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。     

99Tc-MDP与帕米膦酸二钠对MDA-MB-231细胞增殖及凋亡作用的对比研究

目的观察^99Tc-亚甲基二膦酸盐（MDP）与帕米膦酸二钠对人乳腺癌MDA-MB-231细胞生长和凋亡的影响及其作用差异.方法不同剂量^99Tc-MDP与帕米膦酸二钠注射液处理细胞,采用细胞计数及四甲基偶氮唑盐（MTT）法检测MDA-MB-231细胞增殖;流式细胞仪观察细胞凋亡、检测细胞周期及凋亡相关基因bcl-2与bax的表达.结果50 μmol/L ^99Tc-MDP与帕米膦酸二钠处理MDA-MB-231细胞48 h即可抑制其增殖,细胞存活率分别为45.9%和64.0%,差异有显著性（P＜0.05）;50μmol/L^99Tc-MDP与帕米膦酸二钠均可诱导细胞凋亡,用药后大量MDA-MB-231细胞被阻滞于G0/G1期和S期,细胞凋亡率分别为9.59%和5.96%,差异有显著性（P＜0.05）;50 μmol/L^99Tc-MDP即可使MDA-MB-231细胞凋亡相关基因bcl-2表达明显减弱,200 μmol/L帕米膦酸二钠可使bcl-2表达明显减弱,二者对bax表达无影响.结论^99Tc-MDP及帕米膦酸二钠均可抑制MDA-MB-231细胞增殖及诱导MDA-MB-231细胞凋亡,并调控bcl-2的表达;^99Tc-MDP作用强于帕米膦酸二钠.     

双膦酸盐在治疗恶性肿瘤骨转移相关并发症中研究

目的探讨双膦酸盐在治疗恶性肿瘤骨转移相关并发症的有效性。方法回顾性分析骨转移患者应用双膦酸盐治疗的疗效,以及比较应用和未应用双膦酸盐患者病理性骨折、椎体压缩、肿瘤引起的高钙血症及骨痛的发生率。结果唑来膦酸和帕米膦酸二钠均可以有效的降低恶性肿瘤骨转移患者的骨并发症的发生率。唑来膦酸较帕米膦酸二钠可以为骨转移患者提供更多的益处。结论晚期恶性肿瘤患者常发生骨转移,引起骨并发症,影响患者生活质量,增加医疗费用,双膦酸盐可以有效降低骨并发症的发生率,值得在临床中广泛应用。     

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。     

晚期前列腺癌患者26例骨痛的综合治疗

观察晚期前列腺癌患者骨痛的治疗效果。方法：回顾性分析2005-09～2010-09的26例晚期前列腺癌骨痛患者临床资料，所有患者均已在8～32个月前行双侧睾丸切除术及内分泌治疗。针对患者骨痛，采用联合化疗（8例）、局部放疗（6例）、同位素治疗（4例）和帕米膦酸二钠（8例）等综合治疗。结果：26例经随访3个月-5年，平均30个月。完全缓解和明显缓解21例，轻度缓解和无缓解5例，有效率81％。缓解期为3-15个月，平均8个月。结论：积极的综合治疗能缓解晚期前列腺癌患者骨痛的临床症状，提高其生活质量。     

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。     

帕米膦酸二钠(博宁)合并化疗缓解多发性骨髓瘤骨痛疗效观察

目的评价帕米膦酸二钠 (博宁 )在缓解多发性骨髓瘤患者骨痛中的作用。方法应用博宁联合化疗1 6例与单纯化疗 1 8例进行对照研究。结果博宁联合化疗与单纯化疗均能显著减轻多发性骨髓瘤患者的骨痛程度 (与治疗前比较P <0 .0 1 ) ,博宁联合化疗对骨痛的缓解程度强于单纯化疗 (P <0 .0 5 )。在应用博宁的病例中 ,除 1例出现轻度发热外未见明显毒副作用发生。结论博宁是一种安全有效的双膦酸盐制剂 ,与化疗联合应用可以显著缓解多发性骨髓瘤患者的骨痛。     

