【作者】 石超； 熊建萍； 项晓军； 张凌；

【Author】 Shi Chao, Xiong jian‐ping, Zhang Ling, Xiang Xiao‐jun Department of Oncology, The First Affiliated Hospital, Nanchang University, Jiangxi, Nanchang 330006,P.RChina

【机构】 南昌大学第一附属医院肿瘤科；

【摘要】 目的:晚期恶性肿瘤常发生骨转移,骨转移是导致癌痛的最主要原因,且明显降低患者的生活质量。放疗及双磷酸盐在治疗骨转移中占主要地位,第三代酸磷酸盐药物包括唑来膦酸、伊班膦酸钠已被证实对控制转移性骨痛有明显疗效。研究者通过本项回顾性研究对比分析了放疗联合唑来膦酸(ZR组)或伊班膦酸钠(IR组)治疗骨转移癌痛的近期疗效和安全性。方法:回顾分析了同期96例各类晚期肿瘤发生骨转移并伴癌痛患者的临床资料,这些患者均接受过放疗(30GY/10F)联合唑来膦酸(4mg/q28d)或伊班膦酸钠(6mg/q28d)治疗。并对比两组患者的近期癌痛控制率及安全性。结果共96例骨转移并骨痛患者(ZR组50例,IR组46例),两组治疗结束时(2周),ZR组疼痛控制率(完全缓解+部分缓解)为76.0%,IR组78.3%;1个月后ZR组疼痛控制率88%,IR组91.1%;两组间无显著性差异(P>0.05)。治疗30日后阿片类药物使用率降低在ZR组降低至24%,在IR组为21.7%;与基线相比,下降具有显著性差异(P<0.05);但两组间无显著性差异(p>0.05)。两组患者的一般状况(KPS评分)在治疗后均改善约30%。治疗中患者耐受性好,无Ⅲ度以上不良反应,最常见不良反应为发热(ZR组6例,IR组4例)及类流感样症状(ZR组3例,IR组5例)。结论:放疗联合唑来膦酸及伊班膦酸钠治疗骨转移疼痛患者的近期疗效显著,控制疼痛好,能改善患者一般状况,并减少阿片类药物的使用率。放疗联合伊班膦酸钠或唑来膦酸的疗效相当,不良反应轻。更多还原

【Abstract】 Purpose: Bone metastasis is common in advanced cancer and is major reason for cancerous pains.It are also inevitably deteriorate the quality of life(QOL) of patients.Both radiotherapy(RT) and bisphosphonates(BPs) play an important role in the treatment of metastatic bone pain.The third generation of diphosphonate zoledronic(ZR) and ibandronate(IR) bring about a considerable pain response.In this controlled retrospective study,We compared the efficacy and safety.Methods: The clinical data of 96 cases with bone metastases in some kind of advanced cancer have received conventional Multi-fractionated radiotherapy(30GY/10F) plus zoledronic (4mg/q28d) and ibandronate(6mg/q28d)were analyzed retrospectively.Result: 96 cases with metastatic bone pain were identified.Cases in group ZR are 50 and group IR are 46.After combined therapy,The pain response rate(CR+PR) in group ZR and IR are 76.0% and 78.3% respectively in the first time point(d=14).In the second time point(d=30),the pain response rate in both group seem as increase,ZR:88%;IR: 91.1%.However,there was no significant difference of pain response rate between the two group(P>0.05).Opioid use rate decreased from 84% and 82.6% of patients at baseline to 24%and 21.7% respectively at 30d,(comparing with baseline p<0.05,between two group p>0.05).Mean functioning scores also significantly improve.No grade3-4 adverse reaction was seen in all patients.The main side effects were fever (ZR n=6 IR n=4) and grippe-like symptoms(ZR n=3 IR n=5),All patient had not functional lesion of liver and kidney in two time points.Conclusions: Combined radiotherapy and standard dose of ibandronate or zoledronic provided substantial bone pain relief and improvement of quality of life,The opioid use rate were also significantly decreasing.Pain response rate of ZR is similar to IR,and both them are safe and well tolerated for short-term use.更多还原