多发性骨转移癌止痛方法效果比较分析

目的 :分析不同治疗方法对骨转移癌缓解骨痛 ,改善生活质量的临床意义。方法 :对 14 5例多发性骨转移癌患者用局部放疗 ,内照射治疗 (153 Sm EDTMP) ,阿可达 (帕米膦酸二钠 )治疗 ,化疗等不同治疗方法 ,并分组观察治疗后疼痛缓解及生活质量的改善。结果 :153 Sm加止痛性放疗组疗效最好 ,有效率达 95 8%。同化疗加外照射组及化疗加153 Sm组比较有统计意义 ,(P <0 0 0 1)。综合治疗组总有效率为 78 0 % ,高于单一治疗组 (P <0 0 0 5 )。在外照射组与外照射加153 Sm组毒性反应比较组 ,后者的血液毒性反应稍大 ,但经统计学处理无意义。结论 :根据患者病灶及全身情况 ,放射性核素153 Sm ,加局部止痛性放疗等综合治疗 ,是多发性骨转移癌安全、有效、经济的治疗方案     

~(153)Sm-EDTMP 治疗肺癌骨转移

目的　探讨1 53Sm EDTMP治疗肺癌骨转移的临床效果。方法　 1 1 0例肺癌伴骨转移的患者接受该治疗。采用两次给药法 ,第一次先注射示踪剂量 ,分别计算尿排谢率、骨摄取率、骨累积活性、红骨髓的吸收剂量、总用药量以后 ,再注射第二次剂量。结果　疼痛完全缓解者 38例 ,中度缓解者 6 0例 ,总止痛有效率为 89.1 % (98/1 1 0 )。患者疼痛缓解出现的时间为 3h～ 4周 (7.5d± 6 .3d) ,疼痛完全缓解维持的时间范围为 2～ 4周。 1 1 0例中有 1 2例病灶消失 (CR) ,Karnofsky评分上升 2 0分左右 ,减少或取消止痛药 ;2 0例患者转移病灶数量减少、病灶缩小 (PR) ,Karnofsky评分上升 1 0～ 1 5分。转移灶治疗总有效率为 2 9.1 % (32 /1 1 0 )。 35例患者的白细胞和血小板计数与治疗前比较 ,有明显减少 ,1～ 3月后恢复到治疗前水平。结论　1 53Sm EDTMP治疗肺癌骨转移是一种安全、有效的方法     

153Sm-EDTMP治疗癌性骨痛的临床研究

目的:观察153Sm蛳乙二胺四亚甲基膦酸(153Sm蛳EDTMP)对癌性骨痛的治疗作用及影响因素。方法:对56 例首次应用153Sm蛳EDTMP治疗的肿瘤骨转移疼痛患者,按疼痛部位、病理、骨转移灶数目进行统计分析。结果:疼痛缓解的总有效率为69.6 %,前列腺癌和乳腺癌疗效明显好于肺癌(χ2=9.144 P<0.01),疼痛部位、骨转移数目对疗效无显著影响。结论:前列腺癌和乳腺癌骨转移患者,行153Sm蛳EDTMP效果较好。     

^153Sm—EDTMP治疗转移性骨痛疗效分析

用153Sm－sortan治疗48例癌症骨转移性疼痛二按29.6MBq／Kg计算治疗剂量，静脉注射。其中12例接受2—5次治疗，2次间隔4周。本组骨痛完全缓解18例，部分缓解21例，总有效率81．25％。缓解时间2—12周，镇痛疗效可能同原发肿瘤类型、骨转移病灶数量及大小相关。153Sm—EDTMP骨髓毒性低，但多次用药对骨髓毒性有剂量累积。     

放射性核素153SM-EDTMP治疗乳腺癌骨转移

目的 :研究乳腺癌术后骨转移患者的放射性核素 153　Sm EDTMP治疗的临床效果。方法 :静脉注射 153　Sm EDTMP ,给药量 0 .5～ 1.5mCi kg体重。每月 1次 ,3次 1个疗程。结果 :153Sm EDTMP治疗乳腺癌骨转移患者不但可使骨转移疼痛缓解 (87.0 % ) ,而且对骨转移肿瘤灶有治疗作用 (5 4 .3% ) ,多数患者 (80 .2 % )出现白细胞或血小板一过性减少。结论 :放射性核素治疗方法简单 ,副作用较小 ,治疗效果较好 ,已成为一种新的骨转移癌的治疗手段而广泛应用于临床     

