帕米膦酸二钠联合153Sm-EDTMP治疗多发性骨转移瘤28例

目的：观察帕米膦酸二钠联合^153钐-乙二胺四甲撑膦酸（^153Sm—EDTMP）治疗多发性骨转移瘤的疗效及毒副作用。方法：53例多发性骨转移瘤患者前瞻性随机分为帕米膦酸二钠联合^153Sm—EDTMP治疗组（治疗组）和单用帕米膦酸二钠治疗组（对照组），观察疗效及毒性反应。结果：治疗组和对照组的止痛有效率分别为82.1％和76．0％（P〉0．05），骨转移影像缓解率分别为46．4％和20．0％（P〈0．05），毒副作用差异元显著性。结论：帕米膦酸二钠联合^153Sm—EDTMP治疗多发性骨转移瘤近期疗效好、毒副作用小。     

云克与153钐-乙二胺四甲基膦酸对骨转移癌患者骨痛及疼痛因子的影响

目的：探讨云克（^99锝-亚甲基二膦酸盐注射液，^99Tc-MDP）与^153钐-乙二胺四甲基膦酸（^153Sm-EDTMP）对多发性骨转移癌患者骨痛反应与体内疼痛因子的变化的关系。方法：对93例多发性骨转移癌患者用云克与^153Sm-EDTMP治疗。其中单独^153Sm-EDTMP治疗组55例，单独云克治疗组及云克与^153Sm-EDTMP联合治疗组各19例。分别对其治疗前与治疗后（3个月后）血浆内皮素（ET）、降钙素基因相关肽（CGRP）、血栓素B2（TXB2）与6-酮-前列环素F1α（6-k-PGF1α）含量变化进行了测定。结果：治疗后三组患者骨痛缓解率分别为69．1％（38／55）、73．7％（14／19）及89．5％（17／19）。三组中，血浆ET与6-k-PGF1α含量治疗3月后均显著高于治疗前（P〈0．01）。血浆CGRP与TX＆含量治疗后与治疗前相比，^153Sm-EDTMP治疗组差异无统计学意义（P〉0．05）。云克治疗组及联合治疗组两组TXB，含量治疗后与治疗前相比，差异无统计学意义（P〉0．05）；而CGRP则显著降低（P〈0．05）。结论：云克与^153Sm-EDTMP联合治疗骨转移癌明显优于单独云克与单独^153Sm-EDTMP治疗；治疗后骨痛反应与疼痛因子ET、6-k-PGF1α及CGRP含量变化有关。     

前列腺癌骨转移的临床分析

目的探讨前列腺癌（PCa）骨转移的诊治方法。方法对1997～2004年收治的32例PCa骨转移的临床资料进行分析。结果19例PCa患者骨扫描发现骨转移14例,5例术后随访发现骨转移;13例先确诊骨转移瘤,继后查出原发灶。30例骨转移为多发,多累及脊柱与骨盆,2例单发者仅累及一侧骨盆。2例溶骨型改变用博宁治疗均部分缓解;28例多发成骨型骨转移者,9例^153Sm、19例^89Sr内照射治疗,总有效率分别为88．9％和89．5％,病灶客观反应有效率分别为21.4％和33．3％;2例单发成骨型转移者用^153Sm＋局部放疗,均完全缓解,3个月后病灶消失、缩小各1例。结论对PCa应早期和定期进行骨显像,PCa骨转移的诊治应综合病史、临床情况和影像学改变。     

^153钐—乙二胺四亚甲基膦酸治疗112例骨转移癌的临床观察

目的：观察^153^153钐－乙二胺四亚甲基膦酸（^153Sm-EDTMP)治疗恶性肿瘤骨转移癌的临床疗效。方法：按照治疗适应证，对112例经病理证实的恶性肿瘤发生骨转移癌患者者进行一次单剂量^153Sm-EDTMP治疗，观察治疗后1周－8周的疗效及不良反应，治疗后1周、2周、4周复查血像；1周、4周、8周复查血清碱性磷酸酶（ALP）；4周复查骨显像。结果：疼痛完全缓解者占39．3％（44／112），部分缓解者占42．85（48／112），总有效率达82．1％（92／112）；ALP有59．8％（67／112）患者在治疗前异常升高，经治疗后异常组中有86．6％（58／67），患者ALP出现明显下降；骨显像半定量分析显示有40．2％（45／112）患者骨转移病灶消失、缩小、减少或病灶处浓聚减弱。不良反应主要为骨髓抑制，经治疗2－4周内皆能恢复。结论^153Sm-EDTMP治疗骨转移癌疗效好、副反应少，使用安全，能有效改善虱生活质量。     

