^(153)Sm-EDTMP治疗癌性骨痛的影响因素研究

Study on influencing factors of ^(153)sm-EDTMP as a palliative treatment for painful skeletal metastases

目的:通过探讨影响^(153)钐-乙二胺四甲基膦酸(^(153)Sm-EDTMP)治疗癌性骨痛效果的因素,为临床选择性进行^(153)Sm-EDTMP治疗提供依据。方法:将首次应用^(153)Sm-EDTMP治疗的肿瘤骨转移疼痛患者,分别按主要疼痛部位、原发癌类型、病灶骨与正常骨组织放射性比值(T/NT)、骨转移灶数目、骨转移灶占全身骨骼放射性总计数的百分比(MC/TC)以及骨转移灶占全身骨骼总面积的百分比(MA/TA)进行分组,对以上6种因素及其它3种因素(性别、年龄、治疗剂量),进行单因素与多因素回归分析。结果:76例患者首次治疗后疼痛缓解的总有效率为69.74%。前列腺癌组和乳腺癌组疗效明显好于肺癌组(P<0.01);腰痛组和腰痛伴其它部位疼痛组疗效明显好于髋关节或下肢疼痛组(P<0.001);T/NT为1.2～2.0组疗效明显好于T/NT小于1.20组(P<0.005)。影响疗效的因素依次为主要疼痛部位、原发癌类型、MC/TC,而治疗剂量、骨转移数目、疼痛程度、性别、年龄等对疗效的影响不显著。结论:前列腺癌与乳腺癌骨转移者、主要表现为腰痛或腰痛伴其它部位疼痛者及T/NT小于1.2～2.0者,^(153)Sm-EDTMP治疗后疼痛缓解较好,宜行^(153)Sm-EDTMP治疗。肺癌骨转移者,主要表现为髋关节或下肢疼痛者及T/NT小于1.20者疗效较差,对他们行^(153)Sm-EDTMP治疗应慎重。

Objective:To seek for related influencing factors of ^(153)Sm -EDTMP as a palliative treatment for painful skeletal metastases, and to guide the clinical treatment with ^(153)sm-EDTMP. Methods: Seventy-six patients with painful bone metastases from various primary malignancies were treated with ^(153)Sm-EDTMP. The clinical effects were analysed and proof-tested according to types of primary cancers, dominant site of pain, radioactivity rate between skeletal metastases and normal skeletal tissue (T/NT), number of skeletal metastases, radioactive count of skeletal metastases, and area of skeletal metastases. Multifactorial regression analysis was made between the effect and the factors. The parameters included the above six factors and other three factors (sex, age, therapeutic dose). Results: 69.74% of patients treated with ^(153)Sm-EDTMP had a positive response. The response in the group of prostate and breast cancers was better than in the group of lung cancer. The difference was significant(P<0.010). The response in the group of patients with lumbar pain was significantly better than in the group of patients with thigh pain (P<0.001). The response in the group of patients with T/NT=1.21～2.00 was also significantly better than in the group of patients with T/NT=1.00～1.20 (P<0.005). The multifactorial regression analysis showed that the site of pain, the kinds of primar cancer, and radioactive count of skeletal metastases were significant factors of influencing the efficacy, however the efficacy was not influenced by treatment dose, sex, age, number of skeletal metastases, and pain score. Conclusions: The palliative treatment with ^(153)Sm-EDTMP had a better effect in the patients with prostate and breast cancer metastasis, or lumbar pain and that with accompaniment with pain in other sites, or T/NT=1.21～2.00.