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。     

帕米膦酸二钠治疗癌症骨转移性疼痛疗效观察

目的：观察帕米膦酸二钠治疗转移性骨肿瘤疼痛的比较。方法：对32例癌症骨转移痛患者给予帕米膦酸二钠45mg/d,静脉滴注,连用2 d后停用26 d,28 d为1周期,连续4周期。结果：止痛显效13例（40.6%）,有效14例（43.8%）,无效5例（15.6%）,总有效率84.4%。结论：帕米膦酸二钠治疗癌症骨转移性疼痛的疗效肯定。     

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。     

放射性药物联合双膦酸盐类药物治疗肿瘤骨转移研究现状

骨转移是恶性肿瘤远处转移最常见类型之一,其发生率仅次于肺转移和肝转移。前列腺癌、乳腺癌以及肺癌是骨转移发生率最高的恶性肿瘤,近70%的乳腺癌或前列腺癌发展到晚期都会发生骨转移。肿瘤骨转移往往会引起疼痛、骨折以及高钙血症等不适,从而严重影响患者的生活质量。肿瘤骨转移目前尚无标准的规范化治疗方案,往往需要结合多种治疗方法进行综合治疗。双膦酸盐类药物和放射性药物是目前临床治疗多发骨转移广泛应用的药物,对于两者的应用,目前较为普遍的还是单药治疗,关于两者是否应该联合应用的问题一直存在争议。笔者系统回顾了近年来关于放射性药物联合双膦酸盐类药物治疗的相关研究。     

恶性肿瘤骨转移放射治疗进展

骨转移是恶性肿瘤最常见的合并症之一,其引起的进行性骨痛、骨关节功能障碍、脊髓压迫、病理性骨折等,严重影响患者的生活质量。放射治疗是恶性肿瘤骨转移的重要治疗手段。对于单发的骨转移可用局部放疗的方法,而多发的骨转移可用局部放疗、放射性核素、双膦酸盐等联合治疗。     

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.     

唑来膦酸治疗恶性肿瘤骨转移不良反应护理体会

恶性肿瘤骨转移是临床常见的晚期癌症并发症之一,指的是机体任一器官因为原发性的恶性肿瘤向骨发生转移并且继续生长的肿瘤,其多会产生溶骨性破坏,导致疼痛和功能障碍。临床表现以局部疼痛症状逐渐加重为主．晚期甚至引起病理性骨折、高钙血症以及神经和脊髓压迫等情况,严重影响患者生活质量。唑来膦酸是目前已发现的骨转移临床治疗中抗骨吸收作用最强的一种药物,     

双膦酸盐在骨相关疾病诊断和治疗中的研究进展

双膦酸盐是目前治疗骨代谢性疾病中重要的一类抗骨吸收药物,主要运用于Paget's病、骨质疏松症和肿瘤相关性骨病。双膦酸盐类药物已广泛应用于骨相关疾病的治疗中,双膦酸盐类功能化显像剂在核医学骨显像中也被广泛应用。放射性示踪剂可通过螯合作用与双膦酸盐偶联,偶联后的探针作为骨靶向的示踪剂应用于骨显像。双膦酸盐的分子结构中含有P-C-P键,在人体内不易被酶水解。因其与骨组织中的无机物羟基磷灰石晶体有较高的亲和力,故在骨组织中有较高的选择性沉积。基于双膦酸盐的一般特征和作用机制,笔者概述了双膦酸盐功能显像剂、骨质疏松的治疗和双膦酸盐应用于骨转移治疗的临床前研究。     

99Tcm标记双膦酸盐骨显像剂的研究进展

双膦酸盐是一类具有很强亲骨性的药物,99Tcm标记的双膦酸盐如99Tcm-亚甲基二膦酸盐（99Tcm-MDP）等被广泛应用于骨显像。近些年来,为了克服99Tcm-MDP的缺点,许多新型的双膦酸配体被设计与合成,以期望获得性能更加优异的骨显像剂。该文对近10年来发展的99Tcm标记双膦酸盐类骨显像剂的结构与性能进行了综述。     

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。     

Lack of effect of a bisphosphonate (pamidronate disodium) infusion on subsequent skeletal uptake of Sm-153 EDTMP

Patients who are candidates for samarium-153 ethylenediaminetetramethylenephosphonic acid (Sm-153 EDTMP) therapy often receive monthly infusions of pamidronate disodium or other bisphosphonates. Because both drugs are related compounds that concentrate in bone, it was advisable to determine whether previous bisphosphonate administration has blocked subsequent uptake of Sm-153 EDTMP. The authors compared skeletal uptake of Sm-153 EDTMP before and 1 to 4 days after pamidronate infusion in three patients with breast cancer metastatic to bone. In two of the patients, they continued to compare Sm-153 EDTMP uptake at approximately 1, 2, 3, and 4 weeks after pamidronate infusion. There was no difference in skeletal uptake of Sm-153 EDTMP before or at any time after pamidronate infusion. Pamidronate infusion did not interfere with skeletal uptake of Sm-153 EDTMP.     

