双膦酸盐治疗恶性肿瘤骨转移新进展

恶性肿瘤骨转移可以引起多种骨并发症,包括病理性骨折、需要放射治疗的严重骨骼疼痛、脊髓压迫以及危及生命的恶性高钙血症（骨相关事件）。本文回顾了双膦酸盐在多种恶性肿瘤骨转移中的临床研究结果及安全性。结果表明,双膦酸盐在多种恶性肿瘤骨转移所引起的骨相关事件的治疗中意义明确,然而其不良反应及治疗也值得进一步研究。     

镇痛药联合双膦酸盐治疗恶性肿瘤骨转移的相关进展

骨转移是晚期恶性肿瘤最常见的并发症之一.最常见的发生骨转移的恶性肿瘤,主要包括肺癌、乳腺癌、前列腺癌、肾癌、胃肠道肿瘤等.晚期肿瘤一旦发生骨转移,会引起局部的骨质破坏,从而引起骨痛、病理性骨折、神经压迫、高钙血症等一系列骨相关事件(SREs),严重影响患者的生活质量,甚至导致患者脊髓压迫,引起截瘫.晚期恶性肿瘤骨转移的...     

唑来膦酸治疗恶性肿瘤骨转移临床应用新进展

唑来膦酸属于第三代双膦酸盐.治疗恶性肿瘤骨转移临床疗效确切,应用前景广泛.唑来膦酸在体外可抑制破骨细胞活动,诱导破骨细胞调亡;还可以抑制由肿瘤释放的多种刺激因子引起的破骨细胞活动增强和骨钙释放;缓解实体瘤患者骨转移引起骨痛,起效迅速,效果明显.     

注射用唑来膦酸治疗肺癌骨转移疼痛的疗效和安全性临床研究

目的:探讨注射用唑来膦酸治疗肺癌骨转移引起疼痛的有效性及安全性。方法:对41例肺癌骨转移且中度以上疼痛患者进行前瞻、随机、双盲、双模拟平行临床研究,研究组21例,为注射用唑来膦酸4mg;对照组20例,为注射用帕米膦酸60mg。在研究期间两组均未进行任何化疗;对治疗前、治疗后第7天和第14天的主要有效指标NRS、缓解率和加用止痛剂及次要有效指标QOL、KPS情况进行比较,并分析不良事件发生和实验室指标异常情况。结果:组内比较:治疗后的NRS、QOL及KPS较治疗前均明显改善。组间比较:治疗后第14天研究组NRS明显低于对照组(3.38vs4.55,P<0.05),即治疗后第14天唑来膦酸缓解疼痛的作用明显优于帕米膦酸。疼痛总缓解率:研究组第7天57.1%、第14天61.9%;对照组分别为45%、50%,无统计学差异。在加服即释吗啡人数比较中:研究组1例,而对照组3例。不良事件比较:研究组1例,对照组4例,主要表现发烧、恶心呕吐(与输液较快有关,减慢输液速度后消失),不良事件与研究药物有关。结论:注射用唑来膦酸治疗肺癌骨转移疼痛疗效明显、具有良好的耐受性和安全性,且给药方便。     

唑来膦酸治疗既往用过双膦酸盐的实体瘤骨转移患者骨痛的安全性分析

[目的]评价唑来膦酸治疗既往用过双膦酸盐的实体瘤骨转移患者骨疼痛的缓解效果和安全性。[方法]唑来膦酸4mg静脉注射15min以上，每4周1次，治疗既往用过和未用过双膦酸盐的骨转移实体瘤患者，记录疼痛评分、东方协作肿瘤组织（ECOG）体力状态评分和毒副反应。[结果]疼痛评分较基线下降（P〈0．001）。ECOG体力状态评分保持稳定。发热、乏力和恶心是最常见的毒副反应，在既往用过与未用过双膦酸盐患者间毒副反应发生率无统计学意义（P〉0．05）。[结论]既往用过双膦酸盐静脉注射治疗的实体瘤骨转移患者，可以安全地给予唑来膦酸治疗。     

前列腺癌骨转移临床诊疗专家共识(2008版)

在前列腺癌的发展过程中,至少有65%～75%的患者发生骨转移[1].在死于前列腺癌的患者中,有85%～100%的患者存在骨转移[2].目前,国内虽无确切的资料,但前列腺癌患者在初诊时骨转移却较常见,发生率甚至高达85%.前列腺癌骨转移可导致患者发生骨痛、病理性骨折等骨相关事件(skeletal related events,SREs).     

