全身骨显像疗效评价^153钐-EDTMP治疗骨转移癌的疗效

目的：通过骨显像评价^153钐-EDTMP治疗骨转移癌的效果，进而证实其抑制、消除转移灶作用。方法：对182例恶性肿瘤合并骨转移病人共进行560次^153钐-EDTMP治疗，治疗前后常规行骨显像检查。结果：^153钐-EDTMP治疗后疼痛总缓解率为88．46％（161／182），12．64％（23／182）病例发生严重白细胞减低。44．51％（81／182）病例骨转移灶缩小、消失。结论：^153钐-EDTMP是通过抑制、消除骨转移灶达到止痛的。骨显像能显示治疗后骨转移灶的变化。     

全身骨显像疗效评价153 钐-EDTMP 治疗骨转移癌的疗效

目的：通过骨显像评价^153钐-EDTMP治疗骨转移癌的效果，进而证实其抑制、消除转移灶作用。方法：对182例恶性肿瘤合并骨转移病人共进行560次^153钐-EDTMP治疗，治疗前后常规行骨显像检查。结果：^153钐-EDTMP治疗后疼痛总缓解率为88．46％（161／182），12．64％（23／182）病例发生严重白细胞减低。44．51％（81／182）病例骨转移灶缩小、消失。结论：^153钐-EDTMP是通过抑制、消除骨转移灶达到止痛的。骨显像能显示治疗后骨转移灶的变化。     

153Sm-EDTMP治疗骨转移癌疼痛的临床应用

目的 探讨钐－乙二胺四甲撑膦酸（^153Sm-EDTMP)治疗骨转移癌疼痛的临床疗效。方法 应用^153Sm-EDTMP治疗82例骨转移癌疼痛患者，根据治疗后疼痛缓解和生活质量的情况判断疗效，同时比较其病灶摄取放射性的变化。结果 治疗后疼痛缓解有效率为74．4％（61／82），其中显效22例（26．8％），有效39例（47．6％），稳定21例（25．6％）。治疗前列腺癌骨转移、乳腺癌骨转移、肺癌骨转移疼痛的有效率分别为80．6％（25／31）、78．9％（15／19）、63．2％（12／19）。结论 应用^153Sm-EDTMP治疗骨转移癌疼痛是1种有效的姑息治疗技术，尤其对前列腺癌和乳腺癌的骨转移疼痛疗效较好，但要注意骨髓抑制。     

^153Sm—EDTMP对骨转移瘤的骨痛缓解效果初探

目的 :初步评估153Sm -EDTMP对骨转移瘤的骨痛缓解效果。方法 :1995年 1月～ 1999年 12月将 60例骨转移瘤患者作为研究对象 ;男 44例 ,女 16例 ,平均年龄 5 9 7岁。所有患者通过单次静脉注射153Sm -EDTMP进行止痛治疗。以SAS软件分析各种因素与骨痛缓解有效率的关系。结果 :60例病例中 ,骨痛完全缓解 2 6例 ,显著缓解 2 2例 ,总有效率 80 %。多因素分析证实患者性别、肿瘤类型和转移部位与骨痛缓解有效率相关。无效者中男性、肺癌、脊柱、骨盆与下肢转移的比例偏高。结论 :153Sm EDTMP对骨转移瘤的止痛疗效确切 ,但对肺癌、男性和下半身转移者效果可能较差     

