^89SrCl2与^153Sm-乙二胺四亚甲基膦酸治疗骨转移癌的对比研究

目的对比研究^89SrCl2和^153Sm-乙二胺四亚甲基膦酸（^153Sm-EDTMP）治疗骨转移癌疗效。方法120例骨转移患者随机分为SOSrCl2治疗组和^153Sm-EDTMP治疗组,分别为69例和51例,^89SrCl2剂量为1．11-2．22MBq／kg,^153Sm-EDTMP剂量为25．9～37．0MBq／kg,3-6月复查SPECT,对止痛效果、转移灶变化及不良反应进行比较分析。结果^89SrCl2组总有效率、显效、有效、无效分别为92．8％、69．6％、23．3％、7．2％;^153Sm-EDTMP组的总有效率、显效、有效、无效分别为94．2％、66．7％、27．5％、5．8％,两组比较的差异无统计学意义（χ^2=4．98,P〉0．05）;^89SrCl2治疗组骨转移病灶Ⅰ级（变淡,缩小或消失,无新增病灶出现）为56．5％,^153Sm-EDTMP组为54．9％,两组比较的差异无统计学意义（χ^2=4．81,P〉0．05）;骨髓抑制情况（白细胞和血小板中任一项降低）分别为40．8％和59．2％,两组比较的差异有统计学意义（r=7．45,P〈0．05）。结论^153sm-EDTMP和^89SrCl2控制乳腺癌、前列腺癌及大多数肺癌骨转移疼痛有效,可根据经济条件选择相应药物。^89SrCl2疗效持久,相对骨髓抑制较小,更安全可靠,可作为早期骨转移患者的首选药物。     

He-Ne激光静脉内照射加骨膦治疗骨转移癌性疼痛的探讨——附50例分析

为了提高治疗骨转移癌疼痛的效果，我们采用骨膦和骨膦加Ｈｅ－Ｎｅ激光静脉内照射治疗骨转移癌疼痛病人５０例。单纯骨膦治疗组总有效率为６８％（１５／２２），显著缓解率为１４％（３／２２）；激光加骨膦综合治疗组总有效率为９６％（２７／２８），显著缓解率为５７％（１６／２８），两组疗效有非常显著性差异（Ｐ＜０．０１）。说明骨膦加Ｈｅ－Ｎｅ激光静脉内照射能较好地缓解疼痛。     

89SrCL2与唑来膦酸联合治疗乳腺癌转移性骨肿瘤的疗效分析

目的：探讨放射性核素二氯化锶（89SrCl2）联合唑来膦酸治疗激素依赖型乳腺癌转移性骨肿瘤的临床疗效。方法回顾性分析64例激素依赖型乳腺癌转移性骨肿瘤患者的临床资料,将所有患者分为3组：89SrCl2治疗组22例;唑来膦酸治疗组21例;89SrCl2联合唑来膦酸治疗组21例;观察治疗后转移病灶疗效、骨痛缓解情况、生活质量状况、骨髓抑制反应情况。结果89SrCl2治疗骨转移病灶有效率为36.4%（8/22）,视觉模拟评分下降率为77.3%（17/22）,全身状况KPS评分提高率为63.6%（14/22）,27.2%（6/22）的患者出现骨髓抑制反应;唑来膦酸治疗后骨转移病灶有效率为33.3%（7/21）,视觉模拟评分下降率为71.4%（15/21）,全身状况KPS评分提高率为52.4%（11/21）,19.0%（4/21）的患者出现骨髓抑制反应;89SrCl2联合唑来膦酸治疗骨转移病灶有效率为42.9%（9/21）,视觉评分下降率为90.5%（19/21）,全身状况KPS评分提高率为90.5%（19/21）,33.3%（7/21）的患者出现骨髓抑制反应。结论89SrCl2联合唑来膦酸对激素依赖型乳腺癌转移性骨肿瘤的疗效明显,不良反应小,联合治疗效果优于89SrCl2和唑来膦酸单独治疗。     

He—Ne激光静脉内照射加骨膦治疗骨转移癌性疼痛的探讨

为了提高治疗骨转移癌疼痛的效果，我们有膦和骨膦加Ｈｅ－Ｎｅ激光静脉内照射治疗骨转移癌疼痛病人５０例，单纯骨膦治疗组总有效率为６８％（１５／２２），显著缓解率为１４％；激光加骨膦综合治疗组总有效率为９６％，显著缓解率为５７％，两职效有非常显著性差异，，说明骨膦加Ｈｅ－Ｎｅ激光静脉内有较好地缓解疼痛。     

