唑来膦酸联合放疗治疗骨转移癌疗效观察

96例骨转移癌患者随机分为观察组和对照组各48例。观察组采用唑来膦酸4mg,针对最痛点加局部放疗,采用6MV-X线照射,总剂量30GY／10次,之后再静滴唑来膦酸4mg;对照组只采用放射治疗,方法及剂量同观察组。结果显示,观察组止痛总有效率87．5％,对照组为71．7％,两组比较差异显著（P〈0．05）;观察组不良反应轻。认为唑来膦酸联合放疗治疗恶性肿瘤骨转移疗效确切,毒副反应轻微,值得临床进一步推广应用。     

唑来膦酸联合放疗治疗老年恶性肿瘤骨转移的疗效

目的观察放疗联合唑来膦酸治疗老年恶性肿瘤骨转移的临床疗效。方法将101例有骨转移的老年恶性肿瘤患者随机分为两组,治疗组51例,给予唑来膦酸抗骨转移治疗,同时给予放疗;对照组50例,对骨转移部位给予放疗。观察两组患者骨病灶的控制率、疼痛缓解率、生活质量改善情况及毒副反应。结果治疗组的骨病灶控制有效率(RR)为60.8%,略高于对照组的50.0%,两组比较无明显统计学差异(P>0.05)。治疗组骨痛的缓解率(显效+有效)为94.1%,明显高于对照组74.0%(P<0.05)。治疗组生活质量改善显效68.6%,明显高于对照组的40.0%(P<0.05)。治疗组和对照组的主要不良反应为白细胞及血小板下降、发热、恶心呕吐、肌肉酸痛、头痛头晕及手足麻木,主要为Ⅰ～Ⅱ级,经对症处理后均好转。结论唑来膦酸联合放疗对于恶性肿瘤骨转移有明确的止痛作用,能改善患者生活质量,不增加不良反应。     

不同分割剂量放疗联合唑来膦酸治疗老年骨转移癌的疗效

目的探讨不同分割剂量放疗联合唑来膦酸治疗老年骨转移癌的疗效。方法该院2011年1月至2014年6月收治的老年骨转移癌患者80例,按随机数字表法分为低分割放疗组(27例),常规分割放疗组(27例),单纯唑来膦酸组(26例),低分割放疗组给予低剂量放疗联合唑来膦酸、常规分割放疗组给予常规放疗剂量联合唑来膦酸、单纯唑来膦酸组仅给予唑来膦酸治疗,观察三组治疗效果。结果三组治疗总有效率差异显著(P0.05),其中低分割放疗组和常规分割放疗组的总有效率均高于单纯唑来膦酸组(P0.05),低分割放疗组与常规分割放疗组总有效率差异无统计学意义(P0.05)。三组骨痛改善总有效率差异显著(P0.05),其中低分割放疗组和常规分割放疗组有效率均高于单纯唑来膦酸组(P0.05),低分割放疗组与常规分割放疗组有效率差异无统计学意义(P0.05)。三组卡氏(KPS)评分变化有效率差异显著(P0.05),低分割放疗组和常规分割放疗组的有效率均高于单纯唑来膦酸组(P0.05),低分割放疗组与常规分割放疗组镇痛有效率差异无统计学意义(P0.05)。三组发生不良反应差别无统计学意义(P0.05)。结论不同分割剂量放疗联合唑来膦酸治疗老年骨转移癌效果优于单纯唑来膦酸,低分割剂量与常规剂量的治疗效果相当,但低分割剂量治疗周期短、费用低、次数少,值得临床推荐使用。     

唑来膦酸联合化疗治疗乳腺癌骨转移临床观察

将38例乳腺癌骨转移患者随机分为治疗组(唑来膦酸 紫杉醇 顺铂)和对照组(单用唑来膦酸).治疗后,两组骨痛缓解率、生存质量改善率无统计学差异;治疗组骨转移灶修复率为52.7%,高于对照组的15.8%.认为采用唑来膦酸联合化疗治疗乳腺癌晚期骨转移患者效果较好,且毒副反应较小,值得临床推广应用.     

