双磷酸盐和^(153)Sm-EDTMP联合治疗肺癌骨转移80例量效关系探讨

Dose-effectiveness of samarium-153-EDTMP combined with pamidronate disodium for the treatment of lung cancer with bone metastases

目的探讨核素153Sm-EDTMP与双磷酸盐(博宁)联用治疗肺癌骨转移的量效关系。方法将80例肺癌骨转移患者随机分为A、B、C、D组各20例,A组静注153Sm-EDTMP 1.0 mCi/kg(全量);B组将博宁90 mg(全量)加入500 ml生理盐水中缓慢静滴,不少于4 h;C组应用全量153Sm-EDTMP间隔3~5 d后应用全量博宁;D组用药同C组,但剂量减半。均为每月1次,1 d/次。连续使用3次后观察各组临床疗效及不良反应,对各组量效关系进行分析。结果A、B、C、D组骨痛有效率分别为70%、75%、90%、85%;KPS评分提高率分别为70%、80%、90%、85%;影像学改善率分别为20%、25%、40%、30%。血液学不良反应发生率以应用153Sm-EDTMP组较高,主要是Ⅰ~Ⅱ级白细胞和血小板下降;药物经济学分析示D组疗效接近C组,高于A、B组;治疗费用接近B组,低于A、C组。结论半量博宁联合153Sm-EDTMP治疗肺癌骨转移效果可靠,不良反应小,且花费低。

Objective To investigate the dose-effectlveness of samarium-153-EDTMP combined with pamidronate disodium for the treatment of lung cancer with bone metastases. Methods 80 lung cancer patients with bone metastasis were divided into 4 groups randomly. Groap A was given 90 mg pamidrenate ,group B was given 1.0 mCi/kg of Sm-153 ,group C was given 90 mg pamidronate combined with 1.0 mCi/kg of Sm-153 sequentially, group D was given 45 mg pamidronate and 0.5 mCi/kg of Sm-153 ,all by intravenous injection and once a month. Clinical effects and adverse events were observed ,and dose-effectiveness was analyzed. Resttlts The effective rate of pain in four groups were 75% ,70% ,90% ,85% ,the improvement rate of KPS score were 80% ,70% ,90% ,85%, the improvement rate of imageology were 25% ,20% ,40%, 30% . Suppression of platehts and white blood cell counts（ grade Ⅰ-Ⅱ ） were the most common adverse events in group B and C. The total 3 months cost of group D was the most benefical for the patient. Conclusion Half dose of samarium- 153-EDTMP combined with pamidronate disodium is effective and less cost for the treatment of lung cancer with bone metastases.