复方苦参注射液联合伊班膦酸钠治疗非小细胞肺癌骨转移癌疼痛的临床观察

目的：探讨复方苦参注射液联合伊班膦酸钠治疗非小细胞肺癌骨转移癌疼痛的临床观察。方法：选取宜昌市中心人民医院2010年3月至2012年3月收治的非小细胞肺癌骨转移患者98例,根据其治疗方式的不同,分为对照组和治疗组。对照组患者采用伊班膦酸钠进行治疗,治疗组患者采用复方苦参注射液联合伊班膦酸钠进行治疗,比较2组患者的近期疗效、疼痛缓解、KPS评分改善情况。结果：患者近期疗效比较结果显示,治疗组患者部分缓解的例数（百分比）及总有效率要明显优于对照组,且差异有统计学意义（P＜0．05）。治疗组Karnofsky评分改善的例数（百分比）要明显多余对照组,且差异有统计学意义（P＜0．05）。疼痛缓解情况比较分析显示,治疗组患者完全缓解例（百分比）及总的缓解率要明显优于对照组,且差异有统计学意义（P＜0．05）。2组患者不良反应发生情况差异无统计学意义（P＞0．05）。结论：复方苦参注射液联合伊班膦酸钠对非小细胞肺癌骨转移癌疼痛具有明显的作用,能够有效的减轻患者的疼痛,值得在临床上推广应用。     

放射加博宁治疗骨转移癌的病例分析

目的:观察放疗和博宁对骨转移癌的止痛效果。方法:对100例骨转移癌患者进行回顾性分析,单纯放疗30例,博宁加放疗14例,博宁加放化疗56例。结果:全组总有效率为89%,显效率达51%。各组有效率:单放组为83-3%,博宁加放疗组为92.9%,博宁加放化组为91.1%。三组间止痛效果无显著性差异(P>0.05)。在应用博宁治疗组中有一例出现类似过敏反应症状,其他无明显毒副反应发生。结论:放射治疗骨转移癌止痛迅速而有效。博宁治疗骨转移癌止痛效果明显,尤其适合应用于多发性骨转移癌患者。二者联合应用效果更加。     

伊班膦酸钠联合化疗治疗恶性肿瘤骨转移的临床观察

目的:探讨伊班膦酸钠联合化疗治疗恶性骨转移的临床疗效.方法:采用随机分组的方法将60例病人分为二组:单纯化疗组:根据原发肿瘤采用相应的治疗方案;联合治疗组:在化疗基础上联合邦罗力治疗.结果:骨转移灶疗效评价:联合治疗组的有效率为50%,单纯化疗组的有效率为23.3%,前者的疗效明显优于后者,且有显著性差异(p＜0.05);止痛疗效评价:联合治疗组的有效率为83.3%,单纯化疗组的有效率为53.3%,前者明显优于后者,且有显著性差异(p＜0.05).结论:伊班膦酸钠的不良反应轻,联合化疗可显著增强疗效,改善患者体能状态.     

唑来膦酸延缓骨转移癌放射治疗的临床研究

目的以帕米膦酸二钠为对照,研究唑来膦酸对延缓骨转移癌放射治疗事件发生的临床疗效。方法对118例骨转移癌患者,随机分为病例组60例,对照组58例,以疼痛持续加重,X线或CT证实骨转移病灶进展或有可能导致病理性骨折而行放射治疗为观察终点,研究唑来膦酸延缓骨转移癌放射治疗事件出现时间的临床疗效。结果近期止痛有效率和获益率在唑来膦酸组分别为55.36%,65.18%;帕米膦酸组为35.19%,44.44%,P<0.05;放疗事件发生率在唑来膦酸组为34.21%,帕米膦酸钠组为54.28%,P>0.05;发生放疗事件中位时间在唑来膦酸组为121天,帕米膦酸钠组为189天,P=0.041。结论唑来膦酸近期止痛的临床有效率、获益率和总体骨相关事件(SRE)危险性降低的比例均高于帕米膦酸二钠。     