烟酰胺和碳合氧增敏89Sr治疗多发性骨转移癌的临床研究

目的评价烟酰胺和碳合氧（Carbogen）增敏^89Sr治疗多发性骨转移癌的作用、骨痛的缓解及毒副反应。方法97例恶性肿瘤多发性骨转移患者随机分为4组：烟酰胺＋Carbogen＋^89Sr治疗组（A组）；烟酰胺＋^89Sr治疗组（B组）；Carbogen＋^89Sr治疗组（C组）；^89Sr治疗组（D组）。^89SrCl2治疗采用1．48-2．22MBq／kg，静脉注射。注射^89Sr前1h开始给予烟酰胺，6g／d，分3次口服，连服5d。首次口服烟酰胺后开始吸入Carbogen（95％O2＋5％CO2）气体，6L／min，10min，每日1次，连续5d。结果A组治疗后骨痛的缓解及生活质量较B组、C组及D组有效率高（91．7％、77．3％、76．0％和69．2％），且A组与D组比较差异有统计学意义（P=0．048）。治疗后3个月复发性骨转移癌全身骨显像反应，各组之间差异无统计学意义。各组病人治疗后均有Ⅰ-Ⅱ度骨髓抑制，各组之间差异无统计学意义。结论烟酰胺＋Carbogen＋^89Sr治疗多发性骨转移癌，对骨痛的缓解及生活质量的改善有更好的疗效，且未增加^89Sr的治疗毒性反应。     

^89Sr治疗乳腺癌转移性骨痛的疗效评价

目的 评价^89SrCl2对乳腺癌转移性骨痛的临床疗效。方法 对86例乳腺癌骨转移患者按体重静脉注射^89SrC1．48－2．22MBq/kg。结果 治疗后骨痛减轻或消失72例,总有效率为83．72％;治疗后骨显像有59．30％（51例）骨转移灶代谢减低。治疗前后ROI比值比较,P＜0．05。治疗后有27．90％（24例）出现Ⅰ-Ⅱ度血液学毒性反应,对心、肝、肾功能几乎没有影响。结论 ^89Sr对缓解乳腺癌骨转移瘤疼痛有较好疗效,并有一定的治疗作用,副作用小,可重复用药。     

89SrCl2注射液治疗肿瘤骨转移致骨痛的多中心临床研究(Ⅱ)

目的观察成都中核高通同位素股份有限公司自制的^89 SrCl2注射液对前列腺癌、乳腺癌、肺癌等骨转移所致骨痛患者的止痛效果及毒性和不良反应。方法采用多中心、随机、双盲、阳性药物（英国Amersham公司生产的原装Metastron）平行对照试验。5个临床研究中心共对入组的95例原发病灶诊断明确的恶性肿瘤骨转移患者进行了骨痛镇痛治疗。其中A组（对照组）31例，1例失随访，其余男13例，女17例，年龄33～75（56．90±12．08）岁，治疗前骨痛评分为6～9（6．87±1．36）。A组中原发性肺癌7例（23．33％），乳腺癌13例（43．33％），前列腺癌10例（33．33％）；病程0．08～12．25（2．764-3．02）年。资料完整的B组（验证组）64例，其中男32例，女32例，年龄29～75（58．70±11．82）岁，治疗前骨痛评分为6～12（6．81±1．61）。B组中原发性肺癌18例（28．12％），乳腺癌27例（42．19％），前列腺癌19例（29．69％）；病程0．04～26（3．63±4．43）年。所有入选患者均静脉注射同一剂量（148MBq）^89 SrCl2。治疗后观察3个月。有效率=（完全缓解例数＋显效例数）／总例数。统计学处理方法：可比性分析主要采用Fisher确切概率法、CMH检验及t检验等方法；有效性分析采用控制中心效应的CMH方法比较疗效；安全性分析采用Fisher确切概率法。实验室检查主要描述治疗前后正常、异常情况。以上所有的假设检验采用双侧检验，取α=0．05，统计分析软件采用SAS8．2。结果治疗前A，B2组患者间一般资料及体力状况分级、疼痛量表评分、疼痛得分、疼痛部位等指标均具可比性（P均〉0．05）。2组依从性差的发生率及安全性分析结果、合并用药结果差异均无统计学意义（P均〉0．05）。符合方案集（PPS）中，A组有效率为66．67％，B组有效率为71．43％，2组比较差异无统计学意义（P=0．620）；全分析集（FAS）中，A组有效率为66．67％，B组有效率为70．31％，2组比较差异无统计学意义（P=0．700）。2个数据集的结论一致。结论国产^89SrCl：2注射液对肿瘤骨转移所致骨痛有较好的治疗效果，其与Amersham公司生产的原装Metastron等效，且使用安全。     

