as a marker of bone metastases in patients with breast cancer and prostate cancer

Serum activity of tartrate-resistant acid phosphatase 5b (TRAP 5b) in patients with breast cancer and prostate cancer having bone metastases was much higher than in healthy donors and patients without skeletal injuries. TRAP 5b activity in patients with breast cancer and multiple bone metastases surpassed that in patients with single bone metastases. The mean activity of TRAP 5b and range of enzyme activity in women treated with bisphosphonates were significantly lower than in patients not receiving antiresorptive therapy. Diagnostic sensitivity and specificity of TRAP 5b as a marker of skeletal metastases in patients with breast cancer were 82 and 87%, respectively. In patients with prostate cancer these indexes were 71 and 83.4%, respectively. Detection of this marker in tumor patients holds much promise for early diagnostics of bone metastases, estimation of the severity of skeletal metastases, and monitoring of the efficiency of bisphosphonate therapy.