89SrCl2联合99Tc-MDP或唑来膦酸治疗肺癌骨转移疼痛的临床疗效观察

  目的  观察89SrCl₂、89Sr联合99Tc-MDP、89Sr联合唑来膦酸治疗肺癌骨转移的疗效。  方法  95例肺癌骨转移患者随机分为对照组(33例)与试验组A(30例)、试验组B(32例), 分别用89Sr治疗、89Sr联合99Tc-MDP治疗, 89Sr联合唑来膦酸治疗。主要观察三组患者治疗前后的疼痛、生活质量、血象、骨显像所示骨转移灶数目的改善情况。计数资料采用卡方检验, 计量资料采用均数t检验。  结果  对照组、试验组A、试验组B骨痛缓解有效率分别为57.58%、83.33%、81.25%。经统计分析, 试验组A、B与对照组骨痛缓解有效率、全身状况Karnofsky评分提高率(51.52%、80.00%、71.88%)、骨转移病灶治疗有效率(60.61%、83.33%、84.38%), 三组间有效率差异有统计学意义(P均 < 0.05), 而不良反应试验组无明显增加(χ2=1.885, P > 0.05)。  结论  89Sr联合99Tc-MDP、89Sr联合唑来膦酸的治疗方法较单独使用89Sr均能显著提高缓解疼痛的临床疗效。      

~(89)Sr治疗骨转移癌疼痛研究

 目的　评价放射性核素89锶 (89Sr)对骨转移癌的止痛疗效和不良反应 ,并探讨其在癌性骨痛治疗中的应用范围。方法　观察 35例骨转移癌患者使用89Sr治疗后的止痛疗效、肿瘤标记物水平的变化、不良反应及血液学毒副反应。结果　89Sr止痛总有效率为 71 .4 % ,其中来源于前列腺癌和乳腺癌的骨转移癌患者有效率达到 80 .0 %。少数肿瘤标记物水平有下降。副反应主要为轻度可逆性的骨髓造血功能损害。89Sr对血生化无明显不良影响。结论　89Sr是治疗骨转移癌疼痛的一种安全有效的方法     

89 锶内照射治疗转移性骨肿瘤的临床研究

目的 评价放射性核素^89锶（^89Sr)内照射治疗转移性骨肿瘤的应用范围、疗效和副作用。方法 对56例转移性骨肿瘤患者采用^89Sr内照射治疗,分别从缓解骨痛、改善SPECT骨显象病灶和毒副反应三方面进行密切观察、随访。结果 缓解骨痛的总有效率为76．8％,对前列腺癌和乳腺癌转移性骨肿瘤患者有效率达到81．8％以上。81．1％患者SPECT骨显象显示原发病灶有所改善。毒副反应主要表现为白细胞、血小板和红细胞轻度降低。结论 放射性同位素^89Sr内照射治疗转移性骨肿瘤有较好疗效。     

89Sr治疗肺癌转移性骨痛的疗效评价

目的评价89Srcl2对肺癌转移性骨痛的临床疗效.方法观察21例肺癌多发性骨转移伴疼痛患者静脉注射89Srcl2治疗后的镇痛作用及不良反应.结果治疗后骨痛减轻或消失18例,总有效率达到85.7%;治疗后骨显像发现转移灶消失或基本消失62处;治疗后有3例病人出现轻度的白细胞、血小板减少,对心、肝、肾几乎没有影响.结论 89Srcl2对缓解肺癌骨转移瘤疼痛有较好的疗效,并有一定的治疗作用,副作用小,可重复用药.     