唑来膦酸用于骨转移癌患者45例疗效观察

目的观察唑来膦酸治疗骨转移癌的临床疗效。方法对45例骨转移患者予唑来膦酸4mg静滴15min以上,每4周重复。结果止痛总有效率80．00％（36／45）;骨转移病灶治疗总有效率62．22％（28／45）;活动能力改善总有效率73．33％（33／45）;不良反应发生率较低,主要为暂时性发热、骨关节痛、消化道反应。结论唑来膦酸治疗骨转移癌效果确切,用量少,不良反应轻,患者易耐受,是较理想的治疗肿瘤骨转移的药物。     

唑来膦酸联合放疗治疗恶性肿瘤骨转移疼痛

目的观察唑来膦酸联合放疗与单纯药物治疗恶性肿瘤骨转移癌性疼痛的疗效及不良反应。方法40例骨转移瘤患者随机分为A、B两组(各20例)。A组静滴唑来膦酸4 m g;B组静滴唑来膦酸4 m g后局部放疗。结果两组止痛效果比较:A组显效2例,有效12例,无效6例;B组分别为12、7、1例;两组比较,P<0.05。止痛起效时间:A组为(7.2±2.0)d;B组为(3.0±1.2)d;两组比较,P<0.05。两组均无严重不良反应。结论唑来膦酸联合放疗对恶性肿瘤骨转移所致的癌性疼痛具有良好的止痛效果。     

三维适形放疗联合唑来膦酸治疗转移性骨肿瘤的临床探讨

目的观察三维适形放疗联合唑来膦酸治疗转移性骨肿瘤的疗效和不良反应。方法 58例老年转移性骨肿瘤患者,其中35例用三维适形放疗联合唑来膦酸治疗方案（联合组）,将唑来膦酸4mg加入0.9%氯化钠注射液100ml中静脉滴注,滴注时间不少于15min,每3～4周1次,共4次。骨转移灶局部给予三维适形放疗,共行4000Cgy,4周内分20次完成。另外23例患者单纯使用唑来膦酸治疗（单药组）。比较治疗前后2组患者的疼痛缓解率、生活质量提高率以及治疗过程中的不良反应。结果经三维适形放疗联合唑来膦酸治疗后,联合组完全缓解（CR）17例（48.6%）,部分缓解（PR）16例（45.7%）,轻度缓解（MR）2例（5.7%）,有效率（CR＋PR）达94.3%,高于单药组的73.9%（P〈0.05）。联合组患者生活质量明显改善,有效率达77.1%,也明显高于单药组的56.5%（P〈0.05）。2种治疗方案对患者的不良反应除放疗引起的白细胞减少外,无明显差异。结论三维适形放疗联合唑来膦酸相比较单独应用唑来膦酸治疗可明显缓解转移性骨肿瘤引起的疼痛,减少并发症的发生,提高患者的生活质量。     

唑来膦酸联合化疗治疗恶性肿瘤骨转移疗效分析

骨转移是恶性肿瘤患者常见的并发症之一，患者常伴疼痛、功能障碍，影响生活质量。我科自2006年1月至2007年10月用唑来膦酸联合化疗治疗恶性肿瘤骨转移46例，并与单纯化疗组比较，现报道如下。     

~（89）SrCl_2联合唑来膦酸治疗恶性骨转移癌83例临床观察

目的探讨89SrCl2联合唑来膦酸治疗多发性骨转移癌的临床疗效。方法将157例骨转移癌患者随机分为两组,实验组83例应用89SrCl2联合唑来膦酸治疗,对照组74例单纯给以89SrCl2治疗,随访观察3个月,根据治疗后疼痛缓解和生活质量改善判断疗效。结果实验组疼痛缓解总有效率为91.56%（76/83）,生活质量改善总有效率为92.77%（77/83）;对照组分别为81.09%（60/74）、75.67%（56/74）。两组疼痛缓解和生活质量改善比较差异有统计学意义（P〈0.05或〈0.01）,但主要不良反应无统计学差异。结论 89SrCl2联合唑来膦酸治疗恶性骨转移癌是一种综合有效的治疗方法。     