低频脉冲治疗仪治疗老年骨质疏松症的临床研究

目的:观察低频脉冲治疗仪对老年骨质疏松症患者疼痛症状及骨密度的影响。方法:对确诊为骨质疏松症且有疼痛症状的老年患者96例分成两组,观察组46例,采用BG100型骨质疏松脉冲电磁场治疗。对照组50例,给予口服依替膦酸二钠片0.2 g,2次/d,疗程6个月。两组治疗前后均测定跟骨骨密度(BMD),治疗后记录疼痛的缓解情况。结果:治疗组骨密度较对照组明显增加,治疗组骨痛症状缓解效果明显,总有效率91.04%,两组均未发生严重不良反应。结论:低频脉冲电磁场对老年骨质疏松症有增加BMD及缓解临床症状的作用。     

^99Tc—MDP治疗骨质疏松的实验研究

目的采用^99Tc-亚甲基二磷酸盐（MDP）与双磷酸盐类药物帕米磷酸二钠治疗骨质疏松模型动物,比较骨密度及相关指标的变化,评价^99Tc-MDP的治疗价值。方法分别设正常组、骨质疏松组兔。由皮质激素盐酸地塞米松（DX）诱导制作兔骨质疏松模型,模型兔部分行^99Tc—MDP或帕米磷酸二钠治疗,各自疗程时间为15周。取实验兔股骨、腰椎、股骨头部位进行骨密度、骨形态计量、组织病理学等测定。组间数据比较行t检验。结果对除正常组外实验兔予肌内注射DX6周后,骨质疏松模型组股骨头关节表面软骨破坏,骨小梁稀疏、断裂,骨母细胞消失等,股骨头的骨密度降低22．93％（t=7．969,P〈0．01）;正常组基本无骨质破坏征象。表明本次实验骨质疏松的动物模型制作成功。分别经^99Tc-MDP和帕米磷酸二钠治疗15周后,与未治疗骨质疏松模型组比较,其腰椎骨密度分别上升19．30％和12．28％（t=2．649,2．753,P均〈0．05）,股骨头骨密度上升36．70％和20．97％（t=3．497,3．705,P均〈0．01）。同时骨组织病理学、骨形态计量、核素骨显像等结果均也有差异。^99Tc-MDP治疗组和帕米磷酸二钠治疗组比较,骨形态计量和股骨头骨密度前者比后者增高更明显,t=3．499和3．652,P〈0．01;腰椎骨密度相比,t=2．975,P〈0．05。结论^99Tc—MDP与帕米磷酸二钠治疗后骨密度均有上升,^99Tc—MDP疗效更为显著,可能与^99Tc具有清除体内自由基和调节免疫功能有关。     

89SrCl联合依班膦酸钠治疗多发性骨转移癌疼痛

目的 观察89SrCl2联合依班膦酸钠治疗多发性骨转移癌疼痛与单独应用依班膦酸钠或89SrCl2治疗的临床疗效。方法84例骨转移癌疼痛患者,分为3个治疗组,其中30例采用89SrCl,联合依班膦酸钠方法,26例采用单纯89SrCl2治疗,28例采用依班膦酸钠治疗。用SPSS13．0统计软件,疗效比较采用行×列表资料的r检验。结果联合治疗组骨痛缓解总有效率为96．6％（29／30）,依班膦酸钠组及89SrCl2治疗组总有效率分别为71．4％（20／28）和73．1％（19／26）。联合用药组与单独用药组治疗后骨痛缓解有效率（X2=7．497）,全身状况Kamofsky评分提高率[80．0％（24／30）与50．0％（14／28）,53．8％（14／26）,X2=35．476]和病灶治疗有效率[47．6％（50／105）与11．2％（11／98）,22．2％（20／90）,X2=6．564]间比较差异有统计学意义（P均〈0．05）。结论89SrCl2联合依班膦酸钠是治疗骨转移性癌疼痛较为有效和可行的方法。联合用药临床疗效优于单独用药。     

Clinical role of Sm-153 EDTMP in the treatment of painful bone metastatic disease

