唑来膦酸联合放射性核素89Sr治疗晚期前列腺癌骨转移疼痛

目的探讨晚期前列腺癌骨转移性疼痛的理想治疗方法。方法23例确诊为前列腺癌且有多处骨转移病灶伴有疼痛患者，经静脉滴注唑来膦酸同时，辅以核素s9Sr静脉内注射内放疗及部分病灶外放射治疗。结果疼痛缓解率3个月为82．6％，6个月为91．3％，9个月为86．9％。骨转移病灶数量明显减少，肿瘤标志物PSA较前明显下降。结论该方案治疗前列腺癌骨转移性疼痛安全、有效，可以提高患者生活质量。     

前列腺癌骨转移疼痛的~(89)锶(Sr)治疗

目的　探讨前列腺癌骨转移疼痛的89锶 (Sr)治疗。方法　本组 11例明确诊断为前列腺癌 ,并有多个部位骨转移病灶伴有疼痛的病例 ,采用核素89锶静脉内注射治疗。结果　89Sr治疗后 ,疼痛缓解率 3个月为 78.6% ;6个月为 82 .1% ;12个月为 75 .0 %。骨转移病灶数量也明显减少。结论　应用核素89锶治疗中晚期前列腺癌伴骨转移性疼痛是一个比较有效的方法 ,其能够使患者的疼痛获得较为满意的缓解 ,甚至消失 ,从而改善他们的生活质量     

紫杉醇周剂量治疗前列腺癌骨转移性疼痛的近期疗效观察

目的 探讨晚期前列腺癌骨转移性疼痛的治疗方法。方法 2004年～2005年对12例确诊为前列腺癌且有多个部位骨转移灶伴有疼痛的患者，采用国产紫杉醇周60mg／m^2，静脉注射，每周一次，连用3周，休息1周，共使用6周。结果 治疗后疼痛缓解率3个月为85％：6个月为74％。骨转移性病灶减少或缩小，可评价毒副反应8例，均可耐受。结论 本组病例经紫杉醇周剂量化疗后疗效肯定，疼痛缓解较满意，且不良反应轻，患者生活质量明显改善，值得扩大病例进一步研究。     

前列腺癌骨转移疼痛的^89锶（Sr）治疗

目的：探讨前列腺癌骨转移疼痛的^89锶（Sr）治疗。方法：本组11例明确诊断为前列腺癌，并有多个部位骨转移病灶伴有疼痛的病例，采用核素^89锶静脉内注射治疗。结果：^89Sr治疗后，疼痛缓解率3个月为78.6％；6个月为82.1％；12个月为75.0％。骨转移病灶数量也明显减少。结论：应用核素^89锶治疗中晚期前列腺癌伴骨转移性疼痛是一个比较有效的方法，其能够使患者的疼痛获得较得较为满意的缓解，甚至消失，从而改善他们的生活质量。     

~(89)Sr治疗前列腺癌骨转移疗效分析

目的:评价89Sr治疗前列腺癌骨转移的临床疗效。方法:对确认前列腺癌骨转移伴骨痛的116例患者,行双侧睾丸切除术+内分泌药物+89Sr治疗。89Sr治疗静脉给药,剂量1.48～2.22MBq(40～60μCi)/kg。随访分析临床疗效。结果:①33.6%的患者食欲明显改善,56.0%的患者睡眠明显改善,61.2%的患者止痛药用量显著减少;②骨转移性疼痛缓解总有效率为83.6%,24.1%的患者完全缓解;③骨痛缓解开始出现时间3～21d,平均10.2d;④骨痛缓解维持时间3～12个月,平均5.3个月;⑤31.9%的患者出现"闪烁"痛;⑥生活质量(KPS评分)平均升高20.0%;⑦治疗后18.1%的患者血液白细胞由正常水平下降至3.0～3.9×106/L(Ⅰ度血液毒性反应);⑧随访53例骨显像,治疗后73.6%(39例)骨转移灶数目较治疗前明显减少,18.9%(10例)稳定,7.5%(4例)恶化。结论:89Sr治疗能有效抑制骨转移,缓解骨痛,改善生存质量,不良反应轻,是前列腺癌骨转移性疼痛较理想的治疗方法。     

唑来膦酸联合苦参碱治疗晚期前列腺癌骨转移的疗效

目的 评价唑来膦酸联合苦参碱治疗晚期前列腺癌骨转移的临床疗效。方法 79例晚期前列腺癌并发骨转移患者,随机分为两组,治疗组44例患者采用唑来膦酸联合苦参碱静脉滴注,对照组患者35例单纯给予唑来膦酸静脉滴注,治疗3个月后评价两组患者骨痛缓解率及骨转移情况。结果 治疗组与对照组血碱性磷酸酶（ALP）水平均较治疗前出现改变,治疗组血ALP较对照组明显降低,两组比较差异有统计学意义（P＜0.05）。治疗组与对照组的疼痛缓解率分别88.64%（39/44）与62.86%（22/35）,疼痛缓解率差异有统计学意义（P＜0.05）。结论 唑来膦酸联合苦参碱治疗晚期前列腺癌骨转移可较好的缓解疼痛并减低骨代谢水平。     