唑来膦酸联合放疗治疗骨转移癌的临床观察

目的观察唑来膦酸联合放疗治疗骨转移癌的临床疗效。方法将62例骨转移癌患者随机分为观察组32例和对照组30例。观察组放疗前1d静滴唑来膦酸4mg,3w后重复1次,联合局部放疗30Gy;对照组单纯局部放疗。结果观察组和对照组止痛有效率分别为90．6％和70．0％（P〈0．05）;活动能力改善有效率分别为84．4％和56．7％（P〈0．05）;生活质量改善的KPS评分也有显著性差异（P〈0．01）。结论唑来膦酸联合放疗治疗骨转移癌疗效明显,是目前治疗骨转移癌的优选方案。     

唑来膦酸治疗癌骨转移疼痛疗效观察

目的：观察唑来膦酸治疗恶性肿瘤骨转移骨痛及改善活动能力的效果。方法：选择癌骨转移疼痛患者41例，随机分为观察组20例和对照组21例。观察组应用唑来膦酸，1次静脉滴注4rr培；对照组应用帕米膦酸二钠，1次静脉滴注60-90mg。结果：两组镇痛和改善活动能力总有效率分别为90．0％、85．7％和75．0％、71．4％，均无显著差异（P〉0．05）。两组不良反应类似，发热率对照组高于观察组。结论：唑来膦酸与帕米膦酸二钠缓解骨痛、改善活动能力及不良反应类似，但唑来膦酸用药剂量小，给药时间短。     

89SrCl2与153Sm-乙二胺四亚甲基膦酸治疗骨转移癌的对比研究

目的 对比研究89SrCl2和153Sm-乙二胺四亚甲基膦酸(153Sm-EDTMP)治疗骨转移癌疗效.方法 120例骨转移患者随机分为89SrCl2治疗组和153Sm-EDTMP治疗组,分别为69例和51例,89SrCl2剂量为1.11～2.22 MBq/Kg,153Sm-EDTMP剂量为25.9～37.0 MBq/kg,3～6月复查SPECT,对止痛效果、转移灶变化及不良反应进行比较分析.结果 89SrCl2组总有效率、显效、有效、无效分别为92.8%、69.6%、23.3%、7.2%;153Sm-EDTMP组的总有效率、显效、有效、无效分别为94.2%、66.7%、27.5%、5.8%,两组比较的差异无统计学意义(X2=4.98,P>0.05);89SrCl2治疗组骨转移病灶Ⅰ级(变淡,缩小或消失,无新增病灶出现)为56.5%,153Sm-EDTMP组为54.9%,两组比较的差异无统计学意义(X2=4.81,P>0.05);骨髓抑制情况(白细胞和血小板中任一项降低)分别为40.8%和59.2%,两组比较的差异有统计学意义(X2=7.45,P<0.05).结论 153Sm-EDTMP和89SrCl2控制乳腺癌、前列腺癌及大多数肺癌骨转移疼痛有效,可根据经济条件选择相应药物.89SrCl2疗效持久,相对骨髓抑制较小,更安全可靠,可作为早期骨转移患者的首选药物.     

Serum concentrations of IL-2 and TNF-alpha in patients with painful bone metastases: correlation with responses to 89SrCl2 therapy.