^89Sr治疗前列腺癌骨转移临床观察

目的评价放射性核素^89锶（^89Sr）在前列腺癌骨转移中的治疗效果和不良反应。方法观察前列腺癌骨转移并伴有不同程度骨痛患者66例,使用^89SrCl2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66例患者接受。^89Sr治疗后,止痛的总有效率达89．4％（59／66）,无效10．6％（7／66）,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^89Sr治疗前列腺癌骨转移疼痛效果明显,对前列腺癌骨转移灶亦有治疗作用,是一种安全有效的方法。     

放射性核素骨显像对乳腺癌骨转移的诊断价值

目的探讨放射性核素骨显像对乳腺癌骨转移的诊断价值。方法静脉注射^99Tc^m-亚甲基二膦酸盐（MDP）740-925MBq3h后行全身骨显像。结果 99例经病理确诊的乳腺癌,64例发生骨转移,阳性率64．6％（64／99）,其中56例同期行X线片检查,阳性率21．4％（12／56）,而骨显像的阳性率为66．1％（37／56）,两者之间有显著性差异（P〈0．005）。结论 ^99Tc^m-MDP骨显像能早期发现乳腺癌骨转移,对乳腺癌预后评估及治疗方案的制定有重要的参考价值。     

二氯化锶治疗恶性肿瘤骨转移疗效观察

目的探索二氯化锶（^89SrCl）治疗多发性骨转移癌的疗效。方法对126例恶性肿瘤骨转移伴骨痛的患者,静脉注射^89SrCl后,观察其镇痛作用、不良反应及对骨转移病灶的影响。结果治疗后109例骨痛消失或缓解（总有效率86．5%）,38例患者骨转移病灶缩小或消失（总有效率30．2％）;少数（19例）病人出现白细胞一过性减低,肝、肾功能无变化。结论^89SrCl对恶性肿瘤骨转移导致的骨痛、骨破坏有较好的疗效,副作用小,可重复用药。     

心理干预对153Sm - EDTMP治疗骨转移癌患者负性情绪的影响

晚期癌症患者60%～80%发生骨转移癌[1],常表现为癌性骨痛,严重者可发生病理性骨折,病人不仅躯体痛苦,通常伴有不同程度的焦虑和抑郁等负性情绪出现,严重降低病人生活质量.静脉注射153Sm - EDTMP可有效缓解癌性骨痛,减轻病人痛苦,但因为153Sm -EDTMP属放射性核素,病人对此常有恐惧心理,某种程度上加重了病人的负性情绪.     

唑来膦酸化疗对非小细胞肺癌骨转移疗效及白细胞介素-6肿瘤坏死因子-α的影响

骨转移是恶性肿瘤常见的并发症,多见于前列腺癌、乳腺癌和肺癌^[1]。发生骨转移后,由成骨细胞介导的细胞因子,如自细胞介素和肿瘤坏死因子的产生,是破骨细胞修复、出现骨痛的帮凶。目前应用双膦酸盐类药物治疗缓解骨痛、恢复正常活动功能和改善生活质量、降低骨相关事件的风险,是治疗恶性肿瘤骨转移的主要措施之一^[2]。     

放射性核素全身骨显像中单发病灶的临床价值

目的探讨放射性核素全身骨显像中单发病灶的临床价值。方法受检者常规^99Tc^m—亚甲基二膦酸盐(MDP)骨显像．对310例骨显像中单发病灶进行临床分析。结果有肿瘤病史的256例患者。骨转移率为24．2％(62／256),无肿瘤病史的54例患者中。骨转移率为5．5％(3／54),两者差异有显著性;总骨转移率为20．9％(65／310)。其中前列腺癌20.8％(5／24),乳腺癌22.4％(17／76),肺癌32.7％(18/55),泌尿系肿瘤23．1(3/13）,消化系肿瘤16．7％(7／42),其他肿瘤26．1％(12／46),无肿瘤病史患者中．94．4％(51／54)的单发病灶主要是良性病灶。结论在骨显像单发病灶中．有原发肿瘤病史患者24．2％为早期骨转移灶．无原发肿瘤病史患者94．％主要为良性改变。初步得出了全身骨显像中单个病灶临床分析标准和价值。     

Samarium for osteoblastic bone metastases and osteosarcoma

Samarium-153 lexidronam (153Sm-EDTMP) is FDA approved for painful osteoblastic bone metastases that image on bone scan. 153Sm-EDTMP decay has a therapeutic beta-emission and a gamma-photon for bone scan imaging. Monitoring of osteosarcoma radiation treatment effectiveness was performed with bone, CT, MRI and PET/CT fusion imaging. Bone scan and PET/CT improved in 5 out of 9 and 16 out of 18 osteosarcoma sites, respectively. 153Sm-EDTMP targets multiple sites of disease, with a single administration. Side effects of 153Sm-EDTMP (0.5-2.5 mCi/kg) have been minimal and include transient thrombocytopenia and neutropenia. 153Sm-EDTMP can be combined with radiation therapy, bisphosphonates and/or chemotherapy to synergistically improve palliation. This article reviews the rationale, indications and monitoring of standard-dose samarium and investigational high-dose 153Sm-EDTMP treatment of cancer involving bone.     

