47例骨转移癌放疗止痛疗效观察

目的：分析我院骨转移癌的放疗止痛疗效。方法：回顾性分析本科2002年1月～2006年1月间收治47例合并骨转移的晚期癌症患者的治疗情况，分析放疗止痛的疗效。结果：放疗1周后患者疼痛症状就开始逐步减轻，第4周达高峰，然后趋于平稳。总有效率达87．2％。结论：放射治疗骨转移癌的作用快、疗效好。     

图像引导下的大分割调强放射治疗骨转移癌临床研究

目的:本研究采用图像引导下的大分割调强放疗技术,治疗癌症骨转移。评价该方案的可行性、安全性及有效率。方法:选取我科2011²012年收治椎体骨转移患者21名,骨转移灶28处,予肿瘤所在椎体24 Gy/6次,同步予肿瘤加量至36 Gy/6次,限制脊髓D 0.1 ml小于25 Gy。结果:病灶疗前疼痛评分7.54±0.84分;疗后即刻评分4.00±1.59分,缓解程度47.38%±17.75%;疗后1月评分2.46±2.01分,缓解程度67.54%±24.84%;疗后3月评分2.07±1.92分,缓解程度72.92%±24.09%。治疗后即刻、1月、3月疼痛评分较疗前均有显著差异(P<0.01)。疗后即刻有效率为57.14%(16/28),1月有效率为82.14%(23/28),3月有效率为82.14%(23/28)。1例患者出现II度食管副反应,无患者出现神经系统副反应。结论:本研究表明图像引导下的大分割调强放射治疗骨转移癌是安全有效的治疗选择,其长期疗效尚需进一步研究。     

外照射放疗对恶性肿瘤骨转移的止痛治疗作用

骨转移是最常见的肿瘤合并症，疼痛是主要症状。放射治疗是最常用的姑息治疗手段，能有效地控制骨转移灶并缓解疼痛。对提高病人生活质量，延长生存时间很有意义。     

放疗结合心理护理对乳腺癌骨转移的止痛疗效分析

乳腺癌是危害妇女健康的主要恶性肿瘤之一。患者确诊时5％-15％已有远处转移，死亡乳腺癌尸检，50％有骨转移。骨转移多数伴有持续且日益加重的疼痛，持续性疼痛，不仅影响病人的正常生活。而且引起病人的严重的心理变化，特别当疼痛持续时间较长且逐渐加重时，病人常失去生存的希望。我科于2000年1月至2003年12月结32例乳腺癌骨转移患者实行放射治疗结合心理护理止痛，效果显著。结果报告如下。     

帕米磷酸二钠联合放疗减轻恶性肿瘤骨转移疼痛的观察

骨转移是恶性肿瘤的常见并发症之一，而进行性骨痛为其主要表现，严重影响病人的生存质量。我科应用帕米磷酸二钠(博宁)联合放疗治疗骨转移引起的疼痛收到较好的疗效。现报告如下。     

恶性肿瘤骨转移癌痛病人的护理

总结恶性肿瘤骨转移癌痛病人的护理,包括心理护理、一般护理、疼痛护理、放化疗护理及健康教育。     

放疗结合心理护理对乳腺癌骨转移的止痛疗效分析

乳腺癌是危害妇女健康的主要恶性肿瘤之一。患者确诊时5％～15％已有远处转移，死亡乳腺癌尸检，50％有骨转移。骨转移多数伴有持续且日益加重的疼痛，持续性疼痛，不仅影响病人的正常生活。而且引起病人的严重的心理变化，特别当疼痛持续时问较长且逐渐加重时，病人常失去生存的希望。我科于2000年1月至2003年12月结32例乳腺癌骨转移患者实行放射治疗结合心理护理止痛，效果显著。结果报告如下。     