We have used 89SrCl2 for the palliative treatment of painful bone metastases from various malignant diseases. We studied the correlation between serum interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-alpha) levels and the response to 89SrCl2 therapy. METHODS: Forty-two patients (24 men and 18 women) were treated intravenously with 89SrCl2 at a dose of 148 MBq (4 mCi). RESULTS: The response rate was 33 of 42 (79%). In the control subjects, serum IL-2 concentrations were higher but TNF-alpha concentrations lower (P < 0.05) than in the patients with bone metastases. After treatment with 89SrCl2, IL-2 levels increased and TNF-alpha levels decreased, with maximal changes at the fourth month after therapy. After comparing the serum levels of IL-2 and TNF-alpha between responders and nonresponders, we found that these variables did not differ before 89SrCl2 therapy but differed significantly (P < 0.05) after therapy. Responders had higher IL-2 and lower TNF-alpha concentrations than nonresponders. A good correlation was found between IL-2 and TNF-alpha levels and the number of metastases and pain score. CONCLUSION: 89SrCl2 is effective for palliation of bone pain in patients with disseminated bone metastases. In addition to managing pain, 89SrCl2 can improve immunity and the quality of life for most patients. Further studies are needed to elucidate the roles of IL-2 and TNF-alpha in the response to 89SrCl2 therapy and to evaluate their usefulness as indicators of 89SrCl2 efficacy.     

复方苦参注射液联合89Sr治疗骨转移瘤的临床研究

目的:分析复方苦参注射液联合⁸⁹Sr治疗骨转移瘤的有效率和安全性。方法:将84例骨转移瘤患者随机均分为研究组和对照组各42例,研究组采用复方苦参注射液和⁸⁹Sr联合治疗,对照组单用⁸⁹Sr治疗;治疗2个疗程后比较2组的止痛总有效率、止痛起效时间、骨转移灶改善情况、生活质量改善情况和安全性。结果:研究组止痛总有效率为80.95%(34/42),显著高于对照组的66.67%(28/42)(P=0.028),且研究组止痛起效更快[(4.45±1.27)d vs.(7.23±2.05)d,P=0.015];研究组骨转移灶改善率为90.48%(38/42),显著性高于对照组的71.43%(30/42)(P=0.012);研究组生活质量改善率为90.48%(38/42),显著高于对照组的76.19%(32/42)(P=0.031);2组治疗过程中出现的血液毒性比较差异无统计学意义(P=0.574)。结论:复方苦参注射液可增强⁸⁹Sr治疗骨转移瘤的止痛总有效率,提高骨转移灶改善率,改善患者生活质量,且安全性良好,值得临床推广应用。     

The effect of repeated strontium-89 chloride therapy on bone pain palliation in patients with skeletal cancer metastases

One hundred and eighteen patients with painful skeletal metastases of malignant diseases (predominantly prostate, breast and lung cancer) were treated with 150 MBq of strontium-89 chloride (Metastron, Amersham, UK) intravenously. The results were evaluated according to a score considering pain relief, mobility, analgesic intake and general feeling. In only five patients (4.2%) was no improvement observed; mild improvement was noted in 48 (40.7%), and substantial or complete improvement in 56 (47.5%) and 9 (7.6%), respectively. The mean painless period after a single ⁸⁹SrCl dose was 3.3±2.28 months (in patients with prostate, lung, breast and other types of cancer it was 3.65±2.11, 3.29±1.27, 3.08±0.48 and 3.44±1.36 months, respectively). During a 3-year study, ⁸⁹SrCl treatment was successively repeated up to 5 times in some patients (total number of Metastron applications was 256) who benefited from the first Metastron administration and did not show signs of myelosuppression. Even after repeated treatment, relief was consistent and the duration of the period without pain increased (in particular in patients with breast cancer, in whom the period of relief was prolonged from 3.08±0.48 months after the first dose to 5.33±2.36 months after the fifth ⁸⁹SrCl administration). The increased painless period was not observed after repeated treatment in the patient group comprising miscellaneous types of cancer, and the degree of improvement was less apparent. During the course of successive ⁸⁹SrCl treatments, transient signs of myelosuppression indicated by a decrease in white cell and thrombocyte counts of at least 25% were observed 10 times after Metastron administration (twice in two patients), i.e. in 3.9% of all ⁸⁹SrCl administrations; these transient haematological changes of moderate grade were closely connected with Metastron administration. Palliative treatment of metastatic skeletal pain with ⁸⁹SrCl improves the quality of life in most patients suffering from prostate, lung and breast cancer and may be safely repeated with the same benefit and without significant myelosuppression. The beneficial effect of ⁸⁹SrCl treatment seems to be less pronounced in other types of cancer with painful skeletal metastases. Received 9 February and in revised form 20 May 1998     

