^(89)Sr联合唑来膦酸治疗骨转移瘤骨痛的安全性及疗效评价

Safety and efficiency evaluation of the combined therapy of ^(89)Sr plus zoledronic acid in patients with painful bone metastases

目的:评价89Sr及89Sr联合唑来膦酸治疗骨转移瘤骨痛的安全性及疗效。方法:回顾性分析确诊为恶性肿瘤骨转移患者87例,分为89Sr治疗组53例,89Sr联合唑来膦酸34例(其中4例未入组、再分为89Sr治疗优先组17例、唑来膦酸优先组13例);89Sr联合唑来膦酸亚组分组标准为89Sr治疗后2~14天行唑来膦酸治疗,或唑来膦酸治疗后4~7天行89Sr治疗。通过χ2检验、连续校正χ2检验或Fisher精确概率检验方法比较不同治疗方法止痛有效率及KPS变化。通过独立样本Kruskal-Wallis检验比较不同原发肿瘤行89Sr及89Sr联合唑来膦酸治疗后止痛有效率及KPS变化。结果:全部病例均未出现较严重不良反应。89Sr及89Sr联合唑来膦酸治疗后,患者均表现疼痛评分减低,KPS评分提高,其中以89Sr联合唑来膦酸治疗疼痛评分及KPS评分变化更明显,差异有统计学意义(P=0.047;P=0.036)。比较唑来膦酸治疗优先组与89Sr治疗优先组止痛有效率和KPS提高率(P=1.000和P=0.667),差异无统计学意义。不同原发肿瘤89Sr治疗(P=0.837和P=0.074)及89Sr联合唑来膦酸治疗(P=0.321和P=0.118)后骨痛及KPS评分变化比较未见明显差异。结论:89Sr及89Sr联合唑来膦酸治疗骨转移瘤均有较好疗效,其中,两者联合治疗较89Sr治疗安全性无差异,但疗效更佳。

Objective： To evaluate and compare the safety and efficiency of the combined therapy of 89Sr plus zoledronic acid and those of 89St-chloride alone, in patients with painful bone metastases. Methods： A total of 87 patients with osseous metastasis were ran- domly divided into treatment groups of 89Sr-chloride alone （group A, 53 patients） and 89Sr plus zoledronic acid （group B, 34 patients）. A total of 17 patients in group B received zoledronic acid 2-14 days after 89Sr therapy, and 13 other patients in the group received 89Sr 4- 7 days after zoledronic-acid therapy. Pain response and KPS score were evaluated aRer the different treatments. Results： No obvious bone marrow suppression and liver damage were found in all cases. All patients who received both 89Sr-chloride and 89Sr plus zoledronic acid showed reduced bone pain and total discomfort, as well as improved KPS score, but the response was more pronounced in group B （/=-0.047; P=-0.036）. No statistical differences in pain score and KPS scores were observed between the groups treated with zoledronic acid first and 89Sr therapy first （P=1.000; P=0.667）. Comparison of bone pain relief and changes in the KPS score of different primary tumors after treatