^(89)SrCl_2治疗转移性骨肿瘤的临床应用

^(89)SrCl_2 in the treatment of cancer patients with bone metastasis and pain

目的探讨89SrCl2治疗转移性骨肿瘤的临床应用价值和特点。方法504例有不同程度骨痛、伴或不伴活动受限的广泛转移性骨肿瘤患者,静脉注射89SrCl21.48～2.22MBq/kg体重。随访时间最短3个月,最长4.5年。结果89SrCl2治疗后无效(疼痛无明显变化,活动能力无改善)97例,占19.2%;有效(疼痛明显减轻,活动能力有改善)298例,占59.1%;显效(疼痛基本消失,活动能力明显恢复)109例,占21.6%。总有效率为80.8%。疗效发生在89SrCl2治疗后1～46d(大多在14d内),疗效维持56d至13个月以上(大多数为4～10个月)。部分患者复查骨显像显示,原异常浓聚影明显缩小、减少和(或)消失。80.0%患者在接受89SrCl2治疗后的4～6周白细胞和血小板计数有轻、中度下降,55.0%曾下降至正常水平以下。经对症处理后,大多数患者在3～6个月内,1/3患者在7～9个月内,个别患者在1年左右恢复到治疗前水平。血象的变化与疗效无明显相关性。结论89SrCl2可以安全、有效地缓解骨转移癌所致疼痛,大多数患者的生活质量有所改善,部分患者病灶缩小或消失。

Objective To evaluate the clinical value of ^89SrCl2（,Ke xing Inc, Shanghai） as a palliative therapy modality for cancer patients with bone metastasis. Methods In 504 cancer patients with painful limitation of movement due to bony metastasis, a dose of 1.48 - 2.22 MBq/kg （40 - 60 uCi/kg） iv infusion of ^89SrCl2 was given. Results In 97 patients （19.2%） there was no improvement in pain and life quality, 298 patients （59.1%） showed mild to moderate improvement （moderately effective）, 109 patients （21.6%） became free of pain and were subsequently fully ambulatory （markedly effective）. The pain relief appeared from D1- D46 after ^89SrCl2 administration, most frequently from D5 - D14. The palliative effect could last for about 56 days to 13 months. Repeated bone scans of some patients showed that the metastaic foci in the bone became smaller or even disappeared gradually after the administration of ^89SrCl2. Approximately 55 % of patients experienced grade Ⅰ-Ⅲ bone marrow depression attributable to ^89SrCl2, which would return to the pre-treatment level within 3 - 9 months. Conclusion ^89SrCl2 is effective and safe for the relief of bone pain and improvement of quality of life in cancer patients with painful bony metastasis.