89SrCl2治疗转移性骨肿瘤效果评价

目的:评价89SrCl2治疗转移性骨肿瘤的效果,探讨协作治疗的意义。方法:对87例接受89SrCl2治疗的转移性骨肿瘤的临床效果、治疗时期、毒副反应、无效原因以及多学科协同治疗的价值进行回顾性调查和随访。结果:56例患者疼痛不同程度缓解,并伴有骨转移灶放射性摄取减低和血清钙、碱性磷酸酶下降,总有效率71.8%(56/78),其中Ⅰ、Ⅱ级疼痛者有效率80.9%(38/47),III级患者有效率58.1%(18/31),9例无痛病例随访期内持续无痛。87例中肺癌60例,其中腺癌25例,有效率52%(13/25);鳞癌12例,有效率75%(9/12);小细胞肺癌6例,4例有效。治疗后所有病例均出现不同程度的红白细胞或血小板减低,其中合并化疗者32例血象明显低于正常,未合并化疗者,血象虽有降低但多数仍在正常范围以内。在同时接受放疗的32例中,30例疼痛有所缓解。22例2周内使用过双磷酸盐的患者,17例改善,无效病例中有19例合并肝、脑或肺转移,1例为神经根性疼痛患者。结论:89SrCl2能降低碱性磷酸酶,减轻骨溶解,降低血钙,缓解骨痛,治疗效果与原发灶病理类型与疼痛程度有关,多骨转移、重度疼痛、神经根性疼痛以及肿瘤晚期多脏器转移是疗效不佳的原因。早期使用、与放疗和骨吸收抑制剂结合使用有助于提高疗效。     

~（89）SrCl_2治疗转移性骨肿瘤效果评价

目的：评价89SrCl2治疗转移性骨肿瘤的效果,探讨协作治疗的意义。方法：对87例接受89SrCl2治疗的转移性骨肿瘤的临床效果、治疗时期、毒副反应、无效原因以及多学科协同治疗的价值进行回顾性调查和随访。结果：56例患者疼痛不同程度缓解,并伴有骨转移灶放射性摄取减低和血清钙、碱性磷酸酶下降,总有效率71.8%（56/78）,其中Ⅰ、Ⅱ级疼痛者有效率80.9%（38/47）,III级患者有效率58.1%（18/31）,9例无痛病例随访期内持续无痛。87例中肺癌60例,其中腺癌25例,有效率52%（13/25）;鳞癌12例,有效率75%（9/12）;小细胞肺癌6例,4例有效。治疗后所有病例均出现不同程度的红白细胞或血小板减低,其中合并化疗者32例血象明显低于正常,未合并化疗者,血象虽有降低但多数仍在正常范围以内。在同时接受放疗的32例中,30例疼痛有所缓解。22例2周内使用过双磷酸盐的患者,17例改善,无效病例中有19例合并肝、脑或肺转移,1例为神经根性疼痛患者。结论：89SrCl2能降低碱性磷酸酶,减轻骨溶解,降低血钙,缓解骨痛,治疗效果与原发灶病理类型与疼痛程度有关,多骨转移、重度疼痛、神经根性疼痛以及肿瘤晚期多脏器转移是疗效不佳的原因。早期使用、与放疗和骨吸收抑制剂结合使用有助于提高疗效。     

^89Sr治疗乳腺癌多发性骨骼转移临床疗效评价

目的 评价89Sr治疗乳腺癌多发性骨骼转移的临床效果.方法 53例乳腺癌多发性骨转移患者,临床表现为不同程度骨痛,采用静脉注射89Sr治疗并进行疗效评价.结果 疼痛完全缓解21例,部分缓解24例,无缓解8例,总有效率为84.9%.未见明显骨髓抑制与肝肾脏功能损伤.结论 89Sr能快速、有效地缓解和治疗乳腺癌患者多发性骨转移引起的疼痛,是一种安全、有效的治疗方法.     

氯化锶和帕米膦酸二钠治疗多发性骨转移癌疼痛的疗效分析

目的 :比较氯化锶 (89Sr)和(或 )帕米膦酸二钠 (APD)治疗恶性肿瘤多发性骨转移骨疼痛的疗效。方法 :对 96例确诊为骨转移癌的患者随机分为 3组 ,分别为 89Sr治疗组、APD治疗组和 89Sr APD治疗组 ,观察 3组在止痛效果、活动能力改善结果和不良反应之间的差别。结果 :3 2例 89Sr组、40例APD组和 2 4例 89Sr APD组的骨痛止痛有效率分别为 81 2 5 % (2 6/3 2 )、75 % (3 0 /4 0 )和 95 83 % (2 3 /2 4) ,89Sr APD组与单用APD组相比差异有统计学意义 ,P <0 0 5。 3组活动能力改善结果有效率分别为 81 2 5 % (2 6/3 2 )、75 % (3 0 /4 0 )、91 6% (2 2 /2 4) ,89Sr APD组与单用APD组比差异无统计学意义。 3组在不良反应方面 ,在恶心、呕吐及发热方面差异无统计学意义 ,但是在闪烁现象上 3组差异有统计学意义 ,P <0 0 5 ,且单用 89Sr组与 89Sr APD组间差异有统计学意义 ,P <0 0 5。在骨髓抑制方面 3组差异有统计学意义 ,P <0 0 1,但单用 89Sr组与 89Sr APD组之间差异无统计学意义。结论 :89Sr APD联合用药组对骨转移疼痛的治疗 ,止痛疗效更显著 ,且能减少闪烁现象等不良反应 ,而不增加骨髓抑制毒性。     

