放射性核素89Sr治疗前列腺癌骨转移

目的:探讨利用89Sr治疗前列腺癌骨转移的临床效果.方法:选取47例前列腺癌骨转移病人,采用静脉滴注89Sr的方法进行治疗,每6个月注射一次.结果:89Sr治疗前列腺癌骨转移患者不但可使骨转移疼痛缓解(91.7%),而且对骨转移肿瘤灶有显著的治疗作用(85.11%).结论:放射性核素治疗方法简单,副作用较小,治疗效果较...     

唑来膦酸联合内分泌治疗前列腺癌骨转移疼痛的临床思路构建

目的：探讨唑来膦酸与内分泌联合治疗前列腺癌骨转移疼痛的临床效果。方法选择我院2010年6月~2013年9月收治的62例前列腺癌骨转移疼痛患者为研究对象,随机分为对照组31例,观察组31例,对照组使用唑来膦酸治疗,观察组在唑来膦酸基础上加用内分泌治疗,对两组患者的治疗效果进行分析。结果观察组治疗有效率为90.3%,对照组治疗有效率为71.0%,差异有统计学意义(P<0.05)。治疗前,两组患者的PSA和Kamofaky Score评分物明显差异,治疗后,均有明显变化,观察组显著优于对照组。结论采取内分泌和唑来膦酸联合对前列腺癌骨转移疼痛患者进行治疗,其疗效显著,能缓解不良反应,值得临床进一步推广使用。     

89^Sr联合内分泌疗法治疗前列腺癌骨转移的疗效观察

目的：探讨89^锶（89^Sr）联合内分泌疗法治疗前列腺癌骨转移性疼痛的疗效。方法：将45例确诊为前列腺癌且具有骨转移病灶并伴有疼痛的患者随机分为两组：89^Sr联合内分泌疗法治疗的治疗组23例,单纯采用内分泌治疗的对照组22例,观察治疗后两组的止痛疗效、血清PSA水平的变化、血象及生化指标的变化。结果：治疗前两组患者的疼痛级数间差异无显著性意义（P〉0.05）。治疗后治疗组患者疼痛级数及血清PSA水平较对照组显著降低（P〈0.01;P〈0.05）;治疗后治疗组患者骨转移病灶治疗有效率较对照组显著升高（P〈0.01）。结论：89^Sr联合内分泌疗法能迅速有效地缓解前列腺癌骨转移疼痛,使骨转移病灶缩小或消失,副作用小,其疗效明显优于单纯内分泌疗法。     

~(89)SrCl_2治疗前列腺癌骨转移疗效分析

前列腺癌是老年男性常见恶性肿瘤之一,骨转移的发生率较高,国外报道为70%[1].约60%～70%出现剧烈疼痛,严重影响患者生活质量,氯化锶(89SrCl2)是一种用于转移性骨肿瘤所致疼痛的姑息治疗的放射性药物,1941年首次被用于前列腺癌骨转移患者,获得较好疗效.大量临床应用是在20世纪70年代中后期开始的.我们自2003年1月～2005年3月采用89SrCl2治疗27例前列腺癌骨转移患者,现报告如下.     

PSA、SPECT骨显像在前列腺癌诊断和治疗中的临床价值

目的:探讨PSA、SPECT骨显像在前列腺癌诊断及治疗中的临床应用.方法:对72例经临床确诊的前列腺癌患者全部行血清PSA测定及全身骨显像,并对部分患者治疗后进行了随访.结果:前列腺癌组PSA明显高于正常对照组、良性前列腺疾病组;前列腺癌骨转移组PSA明显高于非骨转移组;72例前列腺癌初诊患者骨显像发现24例骨转移瘤,阳性率33.3%.结论:血清PSA与骨显像联检对前列腺癌临床诊断、疗效观察及预后判定具有重要的指导意义.     

89Sr对骨转移癌疼痛的治疗评估及护理指导

目前恶性肿瘤晚期患者的骨转移性疼痛已成为癌症治疗中的一个重要问题.骨痛可由肿瘤浸润并蔓延至神经支配丰富的骨膜;也可由肿瘤机械压迫导致骨组织变薄;也可因肿瘤从骨组织扩散至神经组织所致等[1].为了减轻骨转移癌患者的痛苦,提高其生活质量,2004年至今,我院核医学科用放射性核素89Sr在治疗前列腺癌、乳腺癌等骨转移癌性疼痛方面取得令人满意的效果.以下是52例的治疗及护理.     