~(153)Sm-EDTMP治疗前列腺癌伴骨转移的临床观察

目的 :探讨 1 5 3Sm-乙二胺四甲基膦酸盐 (1 5 3 Sm - EDTMP)治疗前列腺癌伴骨转移的治疗效果。方法 :对39例前列腺癌伴骨转移的患者应用 1 5 3 Sm - EDTMP进行治疗 ,并对其止痛效果、病灶变化和毒副作用进行观察。结果 :骨痛完全缓解 12例 (30 .8% ) ,部分缓解 2 2例 (5 6 .4% ) ,总有效率为 87.2 %。 2～ 6个月 X线和骨扫描复查 ,病灶消失 4例 ,部分消失和变浅 7例 ,有效率为 2 8.1%。治疗 1周后 ,白细胞和血小板稍下降 ,停药 4周后恢复至治疗前水平。结论 :对前列腺癌伴骨转移的患者 ,尤其是有骨痛者 ,采用 1 5 3Sm- EDTMP治疗效果肯定 ,副作用小 ,安全可靠。     

氯化锶治疗泌尿系肿瘤骨转移的应用价值(附8例报告及文献复习)

目的 :探讨氯化锶 (89SrCl2 )治疗泌尿外科肿瘤骨转移的临床应用价值。方法 :1996年 6月～ 2 0 0 1年 6月应用89SrCl2 (0 .0 14 8× 10 10 Bq/次 )静脉注射治疗前列腺癌、膀胱癌及肾癌骨转移8例。随访 1年 1个月～ 4年 11个月。结果 :8例患者疼痛缓解 ,其中 2例前列腺癌骨转移病灶消失 ,1例大部分吸收 ,1例膀胱癌因全身多器官转移用药 4个月后死亡 ,1例前列腺癌用药 3个月后死于心脏病。结论 :89SrCl2 治疗泌尿系肿瘤所引起的骨转移既能缓解疼痛 ,亦可使部分病灶得到缩小 ,使大多数患者生活质量得以改善 ,病情缓解 ,寿命延长。     

晚期前列腺癌患者骨痛的处理(附八例报告)

目的　探讨晚期前列腺癌患者骨痛的治疗方法。　方法　对 8例晚期前列腺癌骨痛患者分别予多种止痛剂 ( 8例 )、二膦酸盐 (博宁 ,8例次 )、89Sr( 8例次 )、外放射 ( 4例次 )等治疗。　结果　 8例患者中 1例死于呼吸衰竭 ,7例疼痛缓解 3～ 5个月 ;博宁治疗者中 2例每次治疗疼痛缓解 1～ 2个月 ;外放射治疗的 2例疼痛缓解期分别为 4和 6个月 ;89Sr治疗的 2例每次治疗疼痛缓解约 1个月。　结论　骨痛是晚期前列腺癌常见的并发症 ,采取综合措施可不同程度缓解患者的痛苦。     

~(153)Sm-EDTMP治疗前列腺癌骨转移的疗效观察

目的:通过对比研究153Sm-EDTMP和唑来膦酸治疗前列腺癌骨转移,以了解153Sm-EDTMP治疗前列腺癌骨转移的疗效。方法:确诊前列腺癌骨转移患者55例,分两组,一组31例用153Sm-EDTMP按37.0 MBq/kg体重静脉注射治疗,一组24例用唑来膦酸4 mg加入0.9%氯化钠注射液100 ml中缓慢静滴。治疗前及治疗后1～2个月行99mTc-MDP骨扫描检查。结果:153Sm-EDTMP组疼痛缓解有效率为83.9%,骨代谢改变有效率为64.5%。唑来膦酸组疼痛缓解有效率为58.3%,骨代谢改变有效率为33.3%。经χ2检验,两组疼痛缓解有效率比较χ2=4.448,P=0.035,骨代谢改变有效率比较χ2=5.263,P=0.022,均有显著性差异。结论:153Sm-EDTMP是治疗前列腺癌骨转移较理想的药物。     