89SrCl2和/或骨膦治疗肺癌骨转移疗效分析

目的：评价^89SrCl2和／或骨膦治疗肺癌骨转移的疗效。方法：选择67例肺癌多发性骨转移患者，其原发肺癌均有病理诊断，全身骨显像及X线检查证实有多发性骨转移，患者均有中度以上骨痛。其中^89SrCl2治疗组19例，骨膦治疗组28例，^89SrCl2联合骨磷治疗组20例，所有病例均随访观察3个月。结果：^89SrCl2治疗组和骨膦治疗组骨痛缓解率分别为84．2％和80．4％，对骨转移病灶有效率分别为15．7％和10．7％，生活质量改善率分别为47．3％和42．8％，其差异均无显著性（P＞0．05）。而联合应用^89SrCl2和骨磷治疗组镇痛有效率为90．0％，与前两组比较差异无显著性（P＞0．05）。而联合应用^89SrCl2和骨膦治疗组镇痛有效率为90．0％，与前两组比较差异无显著性（P＞0．05），对骨转移病灶有效率和生活质量改善率分别为45．0％和80．0％，与前两组比较均有显著性差异（P＜0．05）。结论：^89SrCl2和骨膦对肺癌骨转移均有较好的镇痛疗效，联合应用^89SrCl2和骨磷对缓解骨痛和提高患者生活质量的疗效明显优于单用^89SrCl2或骨膦。     

89锶内照射治疗骨转移性肿瘤的临床价值分析

目的　探讨89锶 ( 89Sr)内照射治疗转移性骨肿瘤的临床应用价值。方法　 80例有不同程度骨痛的广泛性骨转移患者 ,静脉注射 60 μCi/Kg剂量的89Sr ,随访时间为 3个月至 2年。结果　根据病人主观描述及ECT检查判断疗效。本组 80例中 ,A显效 :2 2例( 2 7.5 % )在注射89Sr 1个月后疼痛基本消失 ,活动能力显著恢复 ;骨显像复查 ,转移灶大部分好转 ;其中 8例 ,原广泛性转移病灶 ,基本消失。B有效 :46例 ( 5 7.5 % )疼痛明显减轻 ,活动能力改善 ;骨显像示转移灶部分好转。C无效 :余 12例 ( 15 % ) ,无明显好转。本病例组中 ,治疗后血常规、肝肾功能无明显变化。结论　89Sr为纯 β射线 ,用于内照射治疗 ,起镇痛作用 ,有效率达 85 .0 %。显著改善病人生活质量 ,延长生命。     

Pain control for bone metastasis using radioactive strontium

Palliative therapy using radioactive strontium (89Sr) was performed on 60 patients suffering from cancer. Seventy-one percent of the patients had stopped or reduced their opiates and/or analgesics. Pain relief continued for up to three months. Patients with breast and prostatic cancer showed the best pain reduction. However, pain reduction was limited for lung cancer patients. Repeated usage of 89Sr with/without opiate and analgesics served to maintain the reduced level of pain. Side effects of repeated usage of 89Sr were decrease of hemoglobin, WBC, and platelets. The decreased level was limited within Level 1. The indication of 89Sr therapy is important. DIC cases and renal failure cases will have increased side effect risk. Image diagnosis is also important. A bone scan is a minimum requirement. Poor accumulation of 99mTc-MDP cases are not indication. Rapidly progressive disease cases, radiculopathy cases, and soft tissue invasion cases should not be given 89Sr therapy. At present, the uses of 89Sr are limited to end-stage patients. The use of 89Sr should change from end stage to early stage in combination with chemotherapy.     

