278例骨转移癌与骨痛分析

目的探讨骨转移癌患者的骨痛发生情况及特征。方法对主要通过放射性核素骨显像确诊的278例骨转移癌患者骨痛发生情况及特征进行回顾性分析。结果278例肿瘤骨转移患者中198例有不同程度的骨痛,占71.2%;有80例患者无明显骨痛,占28.2%。骨痛的特征呈多部位性,但以躯干部位疼痛为多见。骨痛的性质为酸痛、钝痛、胀痛、刺痛、撕裂样疼痛等,以近期出现的持续固定性疼痛为多见。结论多数骨转移癌患者存在不同程度的骨痛,骨痛具有一定的特征,部分骨转移癌患者无明显骨痛。     

89锶治疗骨转移癌骨痛疗效分析

目的:探讨89锶治疗骨转移癌骨痛的疗效。方法:回顾性分析218例骨转移癌患者经过89锶治疗后骨痛缓解的有效率、不良反应及影响疗效的因素。结果:218例骨转移癌患者186例患者的骨痛有不同程度的减轻,其中完全缓解68例,部分缓解118例。32例无效。总有效率为85.3%8。9锶的止痛效果和骨转移癌的原发灶的病理类型有关。结论:89锶治疗骨转移癌骨痛,疗效明显,毒副作用小。     

骨转移瘤骨痛临床分析（附168例临床报告）

目的探讨骨转移瘤患者的临床骨痛症状与放射性核素骨显像转移灶的关系。方法对主要通过放射性核素骨显像确诊的168例骨转移瘤患者的临床骨痛情况及特征与核素骨显像转移灶对比进行回顾性分析。结果168例骨转移瘤者中93例有不同程度的骨痛，占55．4％；有75例患者无明显骨痛，占44．6％。骨痛的分布呈多部位性，以身体躯干部位多见。骨痛的性质以酸胀痛为主、有些伴有牵涉痛，多为近期持续固定疼痛。结论大多数骨转移瘤患者有不同程度的骨痛症状，有一定的特征性特点，但是个体差异性很大，疼痛部位、程度与核素骨显像转移灶分布不成正比，相当一部分骨转移瘤患者无明显骨痛。     

云克联合~(153)Sm-EDTMP治疗多发性骨转移癌骨痛49例疗效分析及护理

目的:探讨云克联合153Sm-EDTMP治疗多发性骨转移癌骨痛的疗效及护理方法.方法:将102例患者分为对照组(行单纯153Sm-EDTMP治疗)53例及观察组(行云克联合153Sm-EDTMP治疗)49例.结果:两组治疗后骨痛"闪烁"现象发生率、骨痛缓解率比较差异有统计学意义(P<0.01,P<0.05).结论:云克联合153Sm-EDTMP治疗多发性骨转移癌骨痛的疗效明显优于单纯使用153Sm-EDTMP,可降低骨痛"闪烁"现象发生率,提高骨痛缓解率.     

以骨痛症状为首发表现的前列腺癌临床分析：附51例报道

目的 回顾性分析以骨痛为首发症状的前列腺癌患者的临床特点.方法 收集2003～2010年我院51例以骨痛为首发症状的前列腺癌患者,均经前列腺穿刺或骨转移瘤病理证实.骨转移通过静脉注射555 ～ 925 MBq 99mTc-MDP后通过SPECT/CT采集分析证实,部分经骨肿瘤切除或骨穿刺病理证实.所有患者均接受最大限度雄激素阻断的内分泌治疗.统计其骨转移的部位分布以及前列腺特异抗原（PSA）、碱性磷酸酶（ALP）和Gleason评分对骨转移的预测,分析内分泌治疗对骨痛缓解的有效性和生存分析.结果 患者年龄55 ～ 85岁,平均（72.5±8.5）岁.初诊时骨转移的发生率为92.2％ （47/51）.骨盆转移占21.5％,腰椎转移占29.0％,胸椎转移占15.0％,颈椎转移占3.7％.其中PSA ≥20 ng/ml者44例（86.2％）,其骨转移率达100％;DRE检查阳性者39例（76.5％）;Gleason≥8分者20例（39.2％）;cTNM分期≥T3期者39例（76.5％）.经治疗后80％的患者骨痛症状缓解.1年、3年、5年生存率分别为88.7％、67.8％、54.1％.结论中老年男性以骨痛为首发症状的要考虑发生前列腺癌的可能,若患者PSA≥20 ng/ml,DRE触及结节,Gleason≥8分,cTNM分期≥I3期,发生骨转移的机会大.转移以骨盆、腰椎转移率最高.内分泌治疗可有效缓解骨痛和转移进展.PSA与骨转移有关.     