Percutaneous Cryoablation and Vertebroplasty: A Case Report

A 70-year-old man with a painful vertebral metastasis was treated with combined percutaneous cryoablation and vertebroplasty therapy (CVT) in one session. The patient was suffering from diffuse visceral metastasized cholangiocarcinoma. After several weeks of back pain, magnetic resonance imaging documented a single L2 bone metastasis. In consultation with the oncologists, palliative combined CVT was administered with the aim of obtaining pain relief and bone stabilization. In our experience this combined treatment is safe and effective for immediate pain relief in painful bone metastases when other standard palliative treatments have failed.     

唑来膦酸联合89Sr治疗前列腺癌骨转移的临床疗效

目的评估唑来膦酸联合89Sr治疗前列腺癌骨转移的临床疗效。方法74例前列腺癌骨转移患者按简单随机分组方法分为3组:唑来膦酸联合89Sr治疗组（A组）25例,年龄46~87岁,中位年龄66岁;单独给予唑来膦酸治疗组（B组）25例,年龄43~89岁,中位年龄65岁;单独给予89Sr治疗组（C组）24例,年龄47~85岁,中位年龄66岁。其中,B组和C组为对照组。随访6个月,观察患者骨骼疼痛缓解情况和骨转移病灶数目改善情况。结果3组患者的基线特征相似。治疗后,A组总的疼痛缓解率为88.0%,B组和C组分别为72.0%和79.2%,A组疼痛缓解情况与B组和C组相比差异有统计学意义（χ2=8.959,P < 0.05）。A组骨转移病灶好转率为88.0%,B组和C组分别为44.0%和75.0%,A组病灶好转情况分别与B组、C组相比,差异有统计学意义（χ2=9.096,P < 0.05）。结论唑来膦酸联合89Sr治疗前列腺癌骨转移较单独给药具有更好的缓解疼痛作用,89Sr治疗可有效减少骨转移病灶,提高患者的生活质量。     

89Sr治疗乳腺癌和前列腺癌多发性骨转移的临床观察

目的 探讨放射性核素89Sr治疗乳腺癌和前列腺癌多发性骨转移患者的临床效果.方法 回顾性分析30例乳腺癌和40例前列腺癌多发性骨转移患者接受89Sr治疗的病例资料,采用Karnofsky评分量表和骨显像方法进行疗效评估.结果 乳腺癌组的止痛总有效率为79%,前列腺癌组的止痛总有效率为85%,两组患者之间差异无统计学意义(x2=0.78,P＞0.05).两组患者的生存质量均有明显改善,治疗前后两组患者的Karnofsky评分均有明显提高(t=2.46,P＜0.05;t=2.68,P＜0.05).治疗后两组患者均未见明显骨髓抑制与肝肾功能损伤.结论 89Sr治疗乳腺癌和前列腺癌多发性骨转移止痛效果良好,患者生存质量有明显提高.     

Reirradiation with local-field radiotherapy for painful bone metastases

PURPOSE: The purpose of this study was to evaluate retrospectively the effectiveness, prognostic factors, and sequelae of the first course of local-field reirradiation for painful bone metastases. PATIENTS AND METHODS: From 1994 to 2000, a total of 30 patients were reirradiated for painful bone metastases. The most commonly used initial treatment regimen was 30 Gy/10 Fr/2 wk. An additional dose in the range from 10 Gy/5 Fr to 26 Gy/13 Fr was reirradiated. RESULTS: Fifteen patients (50%) showed some type of pain relief after reirradiation. Patients with initial CR were more likely to respond than those with previous PR (100% vs. 41%). The median duration of pain relief was five months. The duration of response was longer in initial CR than initial PR. The median survival time of responders after retreatment was 11 months. No patient developed radiation myelopathy. Prognostic factors for pain relief were duration from initial treatment, performance status (PS), and status of bone metastases. CONCLUSION: Reirradiation for patients with a long duration from initial treatment (> or = 4 months), good PS (ECOG: 1-2), or solitary bone metastases was effective for pain relief. The appropriate indications, optimal dose, fractions, and technique for reirradiation to painful bone metastases should be further explored in randomized study.