40例恶性肿瘤骨转移疼痛放射治疗研究

目的研究恶性肿瘤骨转移疼痛放射治疗的疗效。方法40例恶性肿瘤骨转移疼痛患者进行放射性治疗，观察恶性肿瘤骨转移疼痛患者的疗效。结果患者获得疼痛完全缓解的有13例，获得部分缓解的20例，轻微缓解的5例，疼痛无缓解2例，有效率达到95%。结论放射性治疗对恶性肿瘤骨转移疼痛患者具有很好的疗效，长期进行治疗，可以有效缓解患者的恶性肿瘤骨转移疼痛。     

血清PSA、FPSA测定在前列腺癌骨转移诊断中的价值

目的 探讨检测前列腺特异性抗原(PSA)、游离PSA(FPSA)对前列腺癌骨转移的诊断价值.方法 对68例经临床确诊的前列腺癌患者的PSA和FPSA检测结果及全身骨显像进行回顾分析.结果 前列腺癌骨转移组和非骨转移组PSA和FPSA的均值差异均有显著性(P<0.01);PSA<10ug/L的7例患者中,发生骨转移者1例,诊断阳性率为14.3%;PSA在10ug/L～50ug/L的患者共18例.发生骨转移者7例,诊断阳性率为38.9%;PSA>50ug/L的患者43例,发生骨转移39例,诊断阳性率为90.7%.结论 PSA<10ug/L的前列腺癌患者发生骨转移的可能性小;PSA>50ug/L的患者发生骨转移的可能性大.     

SPECT全身骨显像、血清tPSA及fPSA/tPSA比值及病理分级与前列腺癌骨转移的关系探讨

目的：探讨SPECT全身骨显像、血清tPSA水平、fPSA/tPSA比值及前列腺癌病理分级与前列腺癌骨转移的关系,并研究其发生骨转移的规律和特点。方法：以核医学SPECT全身骨显像为金标准,回顾性分析了体外放免法测定的107例前列腺癌患者的血清PSA（前列腺特异抗原）水平、血清fPSA/tPSA比值及全身骨显像和病理分级。结果：107例前列腺癌患者：49例发生骨转移,占45.8%（49/107）,其中不同病理分组之间骨转移发生率比较差异有统计学意义,分化程度越低,骨转移发生率越高;随着tPSA水平的升高,骨转移的发生率明显增加;血清tPSA（4～40）ng/ml时,采用fPSA/tPSA比值,可明显提高前列腺癌诊断特异性。结论：前列腺癌患者骨转移发生率与前列腺癌的分化程度、血清PSA水平及fPSA/tPSA比值有一定的关系。分化程度越低,骨转移发生率越高。     

TrACP在诊断和预测前列腺癌骨转移中的临床意义

目的研究抗酒石酸酸性磷酸酶在前列腺骨转移患者血清中的变化,探讨其用来诊断和预测前列腺发生骨转移的临床意义。方法以78例前列腺癌患者以及40例良性前列腺增生患者为研究对象,分为前列腺癌骨转移患者组41例(A组),前列腺癌无骨转移患者组37例(B组),良性前列腺增生患者组40例(C组),同时以40例健康青壮年男性作为健康对照组40例(D组)。应用双抗体夹心酶标免疫分析法测定患者血清标本中的Tr ACP水平,结合病理分级、Gleason评分、PSA、ALP和ALT等进行统计学分析。结果骨转移患者的血清Tr ACP浓度明显高,与其他各组比较差异具有显著性;血清Tr ACP浓度与PSA水平有较强的正相关性;ROC曲线下面积(AUC)均大于ALP和ALT,且Tr ACP与PSA的ROC曲线交叉,提示对骨转移的诊断价值较高。结论Tr ACP的检测对于前列腺癌骨转移具有更直接的诊断价值和预测价值,通过监测前列腺癌患者的血清Tr ACP含量,对了解前列腺癌的生长状态、判断病程进展、预测骨转移的发生具有重要的临床意义。     

89SrCl2联合"云克"治疗前列腺癌骨转移的临床价值

为探讨89SrCl2联合"云克"治疗前列腺癌多发骨转移的临床价值,将95例前列腺癌骨转移患者分为89SrCl2组(A组)46例,89SrCl2加"云克"组(B组)49例.治疗后随访患者的骨痛缓解情况、全身骨显像的变化情况以及前列腺特异抗原(PSA)变化情况.结果显示,B组患者骨痛缓解的总有效率为87.76%,骨显像完全...     

