153钐-乙二胺四甲基膦酸治疗多发性骨转移癌骨痛疗效观察

目的 探讨^153钐－乙二胺四甲基膦酸（^153Sm-EDTMP）核纱治疗多发性骨转移癌的可行性。方法 静脉注射^153Sm-EDTMP32例,每疗程剂量0.4-1.0mci/kg(1mCi=37MBq）,肝静脉一次注入,其中7例接受2－3次治疗。结果 骨痛完全缓解53.1％（17／32）,部分缓解25.0％（8／32）,轻度缓解9.4%（3／32）,无效12.5％（4／32）,总有效率为78.1％。副作用为WBC和（或PLT的Ⅰ度、Ⅱ度下降,占15.6％（5／32）,6－8周内基本恢复至治疗前水平。结论 ^153Sm-EDTMP治疗骨广泛转移癌,止痛效果确切,副作用小。     

钐—乙二胺四亚甲基磷酸治疗骨转移癌的临床观察

目的 观察^153钐－乙二胺四亚甲基磷酸（^153Sm-EDTMP）治疗骨转移癌的疗效。方法 对23例骨转移癌患者给予剂量范围为18.5-55.5MBq/kg的^153Sm-EDTMP治疗。结果 患才疼痛总缓解率为87.0％，部分患者骨转移灶缩小、消失。结论 ^153Sm-DETMP对骨转移癌骨痛疗效显著，使用安全，有临床推广价值。     

^153钐-乙二胺四甲基膦酸联合伊班磷酸钠缓解骨转移性癌疼痛

目的 ^153钐-乙二胺四甲基膦酸(^153Sm-EDTMP)联合伊班磷酸钠控制多发性骨转移癌疼痛，探讨其疼痛缓解率。方法 106例多发性骨转移癌患用^153Sm-EDTMP联合伊班磷酸钠治疗，观察骨痛缓解及生活质量提高情况。结果 严重( )：CR23例，PR16例，MR3例，NR3例。中度( )CR18例，PR15例，MR3例，NR2例。轻度( )：CR14例，PR7例，NR2例。止痛有效率87．7％，生活质量明显提高，无严重毒副反应。结论 ^153Sm-EDTMP联合伊班磷酸钠治疗多发性骨转移安全有效。     

153 钐-乙二胺四亚甲基磷酸治疗骨转移癌的临床观察

目的观察     

^153Sm-EDTMP与中草药联合治疗骨转移癌骨痛的近期临床观察

目的利用中草药与^153Sm-EDTMP联合治疗骨转移癌,以提高^153Sm-EDTMP的疗效和减轻其骨髓抑制的副作用。方法选择经临床和病理确诊为肿瘤的患者54例,随机分为A、B两组进行研究。A组即^153Sm-EDTMP治疗组,30例;B组即^153Sm-EDTMP＋中草药治疗组,24例。^153Sm-EDTMP用量为37—74MBq／kg,中草药选用祛风通络、除湿解毒、益肾补气填精之类。结果A组疼痛缓解和生活质量的改善分别为80％和86．1％,外周血白细胞在用药2周后明显下降（P〈0．05）,血小板在用药后1个月明显下降（P〈0．05）;B组疼痛缓解和生活质量的改善分别为91．7％和95．8％,外周血象未见明显改变。结论中草药和^153Sm-EDTMP联合治疗骨转移癌具有临床应用价值。     

^153Sm-EDTMP和骨膦治疗骨转移癌性疼痛

目的：评价^153Sm-EDTMP和／或骨膦治疗骨转移癌症疼痛60例的治疗效果。方法：对60例确诊为骨转移癌的患者随机分为3组，分别为^153Sm-EDTMP治疗组、骨膦治疗组和^153Sm-EDTMP加骨膦治疗组，观察止痛效果、骨病变有效率和毒副反应。结果：^153Sm-EDTMP组30例、骨膦组20例、联合用药组10例的止痛有效率分别为80％，85％和90％；3组分别比较差异无显著性意义(χ^2=1．597，P&;gt;0.05)。3组骨病变有效率分别为20％，10％和50％；联合用药组与其他两组比较差异有显著性意义(χ^2=12．000，8．940，P&;lt;0.05)，3组毒副反应均少。结论：^153Sm-EDTMP加骨膦联合治疗是骨转移癌疼痛的优选疗法。疗效安全可靠。     

^153Sm—EDTMP治疗骨转移疼痛的临床观察

为探讨＾１５３Ｓｍ－ＥＤＴＭＰ（乙二胺四甲基膦酸）治疗骨转移的效果，选择骨转移骨痛患者４５例行＾１５３Ｓｍ－ＥＤＴＭＰ内放射治疗，结果，骨痛完全消失７例，占１５．６％，骨痛缓解３２例，占７１．１％，总有效率为８７．７％，１次治疗止痛时间最短为１个月，最长可达６个月，结果表明，＾１５３Ｓｍ－ＥＤＴＭＰ内放射治疗是缓解病人骨痛，并提高其生存质量的有效手段。     