国产帕米膦酸钠(博宁)在骨转移性疼痛中的应用

对确诊为骨转移并伴有疼痛的晚期恶性肿瘤患者 85例 ,单纯应用 (国产帕米膦酸钠博宁Bonin) 2 2例 ,Bonin联合放疗 17例 ,Bonin联合153 Sm 14例 ,Bonin联合化疗 32例。Bonin用法 :90mg在 2 4～ 72h内静脉滴入 ,每个月 1次。评价止痛效果和活动能力改善情况。单一应用Bonin止痛有效率 72 .7% ,活动能力改善率 6 3.6 % ,联合放疗或同位素治疗 ,止痛有效率提高 ,活动能力改善明显 (P <0 .0 5 )。研究结果提示 ,对伴有骨转移的恶性肿瘤患者 ,Bonin可作为基础治疗措施应用。     

153SM-EDTMP联合抗雄激素缓解前列腺癌骨转移骨痛27例报告

目的　探讨缓解晚期前列腺癌骨转移所致的骨痛的方法 ,以提高患者的生存质量。方法　153 SM EDTMP联合抗雄激素综合治疗 2 7例前列腺癌骨转移病人 ,观察疼痛缓解和功能障碍的恢复情况。结果　显效 :11例 ,有效 :11例 ,稳定 :5例 ,有效率 82 %。止痛效果与是否切除前列腺无关。对中分化前列腺癌止痛效果较好。结论　应用同位素联合抗雄激素综合治疗前列腺癌骨转移是一种有效的骨痛姑息治疗技术。     

氯屈膦酸二钠治疗骨转移癌疼痛25例疗效观察

骨转移是晚期恶性肿瘤的常见并发症之一 ,产生的骨痛严重影响患者的生活质量。我们 1999年 5月～ 2 0 0 1年 4月应用抗骨溶解制剂氯屈膦酸二钠 (商品名为德维 )治疗晚期癌症骨转移疼痛患者 2 5例 ,取得了满意的疗效 ,总结报告如下。1　临床资料1.1　一般资料本组患者共 2 5例 ,男 17例 ,女 8例 ,年龄 31～ 74岁 ,中位年龄 5 3岁。原发癌种类包括 :肺癌 13例 ,乳腺癌 6例 ,食管癌1例 ,鼻咽癌 3例 ,原发灶不明 2例。行Ｘ线、ＣＴ、ＭＲＩ或ＥＣＴ等检查证实有溶骨性破坏病灶。所有病例均有不同程度的骨痛。血钙、血常规、心、肝肾功能检查结果…     

153SM-EDTMP治疗多发性骨转移癌疼痛

晚期癌症患者骨转移是目前临床面临的严重问题之一。在晚期癌症患者中约有 5 0 %～ 70 %存在骨转移 ,骨转移处引起的疼痛十分剧烈 ,严重影响患者的生存质量。目前 ,临床治疗各种癌痛的方法对多发性骨转移癌效果均不佳 ,以给止痛剂治疗为主 ,大剂量止痛剂易造成恶心、呕吐、便秘等诸多不良反应 ,而对骨痛镇痛疗效较差。近年来 ,文献报道采用1 53 SM EDTMP治疗多发性骨转移癌疼痛疗效较好。我科从 2 0 0 0年 6月至 2 0 0 2年 6月采用中国原子能科学研究院同位素所提供的1 53 SM EDTMP对 2 8例确诊为多发性骨转移的患者进行了骨内照射治…     

氯屈膦酸二钠治疗恶性肿瘤骨转移引起疼痛的疗效观察

目的 :观察国产氯屈膦酸二钠 (洛屈 )治疗恶性肿瘤骨转移引起疼痛的临床效果。方法 :共收治有溶骨性骨转移病灶的患者 4 6例 ,采用氯屈膦酸二钠 30 0mg/d ,静脉滴入 ,连用 5d ,3周为 1个疗程。结果 :止痛显效 18例 (39 1% ) ,有效 19例 (4 1 3% ) ,总有效率 80 4 % ,无效 9例。获效时间 5～ 30d ,有效病例 71 6 %在 2周内获效。 4 6例患者在用药过程中未见有严重不良反应 ,耐受性良好。结论 :国产氯屈膦酸二钠是一种治疗恶性肿瘤骨转移引起疼痛的有效药物 ,临床使用方便 ,患者耐受性良好     