Pathogenesis and pharmacological treatment of bone pain in skeletal metastases.

Sixty-five percent of patients with advanced cancer present bone metastases and most of them present a rather slow clinical course characterized by pain, mobility deficiencies and skeletal complications such as fractures and spinal cord compression. Metastatic involvement of the bone is one of the most frequent causes of pain in cancer patients and represents one of the first signs of widespread neoplastic disease. The pain may originate directly from the bone, from nerve root compression or from muscle spasms in the area of the lesions. The mechanism of metastatic bone pain is mainly somatic (nociceptive) even though, in some cases, neuropathic and visceral stimulations may overlap. The conventional symptomatic treatment of metastatic bone pain requires the use of multidisciplinary therapies such as radiotherapy in association with systemic treatment (hormonotherapy, chemotherapy, radioisotopes) with the support of analgesic therapy. Recently, studies have indicated the use of bisphosphonates in the treatment of pain and in the prevention of skeletal complications in patients with metastatic bone disease. In some patients pharmacological treatment, radiotherapy, radioisotopes administered alone or in association are not able to manage pain adequately. The role of neuroinvasive techniques in treating metastatic bone pain is debated. The clinical conditions of the patient, his life expectancy and quality of life must guide the physician in the choice of the best possible therapy.     

Role of skeletal scintigraphy in advanced retinoblastomas

PURPOSE: To document the incidence of skeletal metastases exclusively in advanced cases of retinoblastoma and to rationalize the use of preoperative skeletal scintigraphy in such patients. MATERIAL AND METHODS: Preoperative bone scans of 36 consecutive patients with advanced retinoblastoma who underwent skeletal scintigraphy during 1998 to 2003 were analyzed retrospectively. Bone scans were classified as: Grade 1 (high probability scan for skeletal metastases), Grade 2 (equivocal malignant or benign abnormalities), or Grade 3 (normal or certainly benign lesions). RESULTS: Grade 1 scan was found in 3 (8.33%) patients; bone metastases were confirmed by additional investigations. Grade 2 scan was found in 5 (13.88%) patients; bone metastases were excluded in all by additional investigations. Grade 3 scan was found in the remaining 28 (77.77%) patients. Extraorbital extension of disease was demonstrated by fine needle aspiration of lymph nodes in five patients, which included all three patients with Grade 1 scan. In addition to lymph node metastases, two patients had intracranial extension of the disease; demonstrated by contrast-enhanced magnetic resonance imaging of the head. One patient had liver metastases detected on abdominal ultrasound. None of the patients had skeletal metastases only. CONCLUSION: Routine preoperative bone scan is not justified in patients with locally advanced retinoblastoma. Bone scan should only be performed in patients with documented extraocular metastatic disease.     

Skeletal complications of bisphosphonate use: what the radiologist should know

Bisphosphonates are widely used for prevention of fractures in patients at risk, mainly in the presence of osteoporosis and bone metastases. A number of adverse effects of prolonged bisphosphonate treatment have emerged. We would like to highlight the skeletal complications from which a radiologist may be the first healthcare professional to recognise the association with bisphosphonate therapy. We illustrate these complications (namely osteonecrosis of the jaw and less well-known atypical femoral shaft fractures), presenting radiological findings in our patients. Recommendations for safer use of bisphosphonates are included in the conclusion of our review.     

The role of positron emission tomography in skeletal disease

The role of positron emission tomography (PET) in the evaluation and management of skeletal disorders is increasing. A number of reports are available in both benign and malignant disease with a variety of tracers. The bone agent 18F-fluoride can be used to evaluate bone metastases both qualitatively and, for a number of focal and systemic skeletal disorders, quantitatively. 18-Fluorodeoxyglucose is used as a tumor agent in both primary and metastatic bone and bone marrow malignancies; its use has also been described in the evaluation of infection within the skeleton. A possible role for the use of the hypoxia selective tracer 18F-fluoromisonidazole in skeletal infection also exists. This article summarizes the current role of PET in the skeleton with regard to these tracers and diseases.     