^153Sm—EDTMP联合热疗治疗骨转移癌骨痛28例疗效观察

目的：探讨^153Sm—EDTMP联合热疗治疗骨转移癌骨痛的疗效。方法：根据患者对治疗方法的选择，将54例骨转移癌患者分为对照组26例和治疗组28例，对照组仅给予^153Sm—EDTMP静脉注射；治疗组在静脉注射^153Sm—EDTMP的基础上给予热疗，比较两组疗效。结果：治疗组发生1级、2级、3级疼痛人数多于对照组，发生4级、5级、6级疼痛的人数较对照组明显减少，两组比较有显著性差异（P〈0．05）。治疗组骨痛治疗有效率为75．0％，好转率为17．9％，无效率为7．1％；对照组骨痛治疗有效率为34．6％，好转率为23．1％，无效率为42.3％，两组疗效比较有极显著性差异（P〈0．01）。结论：^153Sm—EDTMP联合热疗或单独静脉注射^153Sm—EDTMP都是治疗骨转移癌患者骨痛的有效方法，而^153Sm—EDTMP联合热疗效果更佳。     

153Sm-EDTMP联合热疗治疗骨转移癌骨痛28例疗效观察

目的:探讨153 Sm-EDTMP联合热疗治疗骨转移癌骨痛的疗效.方法:根据患者对治疗方法的选择,将54例骨转移癌患者分为对照组26例和治疗组28例,对照组仅给予153 Sm-EDTMP静脉注射;治疗组在静脉注射153 Sm-EDTMP的基础上给予热疗,比较两组疗效.结果:治疗组发生1级、2级、3级疼痛人数多于对照组,发生4级、5级、6级疼痛的人数较对照组明显减少,两组比较有显著性差异(P＜0.05).治疗组骨痛治疗有效率为75.0%,好转率为17.9%,无效率为7.1%;对照组骨痛治疗有效率为34.6%,好转率为23.1%,无效率为42.3%,两组疗效比较有极显著性差异(P＜0.01).结论:153 Sm-EDTMP联合热疗或单独静脉注射153 Sm-EDTMP都是治疗骨转移癌患者骨痛的有效方法,而153 Sm-EDTMP联合热疗效果更佳.     

唑来膦酸治疗癌性骨痛28例临床观察

唑来膦酸是第三代双膦酸盐类药物。我科2005年1月～12月共收治恶性肿瘤骨转移、多发性骨髓瘤引起的疼痛病人28例，用依班膦酸钠为对照进行临床研究，以观察唑来膦酸的临床疗效和安全性，现报告如下。     

^153Sm—EDTMP治疗乳腺癌骨转移疼痛的临床疗效观察

目的：评价^153Sm-乙二胺四甲基膦酸（^153Sm-EDTMP)对乳腺癌转移性骨痛的镇痛效果。方法：采用两次给药法静脉注射^153Sm-EDTMP对76例乳腺癌骨转移疼痛患者进行治疗。结果：治疗后骨痛完全缓解者25例，中度缓解者40例，总有效率为85．52％（65／76）。除Ⅲ度以内的血液学毒性反应外，未见其它严重的毒副作用。结论：^153Sm-EDTMP能有效地缓解乳腺癌骨转移疼痛，且副作用小，是一种安全、有效的治疗方法。     

Symptom clusters in cancer patients with bone metastases

Purpose The purpose of this study is to explore whether bone pain “clusters” with other symptoms in patients with bone metastases. Materials and methods Patients with bone metastases referred to a palliative radiotherapy clinic were asked to rate their symptom distress using the Edmonton Symptom Assessment Scale (ESAS). Analgesic consumption during the previous 24 h was captured at initial consultation. To determine interrelationships between symptoms, a principal component analysis (PCA) with “varimax rotation” was performed on the nine ESAS symptoms. This study defined a “symptom cluster” as two or more symptoms that occur together, are stable, and are relatively independent of other clusters. Patients were followed 1, 2, 4, 8, and 12 weeks post-radiation treatment by telephone. Statistical analysis was performed at each time point for both responders and nonresponders to radiation (response was defined in accordance to the International Bone Metastases Consensus Working Party). Results Five hundred eighteen patients with bone metastases provided complete baseline data using the ESAS. The four most prevalent symptoms were poor sense of well-being (93.5%), fatigue (92.3%), pain (84.1%), and drowsiness (81.8%). Three clusters were identified and accounted for 66% of the total variance at baseline. Cronbach’s alpha coefficient demonstrated high internal reliability in the clusters, with a coefficient ranging from 0.61 to 0.81. It was observed that the clusters changed post-radiation in both responders and nonresponders and that pain clustered with different symptoms (or remained a separate symptom in responders). In nonresponders, three symptom clusters were consistently present, except in week 8. Conclusion Radiotherapy influenced the structure of symptom clusters in both responders and nonresponders. There was evidence that pain clustered out in responders of radiation to pain. It was found that pain clustered with fatigue, drowsiness, and poor sense of well-being at baseline. However, these findings must be heeded with caution, as more work is needed to clearly define symptom clusters and to understand the effects of radiation in the symptom experience of patients with bone metastases.     

