二膦酸盐治疗前列腺癌相关骨痛的疗效观察

Palliative treatment of bone pain related to prostatic cancer metastasis with bisphosphonates

目的 探讨二膦酸盐类药物对晚期前列腺癌骨转移疼痛的治疗价值。 方法 回顾性分析 4 0例因骨转移导致骨痛的晚期前列腺癌患者资料 ,无肝肾功能不全和病理性骨折 ,按去势后病情和治疗分为 3组 :A组 1 2例 ,切除睾丸后口服抗雄激素药物加服氯甲膦酸二钠 (固令 ) ;B组 1 7例 ,切除睾丸后口服抗雄激素药物 ;C组 1 1例 ,诊断为雄激素非依赖性前列腺癌 ,口服固令。采用视觉模拟疼痛评分 (VAS)和Karnofsky生活质量评分对 3组患者治疗前与治疗后 2、4周的疼痛程度与生活质量进行比较分析。 结果 4周后 ,3组患者的骨痛明显改善 ,治疗前后VAS评分 :A组 7.3/ 2 .5 ,B组7.6 / 2 .3,C组 7.9/ 4 .6 ,P <0 .0 5 ;生活质量明显提高 ,治疗前后Karnofsky评分分别为 :A组 4 5 / 70 ,B组 4 0 / 70 ,C组 4 0 / 6 0 ,P <0 .0 5。 4例 (1 0 % )患者发生轻度恶心、呕吐和腹泻。

Objective To investigate the role of bisphosphates in the treatment of advanced prostatic cancer patients complaining of bone pain due to metastasis. Methods The clinical data of 40 cases of prostatic cancer with skeletal complications were retrospectively analyzed.Based on the post castrating conditions and therapeutic approaches,the 40 cases were divided into 3 groups.12 cases in Group A received oral androgen blockade plus bonefos,a type of bisphosphonates,following orchectomy;17 cases in Group B received oral androgen blockade following orchectomy;11 cases in Group C who had hormone refractory prostatic cancer receives oral bonefos.The severity of bone pain and quality of life before treatment and 2, 4 weeks after treatment were compared among the 3 groups using visual analogue score (VAS) and Karnofsky score of quality of life. Results Compared with the state of pre treatment,the patients got bone pain relief after 4 weeks’ treatment (VAS:7.3 vs 2.5 in Group A;7.6 vs 2.3 in Group B;7.9 vs 4.6 in Group C,respectively, P <0.05);and their quality of life improved significantly (Karnofsky score:45 vs 70 in Group A;40 vs 70 in Group B;40 vs 60 in Group C, P <0.05).The side effects were mild;4 patients complained of nausea,vomiting and diarrhea. Conclusions Bisphophonates are promising weapons for the management of advanced prostatic cancer related bone pain.