帕米磷酸二钠治疗恶性肿瘤骨转移及多发性骨髓瘤骨痛

目的观察帕米磷酸二钠治疗恶性肿瘤骨转移及多发性骨髓瘤骨痛的临床疗效及毒副反应。方法分别对19例恶性肿瘤骨转移及6例多发性骨髓瘤骨痛患者采用帕米磷酸二钠60mg加5％葡萄糖静滴4h以上,每月1～2次,3个月为1个疗程。结果25例恶性肿瘤骨转移及多发性骨髓瘤患者骨痛都不同程度的得到减轻,除1例静滴时出现发冷给予5mg地塞米松处理其余24例无明显不良反应。结论帕米磷酸二钠作为双磷酸盐类药物之一,在对晚期肿瘤骨转移及多发性骨髓瘤引起的骨痛治疗安全有效。     

放射性核素89Sr治疗骨转移癌引起骨痛的疗效分析

目的探讨放射性核素89Sr控制骨转移癌引起骨痛的作用。方法选择伴有骨痛的32例骨转移病人,静脉推注89SrCl2,剂量为4mCi/人。结果疼痛缓解总有效率78%(25/32),无效率12·5%(4/32)。结论89Sr治疗能明显缓解骨痛,改善患者的生活质量,有重要的临床意义。     

乳腺癌术后核素全身骨显像160例分析

目的：探讨乳腺癌术后骨转移的发病机率，病灶分布以及临床症状、临床分期、病理类型等与骨转移发生率的关系。方法：对160例乳腺癌术后核素全身骨显像结果进行回顾性分析。结果：160例乳腺癌术后核素全身骨显像有75例发生骨转移，骨转移发生率为46．9％。伴有骨痛者，其骨转移发生率为56．8％，明显高于不伴有骨痛者。单纯癌和浸润性导管癌是乳腺癌术后骨转移的最常见病理类型，同期两者的骨转移发生率差异无显著性。Ⅰ—Ⅳ期的骨转移发生率分别为28.8％、35.6％、69.6％和78．8％，呈明显增高趋势。结论：乳腺癌极易通过血运转移至骨骼，术后伴或不伴临床症状，定期随访骨显像都是必要的，一旦发生骨转移，对治疗方案的制订和预后判断、疗效评估等有重要意义。     

骨代谢标志物在恶性肿瘤骨转移中的研究进展

骨转移是恶性肿瘤常见并发症之一,患者常表现为骨痛、骨折等,不仅严重影响患者生活质量,还暗示不良预后。如何早期发现骨转移是诊治恶性肿瘤的一大难题,也迫切需要发现相关的标志物帮助早期诊断及治疗。骨代谢标志物是指可反映骨代谢及转换情况的骨代谢产物或相关激素,临床广泛用于诊断代谢性骨病、骨质疏松等疾病,可能与恶性肿瘤骨转移存在相关性。该文讨论了骨代谢标志物在恶性肿瘤中的研究进展。     

博宁治疗癌转移性骨痛

骨转移癌导致晚期癌症患者剧烈的骨痛,严重影响着他们的生存质量.近年来我们应用国产帕米膦酸二钠-博宁治疗骨转移癌至骨痛患者30例,疗效满意.     

Should bisphosphonates be standard therapy for bone pain?