大分割放疗联合唑来膦酸治疗肺癌骨转移的临床疗效观察

目的 观察大分割放疗联合唑来膦酸治疗肺癌骨转移的临床疗效及不良反应。方法 90例肺癌骨转移患者随机分成观察组（45例）和对照组（45例）。观察组静滴唑来膦酸4mg加局部大分割放疗30Gy／10f,之后再静滴唑来膦酸4mg×4～6次,1次／月;对照组则单纯放疗,方法剂量同上。结果 观察组止痛总有效率88．8％,显效率60％;对照组总有效率68．8％,显效率26．6％,两组比较P〈0．05。随访3个月后观察组与对照组止痛的总有效率分别为86．6％和57．5％（P〈0．05）。结论 大分割放疗联合唑来膦酸治疗肺癌骨转移,疗效确切,毒副反应轻,耐受性好。     

复方斑蝥胶囊联合化学治疗对转移性结直肠癌的疗效观察

目的 观察复方斑蝥胶囊联合奥沙利铂(L-OHP)、5-氟尿嘧啶/亚叶酸钙(5-FU/CF)组成的FOLFOX4方案治疗转移性结直肠癌的临床疗效及不良反应.方法 收集2006年4月至2008年10月收治的无手术指征的转移性结直肠癌患者107例,随机分为复方斑蝥胶囊联合FOLFOX4方案组(联合治疗组)54例和FOLFOX4方案组53例.联合治疗组给予L-OHP 85mg/m2,第1天静脉滴注2 h,同时或之后予CF 200 mg/m2,静脉滴注2 h,续5-FU 400 mg/m2静脉推注,600 mg/m2持续静脉滴注22 h,次目重复,CF与5-FU每2周重复一次,同时予以复方斑蝥胶囊口服750 mg,每天2次.FOLFOX4方案组患者单纯接受FOLFOX4方案化学治疗.结果 联合治疗组和FOLFOX4方案组有效率分别为44.4%和37.7%,两组间差异无统计学意义(P=0.481).联合治疗组的中位无进展时间(TTP)为11.6个月,FOLFOX4方案组为7.9个月,两组间差异有统计学意义(P=0.020).生活质量评价,联合治疗组的改善率为57.4%,FOLFOX4方案组为32.1%,两组间差异有统计学意义(P=0.008).两组不良反应主要表现为消化道反应、神经系统毒性、脱发和骨髓抑制.联合治疗组Ⅲ/Ⅳ度粒细胞减少发生率为37.0%,FOLFOX4方案组为58.5%,两组间差异有统计学意义(P=0.043).结论 复方斑蝥胶囊联合FOLFOX4方案一线治疗转移性结直肠癌能协同增效,能提高患者TTP及改善患者生活质量,降低粒细胞减少发生.     

Clinical considerations for the use of antiresorptive agents in the treatment of metastatic bone disease

Improved therapies for advanced cancers have prolonged the survival of patients with malignant bone disease (MBD), leading to long-term treatment to prevent skeletal-related events (SREs). Selecting the most suitable antiresorptive agent is influenced by efficacy, practicality of administration, safety, cost, and patient compliance. Intravenous bisphosphonates are an established standard of care for patients with MBD, and denosumab recently gained regulatory approval in the United States for reducing the risk of SREs in patients with MBD from solid tumors. This review examines the pharmacokinetic and pharmacodynamic properties of different antiresorptives in the context of clinical decision making for the treatment of MBD. Continuous, regular treatment with antiresorptives has been shown to provide the greatest protection against SREs. However, continuous treatment is not always achievable over a prolonged period, and differences in pharmacodynamics between various antiresorptives might influence the potential preservation of treatment benefits during such gaps in therapy.     