Evaluating bone mass and bone quality in patients with breast cancer

Bone remodeling is a process by which bone renews itself focally in distinct areas on cancellous (ie, trabecular) bone and/or in the Haversian systems of cortical (or compact) bone. Normal bone turnover involves the ordered metabolism of bone-resorbing cells (osteoclasts) and bone-forming cells (osteoblasts). Estrogen exerts a multitude of actions on bone tissues and is integral to bone health, and estrogen deprivation leads to accelerated bone loss. Bone strength reflects the integration of bone density and bone quality. Methods to assess bone strength fall into 3 categories: radiologic (ie, bone mineral density [BMD]), biochemical (ie, markers of bone turnover), and histologic (ie, bone biopsies for histomorphometry). The beneficial effect of aromatase inhibitors (AIs) and inactivators on breast cancer depends on reducing levels of circulating estrogens in the peripheral blood. There appears to be variability in the effects of AIs on bone in experimental animals, and this variability may not be the same in humans. In general, bone loss is an expected side effect of the AIs. For postmenopausal women receiving adjuvant anastrozole or other AIs, a BMD measurement using dual-energy x-ray absorptiometry is recommended, to be repeated every 1-2 years. Regular physical exercise is advised together with added calcium 1500 mg and vitamin D 800 U daily. If the T-score reaches a level of >2.5, or if it is between -1.5 and -2.5 in the presence of a fragility fracture or vertebral compression fracture, or if height loss > 2 cm occurs or BMD decreases > 3% in 1 year at the lumbar spine or > 5% at the femoral neck, bisphosphonate therapy should be considered.     

Reducing skeletal complications and bone pain with intravenous ibandronate for metastatic bone disease

Complications of metastatic bone disease substantially compromise patient independence and mobility. The goals of management include reducing the rate of skeletal complications and alleviating bone pain, to improve morbidity and patient quality of life. In a 96-week, randomised, double-blind, phase III trial, intravenous (i.v.) ibandronate 6 mg administered over 1–2 h every 3–4 weeks significantly reduced skeletal complications (assessed by the skeletal morbidity period rate [SMPR]) compared with placebo (P=0.004). Individual components of the SMPR were also significantly reduced with ibandronate (vertebral fractures, P=0.023 and need for bone radiotherapy, P=0.011 versus placebo). Ibandronate 6 mg also significantly reduced bone pain scores and maintained them below baseline over 2 years (P<0.001), an effect not reported with other bisphosphonates for metastatic bone disease. Bone pain alleviation was accompanied by significantly improved quality of life compared with placebo (P=0.004). An independent pilot study used intensive i.v. ibandronate treatment (16 mg over 4 days) to treat opioid-resistant bone pain in patients with metastatic bone disease from various tumour types. Supporting the results of the phase III clinical trial, bone pain was significantly reduced (P<0.001 versus baseline), and patients experienced significant improvement in their quality of life (P<0.05 versus baseline). The results of these studies suggest that i.v. ibandronate effectively reduces skeletal morbidity rate and provides significant bone pain and quality of life benefits that have not been demonstrated so far with other bisphosphonates.     

骨保护素/骨保护素配体（OPG/OPGL）在骨髓基质干细胞复合同种骨修复骨缺损中的表达及意义

目的 探讨OPG/OPGL蛋白在骨髓基质干细胞（BMSCs）复合同种骨移植修复大鼠桡骨缺损中的表达及意义.方法 4周龄SD大鼠BMSCs体外分离培养,取生长状态良好的第3代细胞复合同种骨.同时取8周龄SD大鼠32只,雌雄不限,制备大鼠双侧桡骨中段5mm节段性骨缺损模型.采用自身对照的方法 ,一侧植入BMSCs及同种异体骨颗粒复合物作为实验组;另一侧植入等量单纯同种异体骨颗粒作为对照组.按术后2、4、8、12周4个时间点（每个时间点8只）处死动物并立即于骨缺损部位取材,大体及组织学观察、免疫组织化学（PV法）检测OPG、OPGL蛋白的表达.免疫组化所得数据经计算机图像分析系统计算其平均光密度值（OD值）.结果 术后各时间点大体形态与组织学观察：实验组骨缺损修复速度均明显优于对照组;OPG蛋白免疫组化结果 显示：2、4、8周实验组OPG的表达高于对照组（P＜0.05）,而12周时两组比较差异无统计学意义（P＞0.05）;OPGL蛋白免疫组化结果 显示：2、4周实验组OPGL的表达高于对照组（P＜0.05）,而8、12周时两组比较差异无统计学意义（P＞0.05）.结论 骨缺损修复区OPG、OPGL蛋白表达水平与骨修复愈合程度密切相关.OPG蛋白表达升高,其成骨作用加强, 而OPGL蛋白表达则相反.提示OPG的高表达可促进骨愈合,减少骨吸收;反之则促进骨吸收.     