非小细胞肺癌骨转移特征与预后的相关性

摘 要：［目的］ 分析非小细胞肺癌(non-small cell lung cancer,NSCLC)骨转移的临床特征及影响预后生存的相关因素。［方法］ 回顾性分析辽宁省肿瘤医院2011年6月至2014年6月确诊非小细胞肺癌患者117例,统计其6个月、1年、2年生存率,并计算中位生存期（median overall survival,mOS）,分析影响骨转移患者生存的预后因素。［结果］在PS评分低或高(15.1m vs 11.6m)、骨转移灶单病灶或多病灶(15.7m vs 11.9m)、中轴骨或四肢骨转移(14.9m vs 11.2m)、双膦酸盐治疗(15.3m vs 11.3m)四组的中位生存期均有统计学差异(P值均<0.05)。 Cox回归模型中PS评分、骨转移位置、双膦酸盐组间具统计学意义。［结论］ PS评分、骨灶位置、双膦酸盐治疗是非小细胞肺癌骨转移预后的独立的因素。     

艾本与放疗联合治疗恶性肿瘤骨转移的临床疗效

目的:探讨艾本(伊班膦酸钠)全身用药与局部放疗相结合治疗恶性肿瘤局限性骨转移的临床疗效.方法:80例恶性肿瘤局限性骨转移患者随机分为两组,艾本静脉滴注加局部放疗40例(治疗组);单放组40例,只采用局部放疗(对照组).结果:治疗组疼痛缓解率为92.5%,对照组疼痛缓解率为82.5%,两组间比较无明显差异(P＞0.05);溶骨病灶再钙化的有效率治疗组为76.7%,而对照组仅为27.8%,两组比较有显著性差异(P＜0.001);治疗组出现第二部位骨转移的机率明显低于对照组(P＜0.05);1年生存率治疗组明显高于对照组(P＜0.05).两组患者不良反应的发生率相似,无显著性差异(P＞0.05).结论:艾本联合放疗治疗局限性骨转移,具有止痛快、疗效确切、高效修复溶骨病灶,并能防止新转移灶的发生及较高的生存率等优点.     

乳腺癌骨转移机制与靶向治疗进展

乳腺癌骨转移是晚期乳腺癌常见的症状,乳腺癌细胞通过局部浸润、渗入血管和或淋巴管、随循环系统转移到骨、移出血管和或淋巴管、在骨定居并增殖引起溶骨性骨损伤。乳腺癌骨转移的发生发展取决于乳腺癌细胞与骨局部微环境之间相互作用,最后形成骨的结构破坏及功能受损。本文主要从分子水平阐述乳腺癌骨转移机制,并且综述针对乳腺癌骨转移关键靶点的抗骨转移药物的临床应用。     

骨转移癌的外科治疗

目的：探讨骨转移癌的外科治疗原则、手术方法及临床价值。方法：1983年至1998年3月,79例有随访结果的骨转移癌患者行Guy′s疼痛分级和Karnofsky评分,测量X线平片中长骨骨皮质破坏厚度（或椎体骨折塌隐的程度）和肿瘤体积做为定量计算指标。依据全身状况和骨转移灶特征将患者分为4组,并作为包括手术在内的综合治疗的依据。对比治疗前后的Guy′s疼痛分级和Karnofsky评人结果并作统计学分析。结果：本组平均随访28．5个月。79例患者中60例接受综合治疗,早期缓解率56．7％。有病理骨折或骨折危险性的患者治疗后早期缓解率为68．6％。其中25例患者接受大段异体骨关节移植,依据Mankin′s异体骨移植评价标准,术后总评优良率为88．0％。接受治疗与未行治疗的患者盯比,疼痛减轻,Karnofsky 评分增加,统计学处理显示治疗效果显著。结论：根据骨转移癌分组标准进行有选择性的综合治疗可以提高患者终末期期的生存质量和生命活力。在临床应用具有一定的适用性。大段异体骨关节移植治疗骨转移癌可取得满意的疗效。     