55例肺癌骨转移患者的回顾性分析

目的 探讨晚期肺癌骨转移的临床特征及诊断、治疗方法.方法 回顾性分析55例晚期肺癌骨转移患者的临床资料.结果55例晚期肺癌骨转移患者中,腺癌占70.91%,主要转移部位依次是椎体、肋骨、骨盆、肩胛骨、股骨和颅骨.多发骨转移占76.36%(42/55),孤立性骨转移占23.64%(13/55).诊断方法包括发射单光子计算机断层扫描(ECT)、磁共振成像(MRI)、电子计算机断层扫描(CT)及正电子发射计算机断层扫描(PET-CT)等.治疗主要以唑来膦酸联合止痛药物为主,有19例患者伴随疼痛,其中,15例患者经治疗后缓解.结论晚期肺癌骨转移中腺癌的发生率最高,转移部位以椎体为主.唑来膦酸联合止痛药物可以缓解患者的骨痛,改善患者的生活质量.晚期肺癌患者应常规进行全身骨扫描检查.     

唑来膦酸联合89 S r治疗恶性肿瘤晚期多发骨转移的疗效观察

目的 探讨恶性肿瘤晚期多发骨转移患者采用唑来膦酸联合89 Sr治疗的临床疗效.方法 将90例恶性肿瘤晚期多发骨转移患者,按照随机抛硬币法将其分组为对照组(唑来膦酸静脉滴注)与观察组(唑来膦酸静脉滴注联合89 Sr静脉注射),各45例.采用疼痛视觉模拟法(VAS)评价两组患者治疗前、后疼痛情况,通过问卷调查表调查两组患者治疗前、后生活质量改善情况,统计两组临床疗效及不良反应.结果 治疗后,两组患者VAS评分及生活质量各项指标均较治疗前明显改善,而观察组各项指标改善程度优于对照组,P<0.05.观察组治疗临床有效率为84.4%,明显高于对照组(66.7%),P<0.05;两组患者不良反应率比较,P>0.05.结论 唑来膦酸联合89 Sr治疗恶性肿瘤晚期多发骨转移可缓解患者疼痛,提高临床治疗效果,改善其生活质量,同时不会增加治疗期间所产生的不良反应,因此值得深入研究以利于其推广应用.     

Radiopharmaceuticals for the palliation of painful bone metastasis-a systemic review.

BACKGROUND AND PURPOSE: The purpose was to develop a systematic review that would address the following question: what is the role of radiopharmaceuticals in the palliation of metastatic bone pain in adults with uncomplicated, multifocal painful bone metastases whose pain is not controlled with conventional analgesic regimens? The outcomes of interest are pain response, analgesic consumption, overall survival, adverse effects and quality of life. MATERIALS AND METHODS: A systematic review of the English published literature was undertaken to provide evidence relevant to the above outcomes. RESULTS: Six randomized phase III trials, two randomized phase II trials and one randomized crossover trial of strontium-89 were reviewed. A randomized phase III trial comparing strontium-89 plus cisplatin with strontium-89 plus placebo reported a significantly higher proportion of patients experiencing pain relief for a significantly longer duration with strontium-89 plus cisplatin. A randomized phase III trial comparing adjuvant strontium-89 with placebo following radiotherapy reported a higher proportion of pain-free patients with strontium-89. Patients who received strontium-89 also experienced fewer new sites of bone pain. A second, but underpowered study failed to confirm these results. In one randomized trial of strontium-89 versus radiotherapy (hemibody or local), patients treated with strontium-89 developed fewer new sites of pain. In a second trial comparing strontium-89 versus local radiotherapy, median overall survival was improved with radiotherapy, while pain response and time-to-progression were similar in the two groups. One randomized phase III trial reported no difference in pain relief between strontium-89 and placebo. Three randomized phase III trials and two randomized phase II trials investigating samarium-153 were reviewed. In a randomized phase III trial of three different doses of samarium-153, the pain responses were similar for all three doses. In a randomized phase III trial of two different doses of samarium-153 versus placebo, the complete pain response rate was significantly higher with the higher dose of samarium-153 compared with placebo. In a randomized phase III trial comparing samarium-153 with placebo, significant differences favouring samarium-153 were reported for pain and opiate use. In addition, one randomized phase III trial, two randomized phase II trials, one randomized crossover trial and 13 phase II or phase I trials of rhenium, one phase I trial of tin-117 m and one phase II trial of phosphorus-32 were reviewed. The majority of patients treated in trials of radiopharmaceuticals where histology was specified had metastatic breast cancer (approximately 5-10% of patients reported), metastatic hormone-refractory prostate cancer (80-90% of patients reported) or metastatic lung cancer (5-10% of patients reported). Information on histologic subtype was not available for a significant proportion of patients treated on trials (30-40% of patients reported). CONCLUSIONS: Use of single-agent radiopharmaceuticals (strontium-89 and samarium-153) should be considered as a possible option for the palliation of multiple sites of bone pain from metastatic cancer where pain control with conventional analgesic regimens is unsatisfactory and where activity on a bone scan of the painful lesions is demonstrated. Ongoing clinical research should seek to establish the benefit of newer radiopharmaceuticals and radiopharmaceuticals in combination with other systemic therapies.     