 We have been studying bisphosphonates since the early 1980s, initially investigating etidronate in the management of hypercalcaemia and, since the mid-1980s, clodronate in the management of hypercalcaemia, bone pain, and skeletal complications in patients with bone metastases. We have also recently reported that bone metastases can be prevented or delayed in patients without evidence of bone disease but with recurrent disease at other sites. Bisphosphonates are now the standard therapy for hypercalcaemia after rehydration. For patients with bone metastases and bone pain, a trial of clodronate 600–1500 mg i.v. in 500 ml normal saline over 3 h given every 1–2 weeks is worthwhile in association with other modalities such as radiotherapy and analgesic medications. Oral clodronate or intravenous pamidronate should be given as a preventive measure in patients with established bone metastases from breast cancer and myeloma. In patients with no evidence of bone metastases, it may be that bisphosphonates can delay the emergence of bone metastases; at present this remains under clinical investigation and our pioneer trials require confirmation. Clinical trials of bisphosphonates in the treatment of hypercalcaemia, bone pain, management of patients with bone metastases and management of patients with recurrent cancer but no evidence of bone metastases will be discussed.     

大范围扩散加权成像检测恶性肿瘤骨转移瘤:与骨扫描相对照

目的 评价大范围扩散加权成像(DWI)在恶性肿瘤骨转移瘤检测中的应用.方法 18例手术证实的各种恶性肿瘤患者纳入本研究.所有患者均在1个月内同时接受大范围DWI检查和99mTc-MDP骨扫描检查. 结果 18例患者中,15例经常规MRI证实存在骨转移瘤,其中7例为多发骨转移瘤(>10处),另8例共证实23处转移瘤;余3例未见转移瘤.除外7例全身多发骨转移瘤(>10处)患者,对其余11例有(8例)或无(3例)骨转移瘤患者计数病灶数,以患者为单位计算的大范围DWI和骨扫描诊断骨转移瘤的敏感性均为100%,特异性分别为100%、33.33%;曲线下面积分别为1.00和0.67,差异有统计学意义(P=0.04).以病灶为单位计算的大范围DWI和骨扫描诊断骨转移瘤灶的敏感性分别为86.96%、78.26%,特异性均为60.00%;曲线下面积分别为0.74和0.69,差异无统计学意义. 结论 大范围DWI可用于恶性肿瘤骨转移瘤的筛查.     

以骨转移症状首发的肺癌临床特征及误诊分析

目的 探讨以骨转移症状首发的肺癌临床特点,分析误诊原因及预后.方法 回顾分析我院2001年6月～2010年6月诊治的50例以骨转移症状首发的肺癌临床资料.结果 50例均有骨痛,20例伴神经系统症状,6例发生病理性骨折.骨转移以多发、溶骨性骨破坏为主.本组初诊时误诊46例,误诊率92％,误诊时间3d～3个月,误诊疾病前3位为腰椎间盘突出症、椎体骨质增生和原发性骨肿瘤.经手术病理确诊46例,细胞学作出恶性肿瘤诊断但未明确分型2例,影像学确诊2例.本组1年生存率为10％,中位生存期为4个月.结论 以骨转移症状为首发表现的肺癌以多发性、溶骨性骨破坏为特征,腺癌骨转移发生率高,预后差,误诊率高.临床医生对此应高度重视,以减少误诊.     