A prospective analysis of CT density measurements of bone metastases after treatment with zoledronic acid

Objective The objective was to prospectively determine CT density changes in bone metastases, before and after intravenous zoledronic acid for a maximum period of 12 months. Patients and methods Twenty-three consecutive patients presented with bone metastases and underwent therapy with zoledronic acid from December 2004. All patients underwent CT of the chest, abdomen, and pelvis. Bone density, measured in Hounsfield units (HU), was determined by segmenting lesions in the same anatomical area of the metastasis sites on the axial images of the sequential series of CT examinations. The effects of zoledronic acid were evaluated by calculating absolute and relative increases in bone density. Results The patients presented with multiple metastases in 65% of the cases. When compared with the baseline, all groups demonstrated a significant increase in bone density, which significantly (p < 0.01) correlated with the number of zoledronic acid administrations. There was increased bone density of at least 100% in 57%, and an increase of at least 50% in 87% of the patients. This increase was significant in both lytic and sclerotic metastases after 3 months of therapy. No significant bone density difference was found in normal-appearing bone. Conclusion Bone density measured by CT increases at metastatic sites after zoledronic acid treatment, regardless of the type of metastasis, in contrast to apparently normal bone.     

Radionuclide skeletal survey in neuroblastoma.

Of 63 99mTc-phosphate bone images in 49 patients with neuroblastoma, 41 were abnormal, 17 showed tracer uptake within the primary tumor, 29 showed evidence of skeletal metastatic disease, and 17 demonstrated renal/urinary tract involvement. The metastases were asymmetric in 24 patients and symmetrical in 9, in whom they involved the metaphyses and epiphyses of the long bones. Except for one patient with multiple "cold" areas, all metastases were seen as focal hyperactive regions. Eleven of 42 skeletal radiographic surveys were abnormal. The radionuclide study appears to be more accurate than skeletal radiography in estimating bone involvement in neuroblastoma. Primary tumor concentration of the tracer is almost pathognomonic of neural crest neoplasms in childhood.     

Observations on the sequential use of Tc-99m phosphonate and Ga-67 imaging in untreated primary and secondary malignant tumors of the head and neck

Scintigraphy using both Tc-99m phosphonate and Ga-67 was performed in 55 cases of untreated primary and secondary tumors of the head and neck. In 21 patients with primary tumors of jaws, eye, tongue, or parotid gland, Ga-67 scintigraphy visualized the primary tumor in all cases and metastases in 12. Scintigraphy using Tc-99m phosphonate disclosed primary bone involvement in 12 cases and skeletal metastases in two. In eight of 13 patients with metastatic lesions of jaws and skull, bone scintigraphy showed skeletal metastases. In seven of these patients, Ga-67 scintigraphy detected the primary tumor and in 11 cases detected metastases. Bone scintigraphy disclosed skeletal metastases in six of 21 patients with malignant neck tumors. In 13 of these patients, Ga-67 scintigraphy visualized the primary tumor, whereas it showed metastases in seven. It is concluded that Ga-67 scintigraphy should be used in the investigation of untreated primary or secondary malignant tumors of the head and neck. Bone scintigraphy may be indicated as an additional study in selected cases only.     

PET评价骨转移瘤

肿瘤骨转移会产生顽固性骨痛和脊髓受压等严重并发症,并对分期、治疗和判断预后产生深远的影响,因而探测骨转移是制定治疗计划的重要部分。骨转移瘤发现频率因原发肿瘤的类型和所用检查手段不同而不同,虽然目前核素骨扫描是探测骨转移瘤最常用的手段,但其对骨转移瘤的诊断效能仍有一定限度。与99mTc-亚甲基二膦酸盐(99mTc-MDP)骨显像相比,18F-氟化钠(18F-NaF)和18F-氟代脱氧葡萄糖(18F-FDG) PET是分别从骨转移瘤产生的成骨反应和骨转移瘤本身的代谢活性角度进行评价的两种正电子示踪剂,结合PET的高度空间分辨率,特别是最近迅速应用于临床的PET-CT技术,使得正电子体层显像在全身骨骼恶性疾病评价上的准确性进一步提高。