The correlation between palliation of bone pain by intravenous strontium-89 and external beam radiation to linked field in patients with osteoblastic bone metastases

We studied the correlation between the efficacy of local external beam radiotherapy and the efficacy of strontium-89 in the palliation of osteoblastic metastatic bone pain in 43 patients with cancer. All 43 had been treated with hormonal or chemotherapy according to the primary malignancies and analgetic pharmacotherapy as needed, 36 received local external beam radiotherapy as a palliative before strontium-89 injection, and all 43 were ultimately treated with strontium-89 as salvage therapy. Responses to the first strontium treatment, and to the first radiation treatment if given, were taken from patient files. Pain was evaluated by Karnofsky performance status, analgesic dosage, and duration of response to treatment translated into numeric scores on a pain duration scale and an integrated response scale. The efficacy of limited field external radiation in metastatic bone pain palliation was 80.6% versus 58.1% for strontium-89. Patients treated with both external radiation and strontium had a positive correlation of 0.4 with a probability of P = 0.0158 between the responses to the 2 treatments, indicating that response to external radiotherapy could be viewed as an indicator of strontium-89 efficacy in metastatic osteoblastic bone pain palliation in the same patient. No significant correlation was found between strontium efficacy and gender, location of metastases to weight-bearing bones, duration of hormonal therapy or chemotherapy, or type of primary neoplasm.     

氯化锶（^89SrCl2）治疗恶性肿瘤骨转移的临床分析

目的：评价氯化锶（^89SrCl2）治疗恶性肿瘤骨转移癌的临床疗效。方法：79例诊断为骨转移瘤的患者行^89SrCl2治疗，治疗后进行血常规、肝肾功能及SPECT随访3—6个月，对治疗后患者疼痛缓解、ECT病灶变化及血液学、肝肾功能变化进行评价。结果：79例患者中67例（84．8％）有效，疼痛缓解持续时间为38—182天。61例患者ECT结果显示病灶减小或消失31例，病灶数目无明显变化者16例，病灶数目增加者14例。无明显骨髓抑制及肝肾功能损害。结论：^89SrCl2治疗骨转移瘤，能明显减轻患者的骨痛，改善患者的生存质量，同时对骨转移病灶起到一定程度的治疗作用，是一种安全、有效、可靠的治疗方法。     

氯化锶(89SrCl2)治疗恶性肿瘤骨转移的临床分析

目的：评价氯化锶（^89SrCl2）治疗恶性肿瘤骨转移癌的临床疗效。方法：79例诊断为骨转移瘤的患者行^89SrCl2治疗，治疗后进行血常规、肝肾功能及SPECT随访3—6个月，对治疗后患者疼痛缓解、ECT病灶变化及血液学、肝肾功能变化进行评价。结果：79例患者中67例（84．8％）有效，疼痛缓解持续时间为38—182天。61例患者ECT结果显示病灶减小或消失31例，病灶数目无明显变化者16例，病灶数目增加者14例。无明显骨髓抑制及肝肾功能损害。结论：^89SrCl2治疗骨转移瘤，能明显减轻患者的骨痛，改善患者的生存质量，同时对骨转移病灶起到一定程度的治疗作用，是一种安全、有效、可靠的治疗方法。