^153Sm-EDTMP与^89Srcl放射治疗肿瘤骨转移疼痛的评估

目的：对比研究放射性核素制剂^153钐-乙二铵四甲基磷酸（^153Sm-EDTMP）与^89氯化锶（^89Srcl）治疗肿瘤骨转移疼痛的疗效。方法：对123例肿瘤骨转移患者按个人意愿结合家庭经济情况分组,Ⅰ组：^153Sm-EDTMP治疗组;Ⅱ组：^89Srcl治疗组。对治疗前后行SPECT全身骨扫描及骨痛评估。结果：^153Sm-EDTMP及^89Srcl治疗肿瘤骨转移疼痛的有效率分别为77.78%、81.82%;^153Sm-EDTMP及^89Srcl治疗肺癌、乳腺癌、前列腺癌及其他肿瘤骨转移有效率分别为64.71%、89.47%、90.00%、62.50%;72.73、86.67%、100%、75.00%,存在明显差异（P〈0.05）;^153Sm-EDTMP及^89Srcl治疗肿瘤骨转移疼痛起效时间分别为（10.1±3.2）天、（7.3±1.8）天,止痛持续时间分别为（25.5±8.3）周、（30.1±10.4）周,治疗花费分别为（4.1±0.5）千元、（8.3±0.8）千元,存在明显差异（P〈0.01）;^153Sm-EDTMP及^89Srcl治疗肿瘤骨转移疼痛的不良反应率分别为4.4%、3.0%,存在明显差异（P〈0.05）。结论：^153Sm-EDTMP及^89Srcl治疗肿瘤骨转移疼痛均可取得较高有效率,三种常见肿瘤有效率从高到低分别前列腺癌、乳腺癌、肺癌,起效时间、持续时间及治疗花费均有明显差异,应结合患者具体情况选用。     

博宁治疗恶性肿瘤骨转移疼痛的疗效观察

目的：观察博宁（帕米膦酸二钠APD）对骨转移疼痛的临床疗效。方法：22例晚期恶性肿瘤骨痛患者静脉点滴博宁90mg一疗程,连用1－2个疗程,部分病例合并化(n=1）或内照射治疗（n=5)。结果：博宁对骨痛的总有效率为86.3%(19/22),合并化疗、^153Sm(钐）－EDTMP（乙二胺四甲基膦酸）治疗和单纯博宁治疗的有效率分别为90.9％、80.0％、66.7％。获效时间1－20天,83.3％患者在两周内获效,无明显毒副作用。结论：博宁是一种治疗恶性肿瘤骨转移骨痛的有效药物,能有效地缓解骨痛和活动功能障碍、提高患者的生活质量,与化疗、^153Sn-EDTMP内照射治疗联用,疗效更好。     

89 Sr及联合局部放疗治疗多发骨转移癌的疗效观察

目的：观察锶^89Sr及^89Sr联合外放疗治疗肿瘤晚期多发骨转移癌的疗效。方法：将106例恶性肿瘤多发骨转移癌患者分为两组，^89Sr治疗组（单纯组）53例和^89Sr外放疗联合治疗组（联合组）53例，每例患者^89Sr静脉注射剂量均为4mci，放疗采用6MV直线加速器外照射给予30Gy-60Gy／2周～4周。结果：单纯组镇痛缓解率83．01％，联合组镇痛缓解率90．56％；骨病灶好转率单纯组75．48％，联合组86．8％，生活质量得到相应改善。结论：89Sr对肿瘤全身多发骨转移癌具有较好的缓解疼痛作用，而联合放疗可提高疗效和生活质量。     

博宁治疗恶性肿瘤骨转移疼痛的疗效观察

目的:观察博宁(帕米膦酸二钠APD)对骨转移疼痛的临床疗效.方法:22例晚期恶性肿瘤骨痛患者静脉点滴博宁90mg一疗程,连用1～2个疗程,部分病例合并化疗(n=11)或内照射治疗(n=5).结果:博宁对骨痛的总有效率为86.3%(19/22),合并化疗、153Sm(钐)-EDTMP(乙二胺四甲基膦酸)治疗和单纯博宁治疗的有效率分别为90.9%、80.0%、66.7%.获效时间1～20天,83.3%患者在两周内获效,无明显毒副作用.结论:博宁是一种治疗恶性肿瘤骨转移骨痛的有效药物,能有效地缓解骨痛和活动功能障碍、提高患者的生活质量,与化疗、153Sm-EDTMP内照射治疗联用,疗效更好.     