153Sm-EDTMP对小细胞肺癌与非小细胞肺癌骨转移的止痛疗效观察

目的：观察^153Sm—EDTMP(ethylene diamine tetra methylene phosphonic acid)对小细胞肺癌与非小细胞肺癌骨转移疼痛的临床疗效及副作用,方法：对1996年6月至2002年6月168例经病理或细胞学确诊的肺癌骨转移疼痛病人做1～3次^153Sn-EDTMP内照射治疗：肘静脉给药剂量为29．6～37．0MBg／kg体重,骨转移灶经骨显像、X线片、CT或MRI确诊。结果：治疗有效率65．4％,其中完全缓解21．4％,部分缓解44．0%,无效34．5％。小细胞肺癌治疗有效率为54.8％,非小细胞肺癌治疗有效率为67．9%,二者无显著性差异。毒副作用轻微仅有15．6％(26／168)的病人出现不同程序的WBC、Plt、Hb下降。结论：^153Sm-EDTMP静脉注射是肺癌骨转移疼痛的有效治疗手段、副作用小、使用安全、可重复用药。     

唑来膦酸治疗乳腺癌骨转移的疗效观察及护理

目的观察唑来膦酸治疗乳腺癌骨转移的疗效与不良反应,探讨本病的护理方法。方法32例病人均为乳腺癌骨转移。唑来膦酸4mg加生理盐水50ml静脉滴注15rain,每4周1次,共3次。记录治疗效果及不良反应。给予心理护理、用药护理及治疗后不良反应的处理。结果骨疼痛CR51．7％,有效率达78．1％。不良反应主要为发热、感冒样症状、低钙血症。经护理干预,病人心理状态较好,能积极配合治疗,对护理及治疗表示满意。结论唑来膦酸对乳腺癌转移性骨痛有较好疗效。治疗时应给予积极的专科护理。     

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.     

153钐改善骨转移癌痛疗效观察

Wetreatedpainsof３２patientswithbonemetastaticcancerwith１５３Sm－EDTMPfromJuly１９９５toJuly２０００，andcomparedwith３２patientswithbonemetastaticcancertreatedbysimpleradiotherapy，curativeeffectsweresatisfied．Nowreportasfollow．１Subjectsandmethods１．１SubjectsAlloriginaltumorsofthese６４patientswerediag－nosedbypathologicalexamination．Bonemetastasiswasdiagnosedbybonescan，CTand／orMRI，physicalstrengthstateis０～２class（ECOGscore）；hepaticandrenalfunctionswerenormalandwithsymp…     

Palliative radiotherapy of bone metastases: an evaluation of outcome measures

The objective of this study was to identify and evaluate important patient-based outcomes that are specific to the palliative radiotherapy of bone metastases. We first conducted a literature review to identify and evaluate outcomes that are currently in use. To identify outcomes that are important to patients, in-depth patient interviews were conducted. Finally, issues identified through the interviews were quantified through a prospective survey, in which patients completed a questionnaire prior to commencing radiotherapy and again after 6 weeks. In our literature review, we found that there was no standardized definition of either response to radiotherapy or assessment of pain relief. Pain measurement in many studies was undertaken using very simple measures, which could possibly yield inaccurate results. The vast majority of studies did not include quality of life as an endpoint. The patient interviews and survey showed that chronic pain and associated limitation of movement were the disease symptoms causing the most concern. Having a clear, alert mind and being able in self-care were the aspects of daily living given the highest priority. Sustained pain relief and minimizing the risk of future complications were the main priorities relating to radiotherapy treatment. The practical aspects of treatment (travelling distance, remaining at home and brevity of treatment) were of least importance. This study indicates the complexity of evaluating the outcomes of palliative interventions, and confirms the deficiencies of pain relief as the primary end-point. The patient's quality of life is affected by many factors other than pain (such as limited mobility, reduced performance, side effects and impaired role functioning); hence a wider range of end-points is required. Greater sensitivity is required than in currently used end-points. Concurrent diseases as well as concurrent therapies can make it difficult to attribute effects with precision. Unless such factors are considered in research design, the results may prove unreliable.