PURPOSE: Sm-153 EDTMP is an effective treatment of painful bone metastases from different neoplasms. However, there are few studies describing clinical experience with this therapeutic modality. The aim of this clinical study was to evaluate the efficacy of Sm-153 EDTMP in a group of patients with skeletal metastases and poor pain control with conventional therapies. MATERIALS AND METHODS: Sixty-four patients with painful bone metastases treated with Sm-153 EDTMP were retrospectively evaluated. Nine patients were treated twice. The most common primaries were breast in 28 cases (44%) and prostate in 27 (41%). Treatment efficacy was assessed by a visual analog scale, analgesic consumption, and performance status before and after treatment. Response was graded as complete, moderate, or minor. Toxicity evaluation included analytic parameters (blood counts, renal function) and clinical follow up. RESULTS: Efficacy and toxicity were evaluated separately for each dose (total doses: 73), and complete follow up was only possible in 62 of 73 administrations. The response rate was 85% (21% complete, 40% moderate, and 24% minor). Onset of improvement took place a median of 7 days after Sm-153 EDTMP administration, and pain relief persisted for a mean of 3 months. No relevant toxicity was found in the early phase. Myelotoxicity appeared in 29% of the administrations and was mild in most cases (there was one case of grade 4 leukopenia). CONCLUSIONS: Sm-153 EDTMP is a good therapeutic option for patients with painful bone metastases. It is an effective treatment of pain relief without major secondary effects.     

89Sr versus 153Sm-EDTMP: comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma

BACKGROUND AND AIM: Painful bone metastases are most frequent in patients with advanced prostate or breast carcinoma. The aim of this study was to compare the analgesic effect of radionuclide therapy using Sr and Sm-EDTMP in patients with painful bone metastases of these tumours. MATERIAL AND METHODS: One hundred patients treated with radionuclide bone palliation therapy were analysed. The study population consisted of 60 male patients with advanced prostate carcinoma and 40 female patients with advanced breast carcinoma. Fifty patients (30 men and 20 women) were treated with Sr (150 MBq). The other 50 patients were treated with Sm-EDTMP (37 MBq x kg). The treatment efficacy was evaluated by a visual analogue scale (VAS), Karnofsky performance scale, and dosage of analgesic drugs used. RESULTS: Complete pain relief was found in 40% of women and 40% of men treated using Sm-EDTMP and in 25% of women and 33% of men treated with Sr. No analgesic effect occurred in 20% of patients. A better analgesic effect was found in cases of osteoblastic metastases compared to mixed metastases. Statistically significant reduction of pain intensity, use of analgesic drugs and improvement of performance in Karnofsky scale was found in cases of both radionuclides. CONCLUSIONS: The analgesic effects of Sr and Sm-EDTMP was similar in both prostate and breast carcinoma. However, the effect was dependent on the type of metastases; better response was observed in cases of osteoblastic metastases than in patients with mixed metastases. Severe adverse reactions after this therapy were rare.     

89Sr治疗老年患者前列腺癌骨转移骨痛的临床观察

目的 评价89^SrCl2对老年患者前列腺癌骨转移伴骨痛的临床疗效及不良反应.方法 对外科去势治疗术后的老年患者前列腺癌骨转移伴有不同程度骨痛患者48例,使用89^SrCl2静脉注射治疗,观察其镇痛效果、骨转移灶的变化、前列腺特异性抗原（PSA）及不良反应等.结果 48例患者接受89^Sr治疗后,止痛的总有效率达89.6%,无效10.4%,骨转移灶有明显减少.对PSA有不同程度的下降.所有治疗者均未发现严重的不良反应和毒副作用.结论 89^SrCl2对去势治疗术后的老年患者前列腺癌骨转移骨痛的临床止痛疗效明显,特别是对多发骨转移癌伴骨痛患者是一种有效的治疗方法.     