Symptom clusters in cancer patients with bone metastases

Purpose The purpose of this study is to explore whether bone pain “clusters” with other symptoms in patients with bone metastases. Materials and methods Patients with bone metastases referred to a palliative radiotherapy clinic were asked to rate their symptom distress using the Edmonton Symptom Assessment Scale (ESAS). Analgesic consumption during the previous 24 h was captured at initial consultation. To determine interrelationships between symptoms, a principal component analysis (PCA) with “varimax rotation” was performed on the nine ESAS symptoms. This study defined a “symptom cluster” as two or more symptoms that occur together, are stable, and are relatively independent of other clusters. Patients were followed 1, 2, 4, 8, and 12 weeks post-radiation treatment by telephone. Statistical analysis was performed at each time point for both responders and nonresponders to radiation (response was defined in accordance to the International Bone Metastases Consensus Working Party). Results Five hundred eighteen patients with bone metastases provided complete baseline data using the ESAS. The four most prevalent symptoms were poor sense of well-being (93.5%), fatigue (92.3%), pain (84.1%), and drowsiness (81.8%). Three clusters were identified and accounted for 66% of the total variance at baseline. Cronbach’s alpha coefficient demonstrated high internal reliability in the clusters, with a coefficient ranging from 0.61 to 0.81. It was observed that the clusters changed post-radiation in both responders and nonresponders and that pain clustered with different symptoms (or remained a separate symptom in responders). In nonresponders, three symptom clusters were consistently present, except in week 8. Conclusion Radiotherapy influenced the structure of symptom clusters in both responders and nonresponders. There was evidence that pain clustered out in responders of radiation to pain. It was found that pain clustered with fatigue, drowsiness, and poor sense of well-being at baseline. However, these findings must be heeded with caution, as more work is needed to clearly define symptom clusters and to understand the effects of radiation in the symptom experience of patients with bone metastases.     

SPECT/CT同机融合显像对脊柱单发放射性“热区” 鉴别诊断的临床研究

目的：探讨99Tcm-亚甲基二膦酸盐（MDP）SPECT/CT融合显像对脊柱单发放射性浓聚影“热区”良恶性鉴别诊断的价值。方法：对131例常规99Tcm-MDP SPECT/CT全身骨显像时脊柱单发放射性“热区”同时行断层显像、CT图像以及后两者的同机融合图像。由2名核医学科医生共同阅片,作出最终诊断。结果：131例脊柱单发放射性“热区”,34例诊断为肿瘤骨转移,占总病例数的26.0%;94例诊断为良性病变,占总病例数的71.7%;3例诊断为原发骨肿瘤,占总病例数的2.3％。SPECT/CT同机融合显像不仅解决了常规骨显像对阳性病灶精确解剖定位难的问题,同时也显示脊柱单发病灶的良恶性与病灶的位置、形状密切相关。明显降低了骨显像诊断骨转移的假阳性率,对诊断骨转移的类型也有一定的价值。结论：SPECT/CT同机融合显像检查对脊柱单发放射性“热区”良恶性病变的鉴别诊断有重要的临床价值。     

Efficacy of bisphosphonates for bone pain control

Bone metastasis of malignant tumors causes various skeletal related event(SRE) and often harms patients' quality of life (QOL). Bisphosphonate is a standard treatment medicine for the patient with bone metastasis of malignant tumors. Especially zoledronic acid is recommended for bone metastasis of all malignant tumors in a guideline of American Society of Clinical Oncology (ASCO). Zoledronic acid also consistently reduced brief pain inventory (BPI) composite pain scores from baseline and compared with placebo in Japanese women with bone metastases from breast cancer. Bisphosphonates bring about benefit for the patient who suffers from bone pain.     