骨转移瘤46例放疗疗效观察

目的观察骨转移病灶的晚期肿瘤进行骨转移灶的姑息放射治疗临床疗效。方法根据病变转移部位不同和患者生存期的长短不同,对46例骨转移瘤患者给予不同的放疗方式,预期生存期较短的给予每次3 Gg,总量30 Gg/10 f,对于估计寿命超过一年的给予每次2 Gg分割,总量40~50 Gg/20~25 f。结果有40例患者的疼痛得到缓解,放疗总有效率为87%。结论放疗对骨转移瘤止痛治疗是有效可行的首选方法。     

局部放疗联合唑来膦酸治疗骨转移癌疗效观察

目的:观察局部放疗联合唑来膦酸治疗骨转移癌的疗效及对疼痛程度的影响。方法:选取我院2015年1月～2017年10月收治的骨转移癌患者167例,依照治疗方式不同分为对照组83例和研究组84例。对照组接受局部放疗,研究组于对照组基础上采取唑来膦酸治疗。比较两组临床疗效、毒副反应发生率,观察两组治疗前后疼痛程度(VAS)评分及生活质量(WHOQOL-100)评分变化。结果 :研究组治疗总有效率略高于对照组,但差异无有统计学意义;治疗前,两组VAS评分及WHOQOL-100评分比较,差异无统计学意义(P0.05);治疗后,观察组VAS评分低于对照组,WHOQOL-100评分高于对照组(P0.05);两组毒副反应发生率比较,差异无统计学意义(P0.05)。结论:骨转移癌患者采取局部放疗联合唑来膦酸治疗的效果确切,能明显减轻患者疼痛程度,提升其生活质量,且安全性较高。     

恶性肿瘤骨转移放射治疗止痛的疗效观察

目的进行临床试验来评价放射治疗恶性肿瘤骨转移引起疼痛的疗效.方法对恶性肿瘤骨转移伴疼痛共92例进行回顾性分析.结果总有效率为91.3%,其中完全缓解率41.3%,部分缓解率50.0%,未缓解8.7%,毒副作用少.结论放疗能有效地减轻骨转移引起的疼痛,其毒副反应轻微,值得临床进一步推广.     

Pain flare in patients with bone metastases after palliative radiotherapy—a nested randomized control trial

Background Short-course radiotherapy is a common treatment for the palliation of painful osseous metastases. Pain flare can be problematic, but its incidence has previously not been well-documented. The objectives of this study were to determine (1) the incidence of pain flare after palliative radiation for painful osseous metastases, and (2) whether single-fraction radiotherapy increases the risk of pain flare. Materials and methods Patients accrued to a prospective randomized control trial comparing 8 Gy in one fraction to 20 Gy in five fractions (the Canadian Bone Metastasis Study) were approached to fill out a daily pain and analgesia diary for the 7 days post-radiotherapy. Patients assessed their average pain at the index site using the Present Pain Intensity (PPI) scale of the McGill–Melzack pain questionnaire and recorded their daily analgesic medications, which were translated into an analgesic score. Pain flare was defined as a two-point increase in the PPI with no decrease in analgesic score or a 50% increase in analgesic score with no decrease in PPI on at least two consecutive days. Results Forty-seven patients agreed to fill out the diary and 44 (94%) completed it. Fifteen of 44 (34.1%) patients experienced a pain flare that lasted a median of 3 days. Ten of 23 (43.5%) and 5/21 (23.8%) of patients who received 8 Gy and 20 Gy had a pain flare, respectively. Conclusions Pain flare is common after palliative radiotherapy for osseous metastases and patients receiving single fraction radiotherapy may be at higher risk. Further study is warranted to determine predictors and preventive interventions. Preliminary results of this study have been presented at the 2001 Annual Scientific Meetings of the American Society of Clinical Oncology and American Society of Therapeutic Radiology and Oncology.     

Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases—a pilot study

Purpose To investigate the efficacy of dexamethasone as a prophylactic adjuvant analgesic to decrease pain flare and to assess its safety and tolerance of dexamethasone. Materials and methods Patients treated with a single 8 Gy for bone metastases took 8 mg dexamethasone before the radiation treatment. The Brief Pain Inventory was administered at baseline and then daily for 10 days after radiation. Pain flare was defined as a two-point increase in the worst pain or a 25% increase in the analgesic intake when compared with the baseline. Results Thirty-three patients (23 males, 10 females) had complete follow-up data. Their median age was 73 years old. Ten patients had progressive worsening pain during the entire 10-day follow-up. A total of eight patients (24%; 95% CI, 10–39%) experienced pain flare during the 10-day follow-up. Two patients had a 1-day pain flare on day 3. Three patients had a 1-day pain flare on day 7. Three other patients had a prolonged pain flare: one had a 3-day pain flare on days 2–4, one had a 3-day pain flare on days 4–6, and the other, a 6-day pain flare on days 3–8. The half-life of dexamethasone is 36–54 h. Only one patient (3%) experienced pain flare in the first 2 days of follow-up with the action of dexamethasone. Dexamethasone was well tolerated. Conclusion Dexamethasone might be effective in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases. Randomized trials are required to confirm the finding.     

微波放疗联合治疗继发性骨肿瘤30例近期疗效观察

目的 观察微波放疗联合治疗骨继发性恶性肿瘤的效果。方法 ６０例骨转移瘤患者随机分为两组,微波放疗组２０例,单纯放疗组２０例。结果 微波放疗组的骨痛缓解、生活质量改善、均优于单纯放疗组,两组差异有显著性（Ｕ＝１．９６８,２：２７０;Ｐ〈０．０５）,两组的转移灶控制率分别为５７％和３０％,两组差异有显著性（Ｘ＾２＝４．３４,Ｐ〈０．０５）。结论 微波放疗联合组对骨转移病灶的控制效果 佳,毒副作用小,患     

放松训练配合聆听音乐对晚期骨转移癌患者疼痛控制的研究

目的评价放松训练配合聆听音乐在晚期骨转移癌患者疼痛控制中的作用。方法于患者入院时即进行放松训练配合聆听音乐后分别测定患者的疼痛程度及评价患者的主观感受。结果进行放松训练配合聆听音乐后患者疼痛程度明显减轻（P〈0．01）;自制问卷调查显示,患者对放松训练配合聆听音乐的正性评价为94％。结论放松训练配合聆听音乐有助于晚期骨转移癌患者疼痛的控制。     

局部冷喷减轻静脉留置针穿刺疼痛的效果观察

目的观察气雾型皮肤冷喷剂局部冷喷减轻静脉留置针穿刺疼痛的效果。方法将201例静脉留置针穿刺患者按穿刺日单、双号分为对照组100例和观察组101例。对照组采用常规方法进行穿刺;观察组在穿刺前以穿刺点为中心喷气雾型皮肤冷喷剂2次,每次持续时间5s,30S内进行穿刺。评价两组穿刺时疼痛程度、穿刺成功率,观察观察组局部皮肤冻伤情况。结果观察组患者疼痛程度明显低于对照组,X2CMH=54．29,P〈0．01;两组一次穿刺成功率比较差异无统计学意义,X2CMH=0.106,P〉0．745;观察组皮肤零冻伤率。结论局部冷喷可有效减轻静脉留置针穿刺时的疼痛,不影响穿刺结果,安全可行。     

Effectiveness of bisphosphonates on bone pain and quality of life in breast cancer patients with metastatic bone disease: a review

Introduction Almost all patients with breast cancer and bone metastases suffer bone pain. Many receive bisphosphonate therapy only when the pain becomes unbearable or there is a direct threat of skeletal complications. Discussion However, clinical trial data demonstrate that bisphosphonates offer significant and sustained relief from bone pain and can also improve quality of life in patients with metastatic breast cancer. Conclusion Moreover, new treatment schedules using high dose bisphosphonates can offer rapid relief of acute, severe bone pain.     