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^153Sm-EDTMP治疗的临床效果。方法：静脉注射^153Sm-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（54.3%)，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。     

氯化锶(89SrCl2)治疗恶性肿瘤骨转移的临床分析

目的：评价氯化锶（^89SrCl2）治疗恶性肿瘤骨转移癌的临床疗效。方法：79例诊断为骨转移瘤的患者行^89SrCl2治疗，治疗后进行血常规、肝肾功能及SPECT随访3—6个月，对治疗后患者疼痛缓解、ECT病灶变化及血液学、肝肾功能变化进行评价。结果：79例患者中67例（84．8％）有效，疼痛缓解持续时间为38—182天。61例患者ECT结果显示病灶减小或消失31例，病灶数目无明显变化者16例，病灶数目增加者14例。无明显骨髓抑制及肝肾功能损害。结论：^89SrCl2治疗骨转移瘤，能明显减轻患者的骨痛，改善患者的生存质量，同时对骨转移病灶起到一定程度的治疗作用，是一种安全、有效、可靠的治疗方法。     

89Sr和153Sm-EDTMP治疗鼻咽癌多发性骨转移瘤疗效的比较

目的 比较＾８９Ｓｒ和＾１５３Ｓｍ－ＥＤＴＭＰ治疗鼻咽癌（ｎａｓｏｐｈａｒｙｎｇｅａｌ ｃａｒｃｉｎｏｍａ,ＮＰＣ）多发性骨转移瘤的疗效。方法 从１９９７年５月到１９９９年３月,作者用＾８９Ｓｒ和＾１５３Ｓｍ－ＥＤＴＭＰ分别治疗ＮＰＣ多发性骨转移病人４５例和６８例。根据治疗前后骨痛缓解和生活质量的情况决定疗效,同时比较其病灶摄取放射性变化,观察开始起效的时间,对病人血清ＶＣＡ－ＩｇＡ、ＥＡ－ＩｇＡ     

Samarium lexidronam (153Sm-EDTMP): skeletal radiation for osteoblastic bone metastases and osteosarcoma

Radiation therapy can be an effective means to treat bone metastases, which occur in more than 50% of cancer patients. ¹⁵³Samarium lexidronam (¹⁵³Sm-EDTMP; Quadramet, Cytogen) is a radiopharmaceutical designed for deposition into bone metastases. Bone scans can identify patients that may benefit from targeted radiation therapy with ¹⁵³Sm-EDTMP. As an unsealed source of radiation therapy, ¹⁵³Sm-EDTMP is simple to administer: 1 mCi/kg is given in a similar fashion to a bone scan injection (^99mTc-MDP bone scan injection is given at 0.2–0.35 mCi/kg. Therefore, both are administered intravenously. However, the radiation-absorbed dose and radiopharmaceutical energy are different). Nevertheless, despite simplicity of administration, ¹⁵³Sm-EDTMP is underutilized for improving cancer pain in the skeleton. Repeated cycles and combined treatment with other modalities such as bisphosphonates, chemotherapy and/or external beam radiation are possible. ¹⁵³Sm-EDTMP combined with bisphosphonates, chemotherapy and/or radiation may provide better palliation of bone metastases and also in bone-forming tumors (osteosarcoma). Encouraging experience using high-dose ¹⁵³Sm-EDTMP for total marrow irradiation in hematologic malignancies involving the bones (e.g., myeloma or acute leukemia) is also reviewed.     

153Sm-EDTMP治疗多发骨转移瘤的剂量效应关系初步观察

Objective: To calculate the focus absorption dose of 153Sm-EDTMP with the Monte Carlo (MC) EGS4 method for treatment of bone metastases from nasopharyngeal carcinoma or breast cancer, and investigate the relationship between the focus absorption dose and painkilling effect of 153Sm-EDTMP. Methods: Four patients with multiple bone metastases from nasopharyngeal or breast carcinoma and suffered from grade Ⅳ bone pain were treated with radionuclide internal irradiation of 153Sm-EDTMP. The absorption dose and dose distribution of bone metastases and other targeted organs were calculated with MC EGS4 program based on the time-order SPECT/CT scanning and the measurement of the radioactivity in the urine accumulation. The release of bone pain and the improvement of life quality were observed. Results: Bone pain of the patients was significantly alleviated to grade Ⅱ for 3-4 weeks after internal 153Sm-EDTMP irradiation. The 3-dimensional absorption dose distribution image of bone metastases and targeted organs showed that the dose distribution in bone metastases was not asymmetrical. After injection of 0.65 × 37 MBq/kg 153Sm-EDTMP, the highest absorption dose in bone lesions was about 4.9-5.9 Gy, and the dose in the lesion margin was about 2.0 Gy. Using the highest dose as reference dose point, the relative absorption dose values of bone marrow, vertebra and sex organ near lesions were 0.48-1.1 Gy, 0.51-0.85 Gy, and 0.01-0.14 Gy, respectively. Conclusion: The absorption dose of bone metastases is significantly lower than treatment dose of 30 Gy after single irradiation of 153Sm-EDTMP. The painkilling effect is limited and in accordance with clinical observation.     