153钐-乙二胺四甲基膦酸联合治疗肺癌骨转移骨痛的疗效观察

目的 探讨153钐-乙二胺四甲基膦酸(153 Sm-EDTMP)核素加伊班膦酸钠(艾本)治疗肺癌骨转移骨痛的疗效.方法 100例肺癌骨转移患者随机分为153Sm-EDTMP加伊班膦酸钠静脉滴注52例(治疗组)、单用153Sm-EDTMP核素治疗组48例(对照组),比较两组止痛效果、活动能力、生活质量改善、溶骨病灶的修复及毒副作用.结果 治疗组疼痛总缓解率为94.2％,明显高于对照组的64.5％(x2=4.78,P＜0.05);治疗组活动能力改善状况的总有效率为82.6％,明显高于对照组的64.5％(x2=4.13,P＜0.05);治疗组生活质量改善状况的总有效率为84.6％,明显高于对照的62.5％(x2 =4.58,P＜0.05);两组毒副作用差异无统计学意义(x2=0.345,P＞0.05).结论 153Sm-EDTMP联合治疗肺癌骨转移,具有止痛、改善活动能力、提高生治质量的疗效.     

Samarium for osteoblastic bone metastases and osteosarcoma

Samarium-153 lexidronam (¹⁵³Sm-EDTMP) is FDA approved for painful osteoblastic bone metastases that image on bone scan. ¹⁵³Sm-EDTMP decay has a therapeutic β-emission and a γ-photon for bone scan imaging. Monitoring of osteosarcoma radiation treatment effectiveness was performed with bone, CT, MRI and PET/CT fusion imaging. Bone scan and PET/CT improved in 5 out of 9 and 16 out of 18 osteosarcoma sites, respectively. ¹⁵³Sm-EDTMP targets multiple sites of disease, with a single administration. Side effects of ¹⁵³Sm-EDTMP (0.5 – 2.5 mCi/kg) have been minimal and include transient thrombocytopenia and neutropenia. ¹⁵³Sm-EDTMP can be combined with radiation therapy, bisphosphonates and/or chemotherapy to synergistically improve palliation. This article reviews the rationale, indications and monitoring of standard-dose samarium and investigational high-dose ¹⁵³Sm-EDTMP treatment of cancer involving bone.     

Progress in the treatment of bone metastases in cancer patients

Introduction: Bone metastases are a frequent complication of cancer, occurring in up to 70% of patients with advanced breast or prostate cancer. Skeletal-related events involving pathological fractures, spinal cord compression and a need for surgery/radiotherapy, which are frequently observed in cancer patients with bone metastases have a detrimental effect on patients' survival and quality of life. Therefore, prevention of skeletal-related events is a crucial element in cancer treatment.

Areas covered: The aim of this article was to summarize data on bone-modifying agents used for treatment of cancer patients with bone metastases. We searched PubMed, EMBASE, and abstracts from ASCO, AUA, ESMO, AACR congresses for clinical studies evaluating bone-modulating agents in the treatment of patients with bone metastases.

Expert opinion: In breast cancer patients with bone metastasis, several bisphosphonates and denosumab demonstrated clinical efficacy. On the other hand, in patients with bone metastases from prostate cancer or other solid tumors only zoledronic acid and denosumab were clinically active. However, neither bisphosphonates nor denosumab have any positive impact on survival of patients with bone metastases. In a recent interim analysis of a Phase III clinical study, a novel bone-modulating agent – radium-223 chloride (alpharadin), a bone-seeking alpha emitter, has been demonstrated to significantly improve median overall survival of prostate cancer patients with bone metastases compared with placebo.     

~(188)Re-HEDP治疗骨转移癌及疼痛的临床应用

目的 :评价铼 188 1 羟基亚乙基二磷酸盐 (188Re HEDP)治疗骨转移癌疼痛的疗效和安全性。方法 :6 5例骨转移癌疼痛患者静脉注射188Re HEDP ,1次～ 6次 ,2周 1次 ,连用 2次为 1个疗程 ,疗程间隔为 3个月。平均剂量为(10 36± 10 0 )MBq[(2 8± 2 .7)mCi]。结果 :骨转移癌疼痛总缓解率为 89.2 % ,以肺癌、乳腺癌、前列腺癌效果明显 ;随治疗次数增多 (1次～ 6次 ) ,疼痛缓解率 (6 0 %～ 10 0 % )及转移灶缩小或消失率明显增加 (3.6 %～ 5 4 .9% ) ;部分患者 (44 .6 % )的白细胞、血小板于治疗后轻度降低。无恶心、呕吐、头痛等副作用。结论 :188Re HEDP治疗骨转移癌疼痛效果确切、安全性亦好。     

