89SrCl2治疗转移性骨肿瘤效果评价

摘要

Objective:To evaluate the effect of 89 SrCl2 for treatment of metastatic bone tumors,and to explore the significance of collaborative treatment.Methods:Retrospective investigation and follow-up for the clinical results of 87 cases of metastatic bone tumors accept treatment of 89SrCl2,focus on treatment period,toxicity,invalid reasons and multidisciplinary treatment.Results:Of 87 cases 56 patients were with varying degrees of relief,reduce of radioactive intake in focus of bone metastases,and decrease of serum calcium,alkaline phosphatase,the total efficiency was 71.8％ (56/78).38 cases of 47 cases with grade Ⅰ and Ⅱ pain were effective,18 cases of 31 cases with grade Ⅲ patients were effective,follow-up period in 9 cases of painless cases were continued painless,all patients had decrease in red blood cell and white blood cells or platelets,the 32 cases lower than normal in the short term combined with chemotherapy.There were 12 cases of lung adenocarcinoma within 22 cases of invalid cases,among 56 effective cases,there were 13 lung adenocarcinoma cases,19 cases with liver,brain or lung metastases and died in 3 months.Among 32 cases with radiotherapy,30 patients had varying degrees of pain relief.Conclusion:89 SrCl2 can reduce alkaline phosphatase,osteolysis and hypercalcemia,can alleviate pain.Efficiency of treatment have relation with the primary tumor pathological type,stage,location,severe pain.Treatment with chemotherapy,radiotherapy and a bone resorption inhibitor used interchangeably can help to improve efficacy.%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:89 SrCl2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.