^153Sm-EDTMP放射治疗辐射对肿瘤骨转移患者血象的影响

目的：探讨利用放射性制剂153Sm-EDTMP（153钐-乙二铵四甲基磷酸）对肿瘤骨转移疼痛患者进行治疗时,辐射对患者血象的影响。方法：利用全自动血液分析仪,对93例肿瘤骨转移疼痛患者153Sm-EDT-MP治疗前、治疗后1天、7天及1个月血象（包括红细胞、白细胞、血红蛋白、血小板等系列）进行检测并分析研究。结果：153Sm-EDTMP治疗后1天白细胞、粒细胞升高,淋巴细胞降低（P〈0.05）;治疗后7天白细胞、粒细胞、淋巴细胞、红细胞、血红蛋白测定及血小板计数均低于治疗前（P〈0.05）;治疗后1个月红细胞计数升高（P〈0.05）。结论：利用153Sm-EDTMP治疗肿瘤骨转移疼痛时,辐射对患者血象有一定影响,但影响较轻微且为一过性,随时间推移,血象各项指标均可恢复正常。     

High-dose samarium-153 ethylene diamine tetramethylene phosphonate: low toxicity of skeletal irradiation in patients with osteosarcoma and bone metastases.

PURPOSE: Samarium-153 ethylene diamine tetramethylene phosphonate ((153)Sm-EDTMP), a bone-seeking radiopharmaceutical, provides therapeutic irradiation to osteoblastic bone metastases. Because the dose-limiting toxicity of (153)Sm-EDTMP is thrombocytopenia, a dose-escalation trial using peripheral-blood progenitor cells (PBPCs) or marrow support was conducted to treat metastatic bone cancer. PATIENTS AND METHODS: Patients with locally recurrent or metastatic osteosarcoma or skeletal metastases avid on bone scan were treated with 1, 3, 4.5, 6, 12, 19, or 30 mCi/kg of (153)Sm-EDTMP. RESULTS: Thirty patients were treated with (153)Sm-EDTMP. Transient symptoms of hypocalcemia were seen at 30 mCi/kg. Estimates of radioisotope bound to bone surfaces and marrow radiation dose were linear with injected amount of (153)Sm-EDTMP. Cytopenias also occurred in all subjects and were dose-related. At day +13 after (153)Sm-EDTMP, residual whole-body radioactivity was 1% to 65% of whole-body radioactivity considered safe for PBPC infusion, 3.6 mCi. After PBPC or marrow infusion on day +14 after (153)Sm-EDTMP, recovery of hematopoiesis was problematic in two patients at the 30 mCi/kg dose infused with less than 2 x 10(6) CD34(+)/kg on day +14, but not in other patients. Reduction or elimination of opiates for pain was seen in all patients. Patients had no adverse changes in appetite or performance status. CONCLUSION: (153)Sm-EDTMP with PBPC support can provide bone-specific therapeutic irradiation (estimates of 39 to 241 Gy). Hematologic toxicity at 30 mCi (153)Sm-EDTMP/kg requires PBPC grafts with more than 2 x 10(6) CD34(+)/kg to overcome myeloablative effects of skeletal irradiation. Nonhematologic side effects are minimal.     