唑来膦酸联合培美曲塞方案治疗非小细胞肺癌骨转移疗效研究

目的观察唑来膦酸联合培美曲塞治疗非小细胞肺癌（NSCLC）骨转移的疗效。方法 60例NSCLC骨转移患者,随机分为两组,分别为唑来膦酸组30例,对照组30例。唑来膦酸组接受唑来膦酸联合培美曲塞方案化疗,对照组为单纯培美曲塞方案化疗。结果两组肺部原发病灶有效率,唑来膦酸组有效率（CR＋PR）16.7%,疾病控制率（CR＋PR＋SD）60.0%;对照组有效率（CR＋PR）13.3%,疾病控制率（CR＋PR＋SD）53.3%。总体平均生存期7.5个月（2～17个月）,中位生存期唑来膦酸组7个月,对照组6个月。骨病灶控制唑来膦酸组的有效率（CR＋PR）40.0%,控制率（CR＋PR＋NC）83.3%,而对照组有效率13.3%,控制率36.7%。差异有显著性（P〈0.05）。骨转移疼痛缓解率唑来膦酸组79.2%,对照组45.8%。有显著性差异（P〈0.05）。结论唑来膦酸联合培美曲塞方案化疗对NSCLC骨转移不仅有较好的止痛作用,而且提高化疗疗效,是一种较佳的值得推广的临床选择方案。     

Oral versus intravenous ibandronic acid: a comparison of treatment options for metastatic bone disease

Purpose  This trial is the first to compare directly the clinical response to and safety of oral and intravenous (IV) ibandronic acid for metastatic bone disease. Methods  Patients ≥18 years with breast, prostate, lung, urogenital or colon cancer received IV ibandronic acid 6 mg infused over 15 min every 28 days or oral ibandronic acid 50 mg/day. Clinical response was determined using bone scintigraphy, radiography and serum C-terminal telopeptide of type I collagen (S-CTX) at months 3–6. Adverse events and biochemical safety measures were recorded. Results  A total of 84.6 and 88.5% of patients had a complete/partial response to IV and oral ibandronic acid, respectively. Median percentage decreases in S-CTX were −39 and −35%, respectively. Bone pain scores decreased and analgesic use increased from month 0–3 and were stable from months 3–6. Both formulations improved physical and functioning scores. Conclusion  Oral and IV ibandronic acid for bone metastases have similar efficacy and tolerability.     

Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis

Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2 nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur(S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving qualityof life and survival in patients with resectable primary gastric cancer and bone metastasis.     

卡铂与足叶乙甙联合放射同步治疗局限期小细胞肺癌的临床疗效观察

目的　观察卡铂、足叶乙甙 (CE方案 )联合放射同步治疗局限期小细胞肺癌的临床疗效。方法　局限期小细胞肺癌患者 90例 ,采用信封抽签随机分组进入同步治疗组 (A组 )和序贯治疗组 (B组 )。两组患者均接受CE方案治疗 6个周期和放射治疗 (简称放疗 ) 6周 (剂量为 6 0Gy)。A组患者化学治疗 (化疗 )与放疗同时进行 ;B组先给予 4个周期化疗 ,再进行放疗 ,然后再化疗 2个周期。结果　A组患者中位生存时间 2 6个月 ,5年生存率 2 7% ;B组患者中位生存时间 19个月 ,5年生存率 16 % ,两组差异有显著性 ( χ2 =4 10 4 ,P <0 0 5 )。两组患者主要毒副反应为骨髓抑制 ,Ⅲ、Ⅳ度白细胞下降发生率A组为 93 3% ( 4 2 / 4 5 ) ,B组为 75 5 % ( 34/ 4 5 ) ,差异有显著性 ( χ2 =5 4 13,P <0 0 5 )。结论　CE方案联合放射同步治疗 ,能有效提高局限期小细胞肺癌患者的生存时间和生存率     

The critical role of the bone microenvironment in cancer metastases

Bone metastatic disease is a late-stage event of many common cancers, such as those of prostate and breast. It is incurable and causes severe morbidity. Tumor and bone interact in a vicious cycle, where tumor-secreted factors stimulate bone cells, which in turn release growth factors and cytokines that act back on the tumor cells. Within the vicious cycle are many potential therapeutic targets for novel treatment of bone metastatic disease. Therapeutic strategies can be oriented to inhibit bone cells (osteoclasts and osteoblasts) or tumor responses to factors enriched in the bone microenvironment. Many publications, especially from pre-clinical animal models, show that this approach, especially combination treatments, can reduce tumor burden and tumor-derived bone lesions. This supports a novel paradigm: tumor growth can be effectively inhibited by targeting the bone and its microenvironment rather than the tumor itself alone.