唑来膦酸和伊班膦酸钠治疗恶性肿瘤骨转移的成本-效用分析

摘要 目的：评价唑来膦酸和伊班膦酸钠治疗恶性肿瘤骨转移患者的经济性。方法：回顾性分析2020年1月-2022年1月于×医院就诊的86例恶性肿瘤骨转移病例,其中46例使用唑来膦酸治疗（A组）,40例使用伊班膦酸钠治疗（B组）,对比两组疼痛控制效果、不良反应发生情况及简明健康状况测量量表（SF-36）评分,同时汇总两种治疗方案的成本,运用药物经济学原理进行成本-效用分析。结果：A组疼痛控制率为82.61%,与B组的85.00%比较无统计学差异（P>0.05）;治疗后,两组SF-36评分中的生理功能（PF）、生理职能（RP）、躯体疼痛（BP）、总体健康（GH）、社会功能（SF）、精神健康（MH）、情感职能（RE）、活力（VT）均较治疗前明显升高（P<0.05）,但组间比较差异均无统计学意义（P>0.05）;A组、B组不良反应发生率相似,差异无统计学意义（P>0.05）;A组药品成本（C1）和总成本（C）分别为（4052.50±80.50）元、（4453.87±123.56）元,高于B组的（2025.50±70.15）元和（2395.44±109.17）元,差异均有统计学意义（P<0.05）;A组成本-效用比（CUR）采用SF-36量表评分评判为4189.94,B组为2829.17。结论：考虑药物的有效性及经济性,采用伊班膦酸钠治疗恶性肿瘤骨转移具有明显的成本-效用优势,值得临床推广应。     

唑来膦酸联合99Tc-MDP治疗肿瘤多发骨转移的临床价值

目的:探讨唑来膦酸联合99Tc-MDP(云克)治疗多发骨转移瘤的临床价值.方法:将40例确诊为肿瘤伴骨转移的病人,随机分为两组.观察组22例,使用唑来膦酸联合99Tc-MDP治疗;对照组18例,单独使用99Tc-MDP治疗,均治疗3周后比较两组治疗前后骨痛的变化情况、骨转移灶的治疗情况及不良反应的发生情况.结果:观察组和对照组的止痛总有效率分另为95.5％和66.7％,差异有统计学意义(P＜0.05).观察组和对照组骨转移灶的治疗总有效率分别为36.3％和27.7％,差异有统计学意义(P＜0.05).此外,两组治疗过程中均偶见不同程度的发热,但不良反应的发生率并无统计学差异(P＞0.05).结论:唑来膦酸联合99Tc-MDP治疗多发骨转移瘤的止痛效果及骨转移灶的疗效显著优于单纯99Tc-MDP治疗,且毒副作用无明显增加.     

伊班膦酸钠联合钙尔奇D片治疗老年性骨质疏松症的疗效

目的:探讨伊班膦酸钠注射液联合钙尔奇D片治疗老年性骨质疏松症的疗效及对患者血尿常规、肝肾功能及心电图的影响。方法:选择我院收治的72例老年骨质疏松症患者,采用随机数字表法将其分为观察组和对照组各36例,观察组给予伊班膦酸钠注射液联合钙尔奇D片进行治疗,对照组仅给予钙尔奇D片进行治疗,治疗时间为12个月,在治疗前,治疗后6个月及治疗后12个月时对比两组治疗效果及临床不良反应发生情况,并对两组患者的血尿常规、肝肾功能及心电图进行对比检查。结果:观察组在治疗6个月时BALP和TRAP-5b分别为(10.96±0.93)ug/L、(3.71±0.72)U/L,较治疗前和对照组均明显下降,比较差异均有统计学意义(P0.05);观察组在治疗12个月时BALP和TRAP-5b分别为(10.91±0.81)ug/L、(3.73±0.65)U/L,较治疗前和对照组亦显著下降,比较差异均有统计学意义(P0.05);对照组在治疗后6个月及12个月时,各检测指标统计值与治疗前比较,变化不大,比较差异均无统计学意义(P0.05);两种患者在治疗前、6个月、12个月时血尿常规、肝肾功能及心电图之间无统计学差异(P0.05);两组患者中均无明显严重的不良反应发生,不良反应发生情况比较差异无统计学意义(P0.05)。结论:临床中联合应用伊班膦酸钠注射液和钙尔奇D片对老年性骨质疏松症进行治疗,可获得较为满意疗效,且对患者血尿常规、肝肾功能及心电图影响较小,不良反应发生率较低,病人耐受度较好,故值得在临床中应用。     

靶向治疗乳腺癌骨转移的研究进展

本文对双磷酸盐、狄诺塞麦、Sagopilone等特异性靶向药物在乳腺癌骨转移靶向治疗中的作用机制、临床应用、临床疗效等方面的相关研究进展情况进行了简要阐述。双磷酸盐在抑制骨转移和非骨转移中发挥作用,狄诺塞麦可能成为双磷酸盐的合理替代物,尤其在双磷酸盐治疗效果不佳的病人中,而新型抗癌药物Sagopilone、骨唾液酸蛋白抑制剂亦可通过多种机制参与乳腺癌转移过程,具有抑制骨转移的巨大潜力。     