Slow zoledronic acid releasing testis prostheses in the treatment of prostate cancer patients with bone metastases

Surgical castration is still considered the ‘gold standard’ for androgen deprivation therapy which have become the mainstay for the management of advanced prostate cancer. The main drawback of this safe operation is that it may have a negative psychological effect, thus, in recent years, a decline in the utilization of bilateral orchiectomy which is the most cost-effective form of androgen deprivation therapy can be witnessed. Testicular prostheses have been shown to reduce the psychological impact resulting from loss or absence of a testicle in those patients. Besides, patients with advanced prostate cancer are at risk of skeletal complications and bisphosphonates are used in treatment. Zoledronic acid is the only bisphosphonate agent demonstrated to effectively reduce skeletal related events in patients with advanced prostate cancer metastatic to bone. Therefore, zoledronic acid releasing testicular prostheses can be used in the treatment of prostate cancer patients with bone metastases after bilateral orchiectomy. This technology has the potential to become the preferred clinical management tool for prostate cancer patients with bone metasthases after bilateral orchiectomy.     

Radiopharmaceuticals for metastatic bone pain palliation: available options in the clinical domain and their comparisons

Bone pain arising due to skeletal metastases is one of the common complications experienced by the majority of patients suffering from prostate, breast and lung cancer at the advanced stage of the disease. These patients are subjected to palliative care in order to improve the quality of their remaining life. With the gradually increasing number of cancer cases, palliation of metastatic bone pain is gaining importance. Bone-seeking radiopharmaceuticals play a pivotal role in the management of cancer pain, particularly in patients with multiple metastases, as these agents are proven to be effective in controlling the bone pain with minimum side effects. Although a plethora of such radiopharmaceuticals have been developed and evaluated in animal models, only a few are regularly used in clinics while some of these agents are at different stages of clinical evaluations. The present article describes only those bone-seeking radiopharmaceuticals, which have been reported to be clinically administered till date, along with their relative merits and drawbacks.     

Metastatic Adenocarcinoma of Prostate in a 28-Year-Old Male: The outcome is poor in young patients?

Prostate cancer is common in older patients. Rarity in younger population limits the study of natural history and prognosis in this population. Most of the published data has reported poor outcome in younger patients with metastatic prostate cancer. Here, we report a case of prostate cancer in 28-year-old male who presented with bone metastasis. After bilateral inguinal orchidectomy, he was started on anti-androgen therapy and received palliative radiotherapy for bone metastasis. There was only a slight decrease in prostate-specific antigen (PSA) level and pelvic disease post treatment. Subsequently, he was started on opioid analgesics (by World Health Organization, WHO, step ladder) in view of persistent pain. The index case is being presented for its rarity and probable poor outcome in young patients and to stress on the fact that the possibility of primary prostatic adenocarcinoma should be investigated in a male presenting with bone metastasis irrespective of the age.     

A prospective, multicenter, open-label trial of zoledronic acid in patients with hormone refractory prostate cancer

PURPOSE: The short-term safety and efficacy of zoledronic acid for the treatment of skeletal metastasis was evaluated in patients with hormone-refractory prostate cancer. PATIENTS AND METHODS: A total of 19 hormone-refractory prostate cancer patients with bone metastases were enrolled. All patients received up to six infusions of zoledronic acid (4 mg, given intravenously over 15 minutes, every 3-4 weeks). Safety was assessed by monitoring adverse events and serum creatinine levels. Efficacy was assessed by monitoring skeletal-related events, brief pain inventory score, quality of life score, type of pain medication, and analgesic score. Mean age of patients was 67.3 years (46-86 years), mean time from diagnosis of bone metastases was 27.6 months (0-117 months), and mean time from diagnosis of hormone-refractory disease was 7.5 months (0-26 months). RESULTS: There was no clinically significant change in serum creatinine levels. Eleven adverse events (musculoskeletal disorders and systemic disorders) in 8 patients were classed as having a possible relationship to study drug. Fifteen patients completed six courses of zoledronic acid infusion. There were no significant changes in the brief pain inventory composite scores, quality of life questionnaire scores or analgesic score. No new skeletal-related events developed during the treatment period. CONCLUSION: Zoledronic acid administered in this study as a 15-minute infusion demonstrated an acceptable and well-known safety profile in patients with refractory prostate cancer with bone metastases. However, prospective placebo- controlled clinical trials are required to elucidate the efficacy of zoledronic acid.     