Prevalence and Survival Patterns of Patients with Bone Metastasis from Common Cancers in Thailand

Background: Bone metastasis is a single condition but presents with various patterns and severities. Skeletal- related events (SREs) deteriorate overall performance status and reduce quality of life. However, guidelines for early detection and management are limited. This study includes a survey of the prevalence of bone metastasis in cases with common cancers in Thailand as well as a focus on survival patterns and SREs. Materials and Methods: A retrospective cohort analysis was conducted using a database of the Chiang Mai Cancer Registry and the Musculoskeletal Tumor Registry of the OLARN Center, Chiang Mai University. The prevalence of bone metastasis from each type of primary cancer was noted and time-to-event analysis was performed to estimate cancer survival rates after bone metastasis. Results: There were 29,447 cases of the ten most common cancers in Thailand, accounting for 82.2% of the entire cancer registry entries during the study period. Among those cases, there were 2,263 with bone metastases, accounting for 7.68% of entries. Bone metastasis from lung, liver, breast, cervix and prostate are common in the Thai population, accounting for 83.4% of all positive cases. The median survival time of all was 6 months. Of the bone metastases, 48.9% required therapeutic intervention, including treatment of spinal cord and nerve root compression, pathological fractures, and bone pain. Conclusions: The frequency of the top five types of bone metastasis in Thailand were different from the frequencies in other countries, but corresponded to the relative prevalence of the cancers in Thailand and osteophilic properties of each cancer. The results of this study support the establishment of country specific guidelines for primary cancer identification with skeletal lesions of unknown origin. In addition, further clinical studies of the top five bone metastases should be performed to develop guidelines for optimal patient management during palliative care.     

脑转移瘤几种不同治疗方法疗效分析

 目的 回顾性分析脑转移瘤采用单纯放疗（R）、放疗加化疗（R＋C）、立体放射外科加放疗（SRS＋R）治疗效果及影响因素。方法 1993年3月至1998年6月间对收治的脑转移瘤中有61例进行分组治疗观察。结果 6月、12月、＞12月生存率及局部控制率R组分别为54．1％、16．3％、2．7％和16．2％,R＋C组分别为75％、33．3％、25％和41．6％,SRS＋R组分别为83．3％。58．3％、41．6％和91．6％。结论 SRS＋R治疗脑转移瘤在延长患者生存期及局部控制上要优于R和R＋C组。     

Bone Metastasis Prognosis, Diagnosis and Treatment

Carcinoma of the breast, lung or prostate cause the majority of all bone metastases. Prolonged survival is common in patients with breast or prostate tumours. Different types of treatment may significantly increase the quality of life. Single-dose or fractionated radiation therapy may be effective, and 70 to 90 per cent of patients obtain partial or complete relief from pain. Surgery followed by irradiation is indicated in most patients with pathologic femur fractures. Immediate surgical treatment, either alone or combined with radiation therapy, may prevent paraparesis in patients with incipient cord compression. For neoplasms sensitive to systemic therapy such treatment should often be added to local treatment.     

Perspectives of Young Women With Gynecologic Cancers on Fertility and Fertility Preservation: A Systematic Review

BackgroundGynecologic cancers standard treatment often requires the removal of some reproductive organs, making fertility preservation a complex challenge. Despite heightened oncofertility awareness, knowledge about fertility attitudes and decisions of young patients with gynecologic cancer is scarce. The aim of this systematic review was to highlight what is currently known about knowledge, attitudes, and decisions about fertility, fertility preservation, and parenthood among these patients.MethodsPeer-reviewed journals published in English were searched in PubMed, Web of Science and EMBASE from January 1, 2000 to July 1, 2020. Childbearing, fertility, fertility preservation, pregnancy, and parenthood attitudes/decisions after gynecologic cancer from women’s perspective were evaluated.ResultsA total of 13 studies comprised the review. Most of the women valued fertility preservation procedures that could be regarded as a means to restore fertility. A unique feature identified was that fertility preservation was seen also as a way to restore gender identity perceived to be lost or threatened during diagnosis and treatment. Fertility counseling was suboptimal, with wide variability among studies reviewed. Comparisons between gynecologic cancers and other cancer types about fertility counseling rates were inconclusive. The potential negative impact of impaired fertility on patients’ mental health and quality of life was also documented.ConclusionsFertility and parenthood were important matters in patients’ lives, with the majority of patients expressing positive attitudes toward future childbearing. Results confirm that the inclusion of patients with gynecologic cancer in research studies focusing on this topic still remains low. Additionally, the provision of fertility counseling and referral by health professionals is still suboptimal.     