鲑鱼降钙素鼻喷剂对骨质疏松性疼痛和骨密度的影响研究

目的探讨鲑鱼降钙素鼻喷剂对骨质疏松性疼痛和骨密度的影响。方法将106例骨质疏松性疼痛患者随机分成观察组和对照组各53例,两组患者均给予枸橼酸苹果酸钙进行补钙治疗,运动、饮食宣教一致。观察组加用鲑鱼降钙素鼻喷剂喷鼻,每天喷2次,治疗2个月后对两组患者治疗前后骨密度测定及疼痛程度进行比较。结果两组患者治疗后的骨密度值均明显增加（P〈0.01）,疼痛程度明显改善（P〈0.01）,且观察组疗效明显优于对照组（P〈0.01）,差异有极显著意义。结论应用鲑鱼降钙素鼻喷剂治疗骨质疏松性疼痛,能有效缓解患者疼痛和提高骨密度,且用药方便、安全,患者依从性高,能提高患者生活质量。     

Review of patterns of practice and patients’ preferences in the treatment of bone metastases with palliative radiotherapy

Introduction Since the 1980s, randomized clinical trials showed that single fraction radiotherapy (RT) provided equal pain relief as multiple fractions of RT in the treatment of bone metastases. Materials and methods Using Medline, a literature search was conducted on patterns of practice among radiation oncologists and patients’ preferences of dose fractionations for the treatment of bone metastases. Results and discussion Fifteen studies on international patterns of practice published between 1966 and May 2006 were identified. Surveys of Canadian radiation oncologists indicated approximately 85% preferred multiple fractions, most often as 20 Gray in five fractions (20 Gy/5). Surveys in the United States indicated that 30 Gy/10 was most commonly used, and 90–100% of these oncologists preferred multiple over single fraction RT. Multiple fractions were most commonly used in the United Kingdom, Western Europe, Australia and New Zealand, and India; however, more radiation oncologists in these countries would prescribe a single fraction than in North America. Three studies investigated patients’ preferences of dose fractionations. In the Australian study, most patients favored single fraction RT as long as long-term outcomes were not compromised. Durability of pain relief was considered more important than short-term convenience factors. In the Singapore study, 85% of patients would choose extended courses of RT (24 Gy/6) compared to a single 8 Gy. In the Canadian study, most patients (76%) would choose a single 8 Gy over 20 Gy/5 of palliative RT due to greater convenience. Conclusion Despite strong evidence supporting the use of single fraction RT, current practices and preferences favor multiple fractions for the treatment of bone metastases. This has significant implications for the overall quality of life, RT department workload, costs to healthcare systems, and patient convenience.     

The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic

Goals of work  Radiotherapy (RT) for palliation of pain due to bone metastases (BM) is effective but underutilized likely due to the traditional practice of separate clinic visits for consultation, treatment planning, and RT delivery. However, recent evidence proves one RT treatment is as effective as multiple for analgesia, enabling investigation of an alternative model of RT delivery, the rapid access palliative radiotherapy program (RAPRP). Materials and methods  Prior to the start of the program, needs assessment was performed to determine the composition of the optimal team. Screening tools were implemented to streamline holistic, multidisciplinary assessment. An advertising strategy, treatment and research protocols, and mechanisms for patient feedback were established. After RAPRP implementation, patient outcomes such as symptom relief were tracked. Main results  Eighty-six patients with painful BM were referred over the 25-week pilot. Median age was 69.9 years; 64% had prostate cancer, and median performance status was 70. Patient-rated pain was on average 6.1/10 at baseline, improving to 2.6/10 by week 4 post-RT. On average, 6.2 symptoms were reported (baseline) compared to 5.2 (week 4). Team members assessed 10–100% of patients and were successful in stabilizing or improving all symptoms in >75% contacted at week 4. One hundred percent of patients surveyed were satisfied with their experience. Conclusions  Early needs assessment was advantageous in determining the optimal team and methods of assessment for our ‘one-stop’ BM clinic. This approach was successful in improving pain and other symptoms, and the convenience of seeing multiple providers on 1 day was appreciated by the patients.