Malignant bone pain: pathophysiology and treatment

The presence of bone metastases predicts the presence of pain and is the most common cause of cancer-related pain. Although bone metastases do not involve vital organs, they may determine deleterious effects in patients with prolonged survival. Bone fractures, hypercalcaemia, neurologic deficits and reduced activity associated with bone metastases result in an overall compromise in the patient's quality of life. A metastasis is a consequence of a cascade of events including a progressive growth at the primary site, vascularization phase, invasion, detachment, embolization, survival in the circulation, arrest at the site of a metastasis, extravasion, evasion of host defense and progressive growth. Once cancer cells establish in the bone, the normal process of bone turnover is disturbed. The different mechanisms responsible for osteoclast activation correspond to typical radiologic features showing lytic, sclerotic or mixed metastases, according to the primary tumor. The release of chemical mediators, the increased pressure within the bone, microfractures, the stretching of periosteum, reactive muscle spasm, nerve root infiltration and compression of nerves by the collapse of vertebrae are the possible mechanisms of malignant bone pain. Pain is often disproportionate to the size or degree of bone involvement. A comprehensive assessment including a trusting relationship with the patient, taking a careful history of the pain complaint, the characteristics of the pain, the evaluation of the psychological status of the patient, neurological examination, the reviewing of diagnostic studies and laboratory findings, and individualization of the therapeutic approach, should precede any treatment. Radiotherapy is the cornerstone of the treatment. Low doses given in a single session are safe and effective, and reduce distress and inconvenience associated with repeated sessions. Radioisotopes are more imprecise in delivering specific doses of radiation, but have less toxicity and easy administration as well as effectiveness in subclinical sites of metastases, although storage, dispensing and administration should be under strict control. Chemotherapy and endocrine therapy are difficult to measure in terms of pain relief. Prophylactic fixation surgery can lead to improved survival and quality of life of patients with bone metastases. Surgical treatment should be undertaken when fracture occurs. Careful selection of patients for surgical spinal decompression is required. The potential benefits of surgical interventions have to be tempered with patient survival. The use of analgesics according to the WHO ladder is recommended. There is no clear evidence that non-steroidal anti-inflammatory drugs (NSAIDs) have a specific efficacy in malignant bone pain. The difficulty with incident pain is not a lack of response to systemic opioids, but rather that the doses required to control the incidental pain produce unacceptable side-effects at rest. Alternative measures are often required. The inhibition of bone resorption and hypercalcaemia can be reduced by the use of bisphosphonates. This class of drugs potentiate the effects of analgesics in improving metastatic bone pain. Invasive techniques are rarely indicated, but may provide analgesia in the treatment of pain resistant to the other modalities. Neural blockade should never be used as the sole modality for malignant bone pain, but should be considered as a helpful in specific pain situations. Careful appraisal and the application of a correct approach should enable the patient with bone metastases to obtain an acceptable pain relief despite the advanced nature of their malignant disease.     

^153Sm—EDTMP治疗乳腺癌骨转移疼痛的临床疗效观察

目的：评价^153Sm-乙二胺四甲基膦酸（^153Sm-EDTMP)对乳腺癌转移性骨痛的镇痛效果。方法：采用两次给药法静脉注射^153Sm-EDTMP对76例乳腺癌骨转移疼痛患者进行治疗。结果：治疗后骨痛完全缓解者25例，中度缓解者40例，总有效率为85．52％（65／76）。除Ⅲ度以内的血液学毒性反应外，未见其它严重的毒副作用。结论：^153Sm-EDTMP能有效地缓解乳腺癌骨转移疼痛，且副作用小，是一种安全、有效的治疗方法。     

Targeted etanercept for treatment-refractory pain due to bone metastasis: two case reports

BACKGROUND: Parallel bodies of research suggest both a central role for osteoclasts in tumor-induced destruction of bone and the ability of biologic tumor necrosis factor-alpha (TNF-alpha) antagonists to attenuate the osteoclast-mediated bone destruction that accompanies a variety of nonmalignant disorders. Additional studies have implicated TNF-alpha in the promotion of osteoclast-mediated malignant osteolysis and the pathogenesis of neuropathic pain. TNF-alpha antagonists have the potential to interfere in both processes. OBJECTIVE: This article reviews the cases of 2 patients with treatment-refractory pain due to cancer metastases to bone who were given targeted injections of the biologic anti-TNF agent etanercept based on its potential to interfere directly with both malignant activation of osteoclasts and neuropathic pain. METHODS: One patient had a diagnosis of non-small cell lung cancer and the other had a diagnosis of breast cancer. Both presented with treatment-refractory pain due to bone metastases. The 2 patients received etanercept 25 mg by targeted SC injection in anatomic proximity to the site of spinal metastasis for relief of their treatment-refractory pain. RESULTS: Both patients experienced rapid, substantial, and sustained relief of chronic refractory pain at the treatment site after targeted administration of etanercept. Symptomatic improvement was correlated with objective measures of improvement, including weight gain in 1 patient and decreased uptake of radioactive tracer at the targeted site on positron emission tomography in the other. CONCLUSIONS: Etanercept delivered by targeted SC injection may be of clinical benefit in selected patients with treatment-refractory pain caused by bone metastases. Clinical trials are needed to define the potential benefit of biologic TNF-alpha antagonists in the treatment and prevention of malignant osteolysis.