153Sm-EDTMP治疗多发骨转移瘤的剂量效应关系初步观察

背景与目的:核素内照射治疗的剂量计算一直是核医学研究的热点和难点之一,用蒙特卡罗法(MonteCarlo,MC)计算153Sm-乙二胺四甲撑膦酸(Samarium-153ethylenediaminetetramethylenephosphonicacid,153Sm-EDTMP)治疗多发性骨转移患者骨转移灶、骨髓等靶器官的吸收剂量,初步探讨病灶吸收剂量与153Sm-EDTMP止痛疗效的关系。方法:选择鼻咽癌、乳腺癌伴全身多发骨转移患者4例,患者骨痛剧烈,骨痛评分Ⅳ级,按0.65×37MBq/kg药量静脉注射,行153Sm-EDTMP内照射治疗。基于患者的时序性SPECT/CT扫描和累积尿液的放射性强度测定,确定患者的药物代谢动力学特点,利用MCEGS4程序计算骨转移灶和其它靶器官的吸收剂量及其分布。观察骨痛症状的缓解状况和生活质量的改善情况。结果:153Sm-EDTMP治疗后,患者骨痛明显减轻,骨痛评分达Ⅱ级,持续3～4周。骨转移灶和其它靶器官的三维吸收剂量分布图显示:病灶内剂量分布不均匀。骨转移灶的最高吸收剂量约为4.9～5.9Gy,病灶边缘的吸收剂量为2.0Gy左右,以病灶区最高剂量为参考点,则骨髓剂量为0.48～1.1Gy,骨皮质剂量为0.51～0.85Gy;病灶周围软组织的吸收剂量为0.01～0.14Gy。结论:按常规单次153Sm-EDTMP治疗,骨转移病灶远未达到30Gy姑息剂量水平,虽有一定的止痛结果,但止痛持续时间短,疗效有限,与临床观察结果一致。     

Samarium lexidronam (153Sm-EDTMP): skeletal radiation for osteoblastic bone metastases and osteosarcoma

Radiation therapy can be an effective means to treat bone metastases, which occur in more than 50% of cancer patients. (153)Samarium lexidronam ((153)Sm-EDTMP; Quadramet, Cytogen) is a radiopharmaceutical designed for deposition into bone metastases. Bone scans can identify patients that may benefit from targeted radiation therapy with (153)Sm-EDTMP. As an unsealed source of radiation therapy, (153)Sm-EDTMP is simple to administer: 1 mCi/kg is given in a similar fashion to a bone scan injection ((99m)Tc-MDP bone scan injection is given at 0.2-0.35 mCi/kg. Therefore, both are administered intravenously. However, the radiation-absorbed dose and radiopharmaceutical energy are different). Nevertheless, despite simplicity of administration, (153)Sm-EDTMP is underutilized for improving cancer pain in the skeleton. Repeated cycles and combined treatment with other modalities such as bisphosphonates, chemotherapy and/or external beam radiation are possible. (153)Sm-EDTMP combined with bisphosphonates, chemotherapy and/or radiation may provide better palliation of bone metastases and also in bone-forming tumors (osteosarcoma). Encouraging experience using high-dose (153)Sm-EDTMP for total marrow irradiation in hematologic malignancies involving the bones (e.g., myeloma or acute leukemia) is also reviewed.     

153Sm-EDTMP治疗肿瘤骨转移痛的临床观察

目的观察153Sm-EDTMP（153钐标记乙二胺四甲撑膦酸）在治疗肿瘤骨转移疼痛中的止痛效果及其毒副反应。方法103例肿瘤骨转移疼痛患者,使用153Sm-EDTMP（37 MBq/kg）静脉注射单次治疗。记录治疗前后的疼痛评分[用直观类比标度（visual analog scale,VAS）判断]、体力评分,每周观察血常规变化以分析毒性作用,疗效判断以VAS评分下降≥2分为有效,0分为完全缓解。结果治疗后血细胞计数出现下降,但下降是短暂的、可逆的,治疗后8周已接近基线水平,除入组时已处于轻度毒性状态的患者出现级毒性反应外,其余患者均不超过级以上毒性。用药后6周疼痛评分下降到最低值,体力评分于用药后逐渐上升,4周时最高。总有效率为76%,完全缓解率为15%。结论153Sm-EDTMP是行之有效的骨转移骨痛缓解药物,起效快、维持时间长,可明显提高患者的生活质量。