Preparing Patients for Sexual Dysfunction After Radiation for Anorectal Cancers: A Systematic Review

PurposeSuccessful multimodality treatment of anorectal cancers has led to increased numbers of survivors who experience permanent, life-changing side effects of treatment. Little is known about sexual dysfunction (SD) in this population. The etiology of SD after anorectal cancer treatment is complex and multifactorial. However, pelvic radiation plays a significant negative role in anatomic, hormonal, and physiological aspects of sexual function.Methods and MaterialsA systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Information was organized by key concepts useful for patient education, including (1) rates of SD after pelvic radiation for rectal cancer, (2) rates of SD after pelvic radiation for anal cancer, (3) mechanisms of SD and methods to reduce rates of SD, and (4) issues and opportunities related to patient education and discussion of SD after pelvic radiation.ResultsSD after pelvic radiation for anorectal cancers is common in both men and women. Higher radiation doses may increase the risk for vaginal stenosis; however, it is unclear whether there are similar dose–volume relationships for men. Vaginal dilators and advanced radiation techniques can reduce the radiation dose to sexual organs at risk. Improvement is needed regarding counseling and education of patients about SD.ConclusionsThis review provides information from previously published studies that clinicians may use in their discussions with patients embarking on pelvic radiation for anorectal cancers. More modern, standardized, and complete data are needed to quantify the risk of SD after treatment. Some methods of sexual toxicity reduction have been studied, but further study into interventions aimed at treating postradiation sexual function are needed.     

Gastric Metastasis in Renal Cell Carcinoma: A Case Report and Systematic Review

Background

Published report of cases of gastric metastases arising from renal cell carcinoma is a rare event and treatment of such patients can be difficult. Gastrectomy may be a surgical alternative; however, the prognosis for the majority of patients is very poor.

Methods

We report a rare case of a patient with a metastatic renal cell carcinoma that metastasized to the stomach. In addition, we conducted a systematic review of the literature to assess the prevalence of reports and to gain a greater understanding of this particular metastatic cancer spread from the kidney to the stomach.

Results

Published reports of metastases from the kidney to the stomach are not as rare as previously thought with three times of the number of reports found to what most authors thought actually existed. The majority of reports occurred among males (77%). The mean age of presentation was 65 years for males and 68 years for females (range, 40–84 years). Average time from nephrectomy to presentation of gastric metastases was 7 years for both males and females (range, 0–24 years).

Conclusion

Females with gastric metastases from the kidney are slightly older than males, and no difference exists between males and females in terms of the time interval between nephrectomy and subsequent metastasis or select patients treatment options.     

帕米膦酸二钠治疗骨转移引起疼痛的临床研究

背景与目的:临床研究表明,帕米膦酸二钠治疗骨转移引起的疼痛有肯定的疗效,提高使用剂量能否提高疗效尚未明确.本研究的目的是观察两组不同剂量的帕米膦酸二钠治疗骨转移引起疼痛的效果和毒副作用.方法:将90例实体瘤骨转移患者随机分为治疗组和对照组.治疗组45例,采用帕米膦酸二钠120 mg分3天静滴(即60 mg,d1;30 mg,d2～3);对照组采用帕米膦酸二钠90 mg分3天静滴(即30 mg,d1～3).二组均4周为一周期.结果:治疗组45例,显效20例,有效23例,无效2例,总有效率95.6%(43/45);用药一疗程取得疗效40例(88.9%),一周内取得疗效36例(80%);不良反应3例(6.7)%.对照组45例,显效16例,有效20例,无效9例,总有效率80.0%;用药一疗程取得疗效26例(57.8%),一周内取得疗效26例(57.8%);不良反应3例(6.7%).经统计学分析,总有效率及一周内有效率两组比较有显著性差异(P＜0.05),用药一疗程有效率两组间有非常显著性差异(P＜0.01).结论:帕米膦酸二钠对骨转移引起的疼痛有良好的止痛效果,一疗程采用120 mg优于90 mg,患者可以耐受.