放疗联合热疗治疗68例晚期卵巢癌术后复发的放疗联合热疗临床观察

目的:探讨放疗联合热疗治疗晚期卵巢癌术后复发的临床疗效。方法:选择哈医科大学第四临床医院及黑龙江省第二肿瘤医院2010年3月~2013年3月收治的68例卵巢癌术后复发患者(均为术后化疗6-8个疗程盆腔复发),将其随机分为热疗联合放疗组(实验组)和单纯化疗组(对照组)。所有患者均给予化疗6-8个周期以上,实验组在放疗结束后2小时内进行热疗,2次/周,共6-8周。通过影像学检查治疗前后肿瘤体积的变化进行疗效评估,观察两组治疗期间各种不良反应的发生情况及术后3年的生存情况。结果:观察组肿瘤完全缓解率(CR)实验组明显高于对照组(P0.05)。皮肤损伤的发生率显著高于对照组,而白细胞计数下降的发生率明显低于对照组(P0.05)。两组随访1、2年的生存率无明显差异(P0.05),实验组第3年的生存率明显高于对照组(P0.05)。结论:热疗联合放疗可提高晚期卵巢癌术后复发的临床疗效。     

鸦胆子油乳联合放疗治疗鼻咽癌的临床疗效观察

目的:探讨鸦胆子油乳联合放疗治疗鼻咽癌的临床疗效及安全性。方法:将在我科就诊的154例鼻咽癌患者随机分为对照组和治疗组,治疗组患者在常规放射治疗的基础上联合鸦胆子油乳治疗,而对照组患者单纯接受常规放射治疗。待治疗结束后,观察并比较两组患者的临床疗效、血液学指标及不良反应的发生情况。结果:对照组和治疗组的临床有效率分别为63.16%、82.05%,治疗组的临床有效率明显高于对照组,两组间比较有统计学差异(P0.05)。治疗后,治疗组患者的血液学指标如白细胞计数、红细胞计数、血红蛋白水平、CD4+/CD8+等均显著高于对照组,不良反应如恶心呕吐、张口困难、吞咽困难、声音嘶哑、口腔炎均明显低于对照组,差异具有统计学意义(P0.05)。结论:鸦胆子油乳联合放射治疗能够有效提高鼻咽癌患者的临床疗效,并且降低放疗所致的各种不良反应,值得临床推广应用。     

局部刮除肿瘤联合放疗治疗骨巨细胞瘤的临床研究

目的：探讨局部刮除肿瘤联合术中适形固定施源器模型插植放疗和术后外照射治疗骨巨细胞瘤（GCTB）的临床疗效和毒副反应。方法：将2006年2月．2008年2月在湖南省肿瘤医院初次治疗的长骨GCTB患者30例随机分为单纯局部刮除手术组和局部刮除手术联合放疗组,两组患者均行局部肿瘤刮除术,局部刮除手术联合放疗组在此基础上给予术中适形固定施源器模型插植放疗和术后外照射,治疗后比较两组的临床疗效和毒副反应。结果：局部刮除手术联合放疗组1、3、5年均未复发,而单纯局部刮除手术组的1、3、5年复发率分别为9．1％、27．3％、45．5％,3年和5年复发率均显著高于局部刮除手术联合放疗组（P〈0．05）。局部刮除手术联合放疗组中未见严重相关性毒性和死亡,术后两组的关节功能评分比较无明显差剐（P〉0．05）。结论：局部手术刮除病灶结合术中和术后放疗治疗骨巨细胞瘤可显著降低患者的复发率,且不影响关节功能,是一种较为安全的治疗方法。     

Bone Metastasis: Current State of Play

Bone metastasis (BM) in cancer remains a critical issue because of its associated clinical and biological complications. Moreover, BM can alter the quality of life and survival rate of cancer patients. Growing evidence suggests that bones are a fertile ground for the development of metastasis through a “vicious circle” of bone resorption/formation and tumor growth. This review aims to outline the current major issues in the diagnosis and management of BM in the most common types of osteotropic cancers and describe the mechanisms and effects of BM. First, we discuss the incidence of BM through the following questions: Are we witnessing an increase in incidence, and are we now better equipped with modern imaging techniques? Is the advent of efficient bone resorption inhibitors affecting the bigger picture of BM management? Second, we discuss the potential effects of cancer progression and well-prescribed drugs, such as multitarget tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, and immune checkpoint inhibitors, on BM. Finally, we examine the duality of the effects of some therapies that may help in cancer treatment but may also contribute to further BM.     

The Usefulness of Bone Biomarkers for Monitoring Treatment Disease: A Comparative Study in Osteolytic and Osteosclerotic Bone Metastasis Models

BACKGROUND: The skeleton is the most common site of colonization by metastatic cancers. Zoledronic acid (ZA) has been shown to be effective for the treatment of bone metastases regardless of whether the bone lesions are osteolytic or osteoblastic. Biochemical markers of bone turnover may be useful tools to quantify the degree of bone remodeling in the presence of bone metastases. The aim of this work was to establish the correlation between tumor dispersion (bioluminescence) and biochemical markers of bone turnover in two osteolytic and osteoblastic metastasis models in mice. METHODS: The A549M1 cell line that produces osteolytic metastases and the LADOB cell line extracted from a patient with a lung carcinoma and osteoblastic metastases cells were retrovirally transduced with a luciferase reporter gene for in vivo image analysis. Forty-four-week–old mice were inoculated in the left cardiac ventricle with A549M1 or LADOB cells. Twenty mouse of each group were treated with a single dose of ZA (70 μg/kg) 5 days after i.c. Ten animals of each group were sacrificed at 21 and 28 days postinoculation in A549M1 and 60 and 75 days in the LADOB assay. Bioluminescence analysis was quantified 7, 14, 21 ,and 28 days postinoculation in A549M1 mice and 33, 45, 60, and 75 days after inoculation in LADOB mice. Osteocalcin (BGP), aminoterminal propeptide of procollagen I (PINP), carboxiterminal telopeptide of type I collagen (CTX), and 5b isoenzyme of tartrate-resistant acid phosphatase were measured by ELISA (IDS, UK). RESULTS: Bioluminescence imaging revealed a significant increase of tumor burden on time in both osteolytic and osteoblastic mice models. ZA administration resulted in a significant decrease in tumor burden at 21 and 28 days in the A549M1 animals and 60 and 70 days postinoculation in the LADOB line. Biomarkers levels were significantly increased in the untreated group at every point in the osteolytic model. In the osteoblastic model, 2 months after inoculation, all biomarkers were significantly increased. However, 2.5 months postinoculation, only PINP and CTX were significantly increased. Serum bone remodeling markers decreased in ZA-treated mice as compared with tumor groups in both models. With respect to the correlation between bone turnover markers and tumor burden, in the osteolytic model, PINP and BGP demonstrate a strong correlation with bioluminescence in both tumoral and ZA animals, and only CTX was significantly associated with bioluminescence in the group of animals that were not treated with ZA. CONCLUSIONS: We found that the best biomarkers for the diagnosis of both osteolytic and osteoblastic metastasis are formation markers, especially BGP. Moreover, these markers can be useful in the follow-up of the treatment with ZA in both types of metastasis.     

Phase II Study of Concurrent Capecitabine and External Beam Radiotherapy for Pain Control of Bone Metastases of Breast Cancer Origin

Background

Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer.

Methodology/Principal Findings

Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m² twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial) at 12 weeks was 86%. Side effects were of mild intensity (grade I or II) and included nausea (38% of patients), weakness (24%), diarrhea (24%), mucositis (10%), and hand and foot syndrome (7%).

Conclusions/Significance

External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01784393","term_id":"NCT01784393"}}NCT01784393{"type":"clinical-trial","attrs":{"text":"NCT01784393","term_id":"NCT01784393"}}NCT01784393     

Radiotherapy for Adrenal Metastasis from Hepatocellular Carcinoma: A Multi-Institutional Retrospective Study (KROG 13-05)

Although the adrenal glands are not common sites of metastasis from hepatocellular carcinoma (HCC), this metastasis can be met in patients with advanced HCC in some clinical settings. However, the effectiveness of radiotherapy against such metastases is unclear. Therefore, we performed the present multi-institutional study to investigate tumor response, overall survival (OS), treatment-related toxicity, and prognostic factors after radiotherapy. We retrospectively reviewed 134 patients who completed a planned radiotherapy for their adrenal metastases. Complete response was noted in 6 (4.3%), partial response in 48 (34.0%), and stable disease in 78 patients (55.3%). The median OS was 12.8 months, and the 1-, 2-, and 5-year OS rates were 53.1%, 23.9%, and 9.3%, respectively. Grade 3 anorexia occurred in 2 patients, grade 3 diarrhea in 1, and grade 3 fatigue in 1. Multivariate analyses revealed that the following factors had significant effects on OS: controlled intrahepatic tumor; controlled extrahepatic metastasis; and Child-Pugh class A. Although patients with adrenal metastasis from HCC had poor OS, radiotherapy provided an objective response rate of 38.3% and disease stability of 93.6%, with minimal adverse events. Therefore, radiotherapy for these patients could represent a good treatment modality, especially for patients with controlled intrahepatic tumors, controlled extrahepatic metastasis, and good hepatic function.