Progress in the treatment of bone metastases in cancer patients

INTRODUCTION: Bone metastases are a frequent complication of cancer, occurring in up to 70% of patients with advanced breast or prostate cancer. Skeletal-related events involving pathological fractures, spinal cord compression and a need for surgery/radiotherapy, which are frequently observed in cancer patients with bone metastases have a detrimental effect on patients' survival and quality of life. Therefore, prevention of skeletal-related events is a crucial element in cancer treatment. AREAS COVERED: The aim of this article was to summarize data on bone-modifying agents used for treatment of cancer patients with bone metastases. We searched PubMed, EMBASE, and abstracts from ASCO, AUA, ESMO, AACR congresses for clinical studies evaluating bone-modulating agents in the treatment of patients with bone metastases. EXPERT OPINION: In breast cancer patients with bone metastasis, several bisphosphonates and denosumab demonstrated clinical efficacy. On the other hand, in patients with bone metastases from prostate cancer or other solid tumors only zoledronic acid and denosumab were clinically active. However, neither bisphosphonates nor denosumab have any positive impact on survival of patients with bone metastases. In a recent interim analysis of a Phase III clinical study, a novel bone-modulating agent - radium-223 chloride (alpharadin), a bone-seeking alpha emitter, has been demonstrated to significantly improve median overall survival of prostate cancer patients with bone metastases compared with placebo.     

乳腺癌骨转移57例回顾性分析

目的研究乳腺癌骨转移的临床病理因素。方法对1998-12～2005-12笔者所在医院收治的503例原发乳腺癌发生骨转移的57例患者的临床资料进行回顾性分析。结果乳腺癌骨转移发生率9．1%,术后前3年发生率占71．7%,乳腺癌骨转移与雌激素受体、腋淋巴结转移和TNM分期有相关性。CA～153、AKP在乳腺癌患者骨转移的检测中具有明显相关性。结论术后前3年是乳腺癌骨转移的高发时间,CA-153、AKP、ECT和X线的联合检测可作为早期诊断乳腺癌骨转移的标准。     

89锶内照射治疗前列腺癌相关骨痛的疗效观察

目的 探讨核素89锶(89Sr)内照射对前列腺癌骨转移疼痛的治疗效果和不良反应.方法 对18例明确诊断为前列腺癌骨转移伴有明显疼痛症状的患者采用双侧睾丸切除加氟他胺治疗后,均接受核素89Sr内照射治疗,观察治疗后的止痛疗效、PSA变化、不良反应.结果 经89Sr治疗后,总有效率为88.9%(16/18),骨转移病灶数量也明显减少,疼痛缓解率4～7 个月,PSA有不同程度下降,不良反应主要为轻度可逆性骨髓造血功能损害.结论 应用核素89Sr内照射治疗能明显缓解前列腺癌骨转移引起的疼痛,对前列腺癌骨转移灶亦有抑制生长作用.     

Denosumab: in the prevention of skeletal-related events in patients with bone metastases from solid tumours

Denosumab, a fully human monoclonal antibody, binds to the receptor activator of nuclear factor-κB ligand (RANKL) and thereby inhibits RANKL-mediated bone resorption. In various individual countries, subcutaneous denosumab is indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumours (featured indication), and/or for the treatment of postmenopausal osteoporosis and/or of cancer treatment-induced bone loss in prostate or breast cancer patients. In three, pivotal, double-blind, multinational trials in adult patients with cancer-related bone metastases (total n?>?5700), including trials in patients with advanced breast or prostate cancer, subcutaneous denosumab (120 mg every 4 weeks) was shown to be noninferior to intravenous zoledronic acid (4 mg every 4 weeks), as determined by the median time to first on-study skeletal-related event (primary endpoint) at the time of the primary analysis (≈34 or 41 months). Denosumab treatment was superior to zoledronic acid in terms of the primary endpoint in two trials in patients with breast cancer or prostate cancer, based on secondary superiority analyses. In a third trial in patients with solid tumours excluding breast or prostate cancer, superiority of denosumab treatment versus zoledronic acid treatment was not demonstrated. The tolerability profile of denosumab was manageable in patients with bone metastases from solid tumours. Osteonecrosis of the jaw occurred in 1.8% and 1.3% of patients in the denosumab and zoledronic acid groups during the primary treatment phase; the incidence after approximately 4 additional months of denosumab treatment was 2.2%.