~(89)Sr联合"云克"治疗前列腺癌骨转移疼痛

目的 评价~(89)Sr联合"云克"(~(99)Tc-MDP)治疗前列腺癌骨转移性疼痛的临床疗效.方法 确 认前列腺癌去势术后骨转移伴骨痛患者138例,年龄58～95岁,平均(69.3±8.2)岁,随机分组治疗.(1)对照组73例,单纯~(89)Sr治疗:一次性静注,剂量1.48～2.22 MBq(40～60 μCi)/kg.(2)联合组65例,~(89)Sr+云克治疗:~(89)Sr方案,同对照组:云克200rag,每日1次静滴,共计5次.每月一次随访临床疗效,两组对比分析.结果 (1)对照组与联合组骨痛缓解总有效率分别为73.97%和90.77%,差异具统计学意义;(2)"闪烁"痛发生率两组分别为30.14%和27.69%,差异无统计学意义;(3)治疗后分别有72.60%和83.08%的病例镇痛药量减少或停用,差异显著;(4)骨痛缓解持续时间,两组各平均为(4.41±1.57)个月和(5.64±2.52)个月,差异具统计学意义;(5)两组治疗后活动能力提高的例数百分比分别为64.38%和81.54%,差异显著.结论 ~(89)Sr联合云克治疗对缓解前列腺癌骨转移性疼痛有协同作用,可减少镇痛药用量,延长疼痛缓解的持续时间,改善患者的活动能力.     

放射性核素89Sr治疗前列腺癌骨转移疼痛的临床研究

目的:探讨晚期前列腺癌骨转移疼痛治疗的方法,评价放射性核素89Sr的疗效与安全性。方法:对15例未接受过任何放疗的晚期前列腺癌骨转移疼痛患者,经静脉注射放射核素89Sr治疗。结果:疼痛治疗的有效率为86.7%,80%患者的肿瘤标记物PSA水平较治疗前轻度下降,26.6%患者出现造血功能抑制。结论:放射性核素89Sr治疗前列腺癌骨转移疼痛较为安全、有效,可以提高患者生活质量。     

Serum hemoglobin levels predict response to strontium-89 and rhenium-186-HEDP radionuclide treatment for painful osseous metastases in prostate cancer

OBJECTIVE: Retrospective comparative analysis of strontium-89 chloride (Sr89) and rhenium-186-hydroxyethylidene diphosphonate (Re186-HEDP) radionuclide treatment to find predictors of response in patients with painful metastases from hormone refractory prostate cancer. PATIENTS AND METHODS: Clinical data from 60 hormone refractory PCA patients (i.e. rising PSA at castrate testosterone serum levels) was obtained. Twenty-nine were treated with Sr89, 31 were treated with Re186-HEDP for painful osseous metastasis. Response was defined as a patient-reported decrease in pain and/or reduction in pain medication with stable pain level. Hematological parameters and serum levels of PSA, alkaline phosphatase, and lactate dehydrogenase were assessed prior to and at 4-week intervals after treatment. RESULTS: Median survival of all patients was 7 months (95% CI: 6-9 months). Overall, 33/60 (55%) patients reported a decrease in pain after the first radionuclide treatment. This percentage was similar for patients treated with Re168-HEDP and Sr89. Mean duration of reported pain response was 75 days (+/- 68 days) for Sr89 and 61 days (+/- 56 days) for Re186-HEDP, which was not significantly different. A lower blood hemoglobin concentration was associated with a lower pain response rate. In a multivariate Cox regression analysis, pain response to radionuclide treatment predicted longer survival after treatment. CONCLUSIONs: Pain response was present in 55% of patients. Serum hemoglobin concentration prior to radionuclide treatment predicted pain response for both Re186-HEDP and Sr89. A reduction in pain upon radionuclide treatment was associated with a longer survival after treatment.     

A retrospective study of the treatment of locally advanced prostate cancer by six institutions in eastern and north-eastern Japan

OBJECTIVE: To investigate patients with locally advanced prostate cancer treated at six academic institutions in eastern and north-eastern Japan from 1988 to 2000, to facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer. PATIENTS AND METHODS: The study included 391 eligible patients with locally advanced prostate cancer who were treated by radical prostatectomy (RP), radiotherapy and/or primary hormone therapy. Disease-specific survival rates for these patients were assessed in relation to their clinicopathological characteristics and the types of treatment they received. The Mann-Whitney U-test, Kruskal-Wallis, chi-square and log-rank test were used for statistical analysis, as appropriate. RESULTS: In all, 128 patient with lower prostate-specific antigen levels (P = 0.023) and/or better performance status (P = 0.001) had RP. Neoadjuvant hormone therapy before RP was the treatment in 68 (53%) of these 128 patients; 66 (52%) received immediate adjuvant hormone therapy. Of 87 patients treated with radiotherapy, 75 (86%) had external beam radiotherapy (EBRT) as the primary treatment with no brachytherapy, and 12 (14%) had brachytherapy as the primary method. Neoadjuvant hormone therapy was given to 56 of the 87 patients (64%); 48 (55%) received immediate adjuvant hormone therapy. Of the 176 patients treated with primary hormone therapy alone, combined androgen blockade and surgical or medical castration was the treatment in 76 (43%) and 85 (48%), respectively. Disease-specific survival rates at 5 years for patients treated with RP, EBRT and primary hormone therapy were 90%, 98%, and 89%, respectively. CONCLUSION: The treatments provided by the participating institutions did not differ significantly from those set out in European and American guidelines, and short-term disease-specific survival rates for each treatment did not differ significantly from those of historical controls. Further investigation may facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer.     