Results of a Nationwide Survey on Radiotherapy of Bone Metastases in Germany

BACKGROUND: Assuming interinstitutional differences in the treatment of bone metastases, a survey of German radiotherapy institutions was carried out. The goal was to demonstrate regional strategies in pretherapeutic diagnosis, radiation treatment, and follow-up. PATIENTS AND METHODS: A structured questionnaire (eleven multiple-choice questions, ten tables to complete) was sent to all institutions primarily performing radiotherapy. The reply rate was 63.7% (86/135). RESULTS: The estimated proportion of patients with irradiated bone metastases was 18.2% (5-60%). The overall number of treated patients with bone metastases has increased. 45% of all radiation treatments for bone metastases wer performed in patients with mammary carcinoma, followed by lung carcinoma (17%). Central beam dose calculation was performed in 72% of patients, in other cases computer-assisted planning (23%) and 3-D planning (5%) were carried out. Special techniques (individual shielding, special fixations) were used in 57 institutions in 19.8% of patients. The applied single dose varied between 1 and 10 Gy, and the total dose between 5 and 60 Gy. The majority of institutions vary their treatment schemes. In most institutions, the definitive result assessment followed 4-6 weeks after the end of irradiation. Conventional X-rays play the most important role in evaluation of the radiation result. Approximately a quarter of patients are permanently included in the radiation oncological follow-up. CONCLUSIONS: The therapeutic variety corresponds with the greatly varying recommendations in the literature. There were no major differences between private practices, hospitals and university facilities. Considering the standards of diagnosis, treatment, and results assessment, a high quality of palliative treatment can be assumed.     

The percutaneous irradiation of osteolytic bone metastases--a course assessment]

Percutaneous radiotherapy is the most effective modality for treatment of metastatic bone cancer. Local irradiation improves overall quality of life by relieving pain in most patients. It also helps preventing complications as pathological fractures in lytic bone lesions by new bone formation. In a retrospective study on 100 patients, irradiated for lytic bone metastases, the radiotherapeutic effect on alleviation of pain and on recalcification rate was investigated. In our experience in 84% of the cases pain and disability associated with bone metastases could be decreased. 38% of the patients had complete relief of symptoms. A correlation between subjective therapy effect and histology of the primary tumor was not demonstrated. Remineralization was found in 67% of all irradiated skeletal areas (n = 137) (recalcification rate in breast cancer 77%, in bronchial carcinoma 27%, and in renal cell carcinoma 25%). After a total dose of 30 Gy reduction of the metastases-associated pain was achieved in 81% of the cases and remineralization was observed in 70% of the cases.     

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。     

骨转移癌痛的立体定向放射治疗

目的评价立体定向大剂量少分次放射治疗骨转移癌痛的临床疗效。方法采用深圳奥沃公司生产的OUR-QGD型立体定向伽玛射线体部治疗系统(简称体部伽玛刀)治疗156例骨转移癌痛患者,用50%等剂量曲线覆盖整个靶区,单次周边剂量给予7.5～10Gy,周边总剂量控制在30Gy,分割3～4次,1周内完成治疗总剂量控制在30Gy,分割3～4次,1周内完成治疗。结果 156例患者治疗后疼痛症状完全缓解110例(70.51%)、部分缓解43例(27.56%),总有效率为98.08%。治疗后随访时间2～20个月,疼痛的中位缓解时间为12.6个月。结论立体定向大剂量少分次放射治疗骨转移癌痛,疗效满意,治疗时间短,止痛起效快,缓解时间长,复发率低,是一种安全、有效的止痛方法。     

Bone metastasis of hepatocarcinoma. Review of the literature, radiologic pictures and personal caseload]

Prognosis of patients affected with hepatocellular carcinoma (HCC) has been improved by the modern imaging techniques allowing an early diagnosis and by the value of the therapeutic protocols employed. Staging has also become more and more important. Bone metastases from HCC are reportedly rare. The authors observed a 5.5% incidence in 90 cases of hepatocarcinoma. The metastases were demonstrated by radiography, CT, and nuclear scintigraphy, in patients with skeletal pain. The plain film appearance of skeletal metastases from HCC was osteolytic in all cases; no surrounding sclerosis was seen. CT scans demonstrated the destructive nature of these lesions, which were associated with bulky soft-tissue masses. Metastases exhibited increased radiotracer (99mTc-MDP) uptake at bone scintigraphy. The authors believe that bone scintigraphy should be included in the staging protocols of the HCCs which need a potentially curative therapy.