选择性动脉插管灌注^(89)锶治疗骨肿瘤

Intraarterial Infusion of Strontium-89 for Therapy of Bone Tumor

目的探讨动脉插管灌注89锶(89Sr)及化疗药物对骨肿瘤的疗效。方法骨肿瘤患者69例,化疗组(46例)选择性动脉插管灌注化疗药物,综合组(23例)灌注化疗药物同时灌注89Sr 4mCi。介入治疗后57例进行手术治疗,其中化疗组38例,综合组19例。观察:①治疗后疼痛缓解程度;②肿瘤细胞坏死率;③患者有无胃肠道症状及血象改变。结果 (1)综合组20例局部疼痛明显减轻或消失,总有效率为86.9%(20/23);化疗组36例疼痛缓解,总有效率为78.3%(36/46),两组有效率无显著性差异(χ2=0.76,P>0.05)。综合组缓解疼痛的显效率为35%,明显高于化疗组(9%)(χ2=7.26,P<0.01)。(2)以肿瘤坏死Ⅰ级+Ⅱ级视为无效,Ⅲ级+Ⅳ级为有效,化疗组与综合组肿瘤坏死的有效率分别为68.4%(26/38)、84.2%(16/19),二者无明显差别(χ2=2.04,P>0.05)。以介入治疗3周后统计,综合组有效率为100%(12/12),明显高于(P=0.03)化疗组66.7%(14/21)。(3)化疗组出现胃肠道症状7例(15.2%),综合组4例(17.4%)。化疗组白细胞、血小板降幅分别为10.8%、12.9%,综合组降幅分别为13.1%、14.8%。结论选择性动脉灌注89Sr及化疗药物治疗骨肿瘤,对止痛及肿瘤细胞坏死的效果优于单纯灌注化疗,对消化系统与骨髓的不良反应与单纯灌注化疗无显著性差异。

Objective To investigate the therapeutic effects on bone tumor with intraarterial infusion of strontium - 89 and and che- motherapeutic agent. Methods Among 69 patients with bone tumor,46 cases received strontium -89 and chemotherapy by intraarterial infusion（ combined treatment group） ,and the rest 23 cases received simple chemotherapy. All patients were followed up regulary. Results In combined treatment group, pain relieved in 20 patients and the total effective analgesic rate was 86.9% （20/23）. In chemotherapy group,it was 78.3 % （36/46） , which showed no significant difference （X2 = 0. 76,P 〉 0.05 ）. But the complete response rate in combined group（ 35 % ） was obviously higher than that in chemotherapy group（x2 = 7.26, P 〈 0. 01 ）. Three weeks after inventional treatment, combined therapy caused Ⅲ or Ⅳdegree necrosis in 100% patients（12/12） , which was remarkably higher than 66.7% （ 14/21 ） in chemotherapy group（ P = 0.03 ）. In chemotherapy group, gastrointestinal discomfort such as nausea, vomiting occurred in 7 cases（ 15.2% ） and 4 cases （ 17.4% ） in combined group. WBC and PLT showed no significant decrease in two groups. Conclusion For bone tumor, selectively intraarterial infusion of strontium - 89 and chemotherapeutic drug is more effective than simple chemotherapy. This technique can increase the drug concentration in lesion and decrease the systemic toxic action, hence improve the life quality and prognosis.