Strontium-89 combined with doxorubicin in the treatment of patients with androgen-independent prostate cancer

We investigated the activity of a bone-targeting regimen consisting of strontium-89 and doxorubicin in the treatment of patients with androgen-independent prostate cancer. Three and 22 patients with androgen-independent prostate cancer and bone metastasis received doxorubicin at 15 mg/m² and 20 mg/m², respectively (intravenously by continuous infusion over 24 hours, once per week). All patients received strontium-89 55 μCi/kg, intravenously, every 3 months. Antitumor activity (a prostate specific antigen decrease of ≥75% from baseline) was seen in 32% of evaluable patients. Clinical benefit based on pain relief and performance improvement was achieved in 76% and 40% of patients, respectively. Strontium-89 combined with doxorubicin can be delivered with acceptable toxicities. Strontium-89 combined with doxorubicin is active in the treatment of androgen-independent prostate cancer and may be useful in future studies designed to optimize organ (bone)-specific therapies.     

帕米膦酸二钠联合^89Sr治疗激素非依赖型前列腺癌骨转移疗效观察

目的：观察帕米膦酸二钠与^89Sr联合应用对激素非依赖型前列腺癌（PCa）伴骨转移的治疗效果。方法：将我院收治的29例激素非依赖型PCa伴骨转移患者随机分成A、B两组,A组采用帕米膦酸二钠90mg溶于5％葡萄糖500ml,缓慢滴注4周1次,共2次;B组静脉注射^89Sr Cl21．48mBq／kg,1周后与A组治疗方法相同。采用疼痛视觉模拟法（VAs）评定患者主观骨痛,生活质量（QOL）评分来判定疗效。结果：在疼痛评分方面B组治疗后评分显著低于A组,生活质量评分有效率的差异无统计学意义。结论：帕米膦酸二钠联合^89Sr治疗激素非依赖型PCa伴骨转移在疼痛缓解有效率上高于单独使用帕米膦酸二钠,同时表明帕米膦酸二钠与^89Sr具有协同作用,其在不良反应方面无明显增加。     

综合治疗中晚期前列腺癌的疗效分析

目的 探讨一种对中晚期前列腺癌较理想的治疗方法。方法 回顾性分析2001年3月～2005年1月收治的前列腺癌临床病例78例，采用综合治疗：经尿道等离子束腔内微创手术加双侧睾丸白膜下切除去势，术后应用抗雄激素药物阻断治疗，对伴有骨转移者同时行核素89^Sr内放射治疗。与同期用单纯膀胱造瘘加双侧睾丸切除的45例病人进行比较。结果 随访3～48个月，综合治疗后下尿路梗阻症状明显改善，血清PsA水平下降，骨痛缓解，生活质量显著提高，生存时间明显延长。结论 对于中晚期前列腺癌采取积极的综合治疗可取得较好的疗效，是一种较为理想的治疗手段。     

单纯内分泌与内分泌加内照射治疗晚期前列腺癌的疗效对比分析

目的：研究核素内照射改善前列腺癌骨转移引起的疼痛及对骨转移治疗的疗效，并与内分泌治疗进行比较。方法：对52例前列腺癌骨转移患者均采用双侧睾丸切除加氟他胺（250mg,3次／d)治疗。所有患者均于术前不同时间出现明显的疼痛症状，其中15例接受^89锶内照射治疗（148MBq静脉注射），8例接受^153Sm-EDT-MP内照射治疗（37MBq/kg静脉注射，1次／月）；29例未接受内照射治疗者作为对照组。结果：^89锶治疗组有14例患者疼痛明显缓解，占93．3％（14／15）；^153Sm-EDTMP治疗组有6例疼痛明显缓解，占75．0％（6／8）；单纯内分泌治疗组经调整药物剂量或结构后，疼痛明显缓解者仅9例，占31．0％（9／29）。^99Tcm-MDP全身骨显像示骨转移病灶出现不同程度的好转，其中^89锶治疗组有11例，占73．3％（11／15）；^153Sm-EDTMP治疗组有5例，占62．5％（5／8），而单纯内分泌组有7例，占24．1％（7／29）。^89锶治疗组3例、^153Sm-EDTMP治疗组有2例出现血白细胞和血小板明显下降，经对症治疗后恢复。结论：核素内照射治疗能改善前列腺癌骨转移引起的疼痛，并可不同程度地抑制肿瘤骨转移灶的生长，但必须密切观察血红蛋白、白细胞及血小板的变化。