Strontium 89 in the treatment of pain due to diffuse osseous metastases: a university hospital experience

More than two-thirds of the patients with osseous metastases experience debilitating bone pain, requiring some form of pain relief. Analgesics are limited in their efficacy. Palliative application of hemi-body external beam radiation therapy in the treatment of multiple osseous metastases also is limited due to toxicity associated with large treatment ports. Intravenous injections of bone seeking radioisotopes are effective in the palliation of pain with fewer side effects. Forty-one patients with multiple osseous metastases due to prostate and breast cancer were treated with strontium chloride 89 (89Sr) at the department of radiation oncology, in a university hospital. A retrospective analysis of these patients indicated that all subjects had severe pain that diminished their quality of life. Most of these patients had multiple co-morbid factors. Many were on opioids leading to adverse effects such as nausea, constipation, and drowsiness that required additional medication. Objective findings and evaluation of the responses were not always available for all patients. Following treatmentwith 89Sr, over two-thirds of the patients responded favorably and required lower doses of opioids.     

Endothelin and the tumorigenic component of bone cancer pain

Tumors including sarcomas and breast, prostate, and lung carcinomas frequently grow in or metastasize to the skeleton where they can induce significant bone remodeling and cancer pain. To define products that are released from tumors that are involved in the generation and maintenance of bone cancer pain, we focus here on endothelin-1 (ET-1) and endothelin receptors as several tumors including human prostate and breast have been shown to express high levels of ETs and the application of ETs to peripheral nerves can induce pain. Here we show that in a murine osteolytic 2472 sarcoma model of bone cancer pain, the 2472 sarcoma cells express high levels of ET-1, but express low or undetectable levels of endothelin A (ETAR) or B (ETBR) receptors whereas a subpopulation of sensory neurons express the ETAR and non-myelinating Schwann cells express the ETBR. Acute (10 mg/kg, i.p.) or chronic (10 mg/kg/day, p.o.) administration of the ETAR selective antagonist ABT-627 significantly attenuated ongoing and movement-evoked bone cancer pain and chronic administration of ABT-627 reduced several neurochemical indices of peripheral and central sensitization without influencing tumor growth or bone destruction. In contrast, acute treatment (30 mg/kg, i.p.) with the ETBR selective antagonist, A-192621 increased several measures of ongoing and movement evoked pain. As tumor expression and release of ET-1 has been shown to be regulated by the local environment, location specific expression and release of ET-1 by tumor cells may provide insight into the mechanisms that underlie the heterogeneity of bone cancer pain that is frequently observed in humans with multiple skeletal metastases.     

Efficacy of oral etidronate for skeletal diseases in Japan

Etidronate is an oral bisphosphonate compound that is known to reduce bone resorption through the inhibition of osteoclastic activity. The efficacy of etidronate for involutional (postmenopausal and senile) and glucocorticoid-induced osteoporosis, as well as that for other skeletal diseases, was reviewed in Japanese patients. Cyclical etidronate treatment (200 mg or 400mg/day for 2 weeks about every 3 months) increases the lumbar bone mineral density (BMD) in patients with involutional osteoporosis and prevents incident vertebral fractures in patients with glucocorticoid-induced osteoporosis. The losses of the lumbar BMD in patients with liver cirrhosis and the metacarpal BMD in hemiplegic patients after stroke are prevented, and the lumbar BMD is possibly increased, preventing fragile fractures in adult patients with osteogenesis imperfecta type I. Furthermore, proximal bone resorption around the femoral stem is reduced and some complications may be prevented in patients who undergo cementless total hip arthroplasty. Oral etidronate treatment may also help to transiently relieve metastatic cancer bone pain followed by a decrease in abnormally raised bone resorption in patients with painful bone metastases from primary cancer sites, such as the lung, breast and prostate. Thus, oral etidronate treatment is suggested to be efficacious for osteoporosis, as well as other skeletal diseases associated with increased bone resorption, in Japanese patients. Randomized controlled trials needed to be conducted on a large number of patients to confirm these effects.