Genes associate with abnormal bone cell activity in bone metastasis

Bone is one of the most frequent sites of metastasis in patients with malignancies. Up to 90?% of patients with multiple myeloma, and 60?% to 75?% patients with prostate cancer and breast cancer develop bone metastasis at the later stages of their diseases. Bone metastases are responsible for tremendous morbidity in patients with cancer, including severe bone pain, pathologic fractures, spinal cord and nerve compression syndromes, life-threatening hypercalcemia, and increased mortality. Multiple factors produced by tumor cells or produced by the bone marrow microenvironment in response to tumor cells play important roles in activation of osteoclastic bone resorption and modulation of osteoblastic activity in patients with bone metastasis. In this chapter, we will review the genes that play important roles in bone destruction, tumor growth, and osteoblast activity in bone metastasis and discuss the potential therapies targeting the products of these genes to block both bone destruction and tumor growth.     

Leiomyosarcoma of bone arising in association with a bone infarct

Both primary leiomyosarcoma of bone and sarcoma arising in association with a bone infarct are rare events. In this case report we describe for the first time a case of leiomyosarcoma arising in a bone infarct. The tumour arose in a medullary infarct in the proximal femur of an elderly patient. As in other cases of sarcoma arising in a bone infarct, the prognosis was poor, the patient dying within 6 months of diagnosis.     

骨髓活检对诊断非霍奇金淋巴瘤骨髓浸润及分期意义的探讨

目的:探讨骨髓活检切片分析在非霍奇金淋巴瘤骨髓浸润(NHLBMI)诊断及临床分期方面的价值。方法:对128例非霍奇金淋巴瘤患者行骨髓活检术,分析活检切片。结果:骨髓活检切片中非霍奇金淋巴瘤骨髓浸润的阳性率为35.9%(46例)。经骨髓活检后,16例Ⅰ～Ⅲ期提升为Ⅳ期,骨髓活检前、后Ⅳ期所占比例有明显差异(P<0.01)。结论:骨髓活检切片分析对非霍奇金淋巴瘤骨髓浸润的诊断及临床分期具有重要意义。     

Normalization of bone markers is associated with improved survival in patients with bone metastases from solid tumors and elevated bone resorption receiving zoledronic acid

BACKGROUND: For patients with bone metastases, high N-telopeptide of type I collagen (NTX) levels correlate with increased risks of skeletal-related events and death. However, the relation between NTX decreases and clinical benefits is unclear. METHODS: Correlations between NTX normalization during treatment and clinical outcome were retrospectively analyzed in 3 large, phase 3 trials. Urinary NTX levels were measured at baseline and at Month 3 in patients with bone metastases from breast cancer (BC; n = 578), hormone-refractory prostate cancer (HRPC; n = 472), or nonsmall-cell lung cancer and other solid tumors (NSCLC/OST; n = 291) who received zoledronic acid or control (pamidronate for BC; placebo for HRPC and NSCLC/OST) for up to 24 months. NTX levels were characterized as normal (N; <64 nmol/mmol creatinine) or elevated (E; > or =64 nmol/mmol creatinine). RESULTS: After 3 months of zoledronic acid, most N-group patients maintained normal levels; however, most E-group patients normalized their NTX levels (BC, 81%; HRPC, 70%; NSCLC/OST, 81%). In contrast, NTX levels normalized with pamidronate in 65% of BC, with placebo in 8% of HRPC, and in 17% of NSCLC/OST E-group patients. Normalized NTX correlated with improved overall survival versus persistently elevated NTX (significant for zoledronic acid-treated patients; trend for placebo-treated patients). Moreover, percentage reductions from baseline NTX levels correlated with benefits regardless of whether patients transitioned from E to N. CONCLUSIONS: Zoledronic acid normalizes or maintains normal NTX levels in most patients with bone metastases. Normalized NTX within 3 months of treatment, versus persistently elevated NTX, was associated with reduced risks of skeletal complications and death.     

自体骨与同种异体骨植骨治疗骨巨细胞瘤临床对比观察

目的总结同种异体骨与自体骨移植在骨巨细胞瘤刮除植骨治疗中的临床效果。方法回顾性分析1997年1月至2002年12月,30例用同种异体辐照骨与自体骨(3例加骨水泥)充填修复骨巨细胞瘤刮除后遗留的局限性缺损病人的病历资料。结果随访时间2.5～9年,植骨全部愈合,功能恢复正常,复发3例。结论术前准确评估,术中彻底清除对降低肿瘤复发率有重要作用;同种异体骨移植具有良好的组织相容性和成骨活性,与自体骨移植疗效相当,是骨巨细胞瘤刮除术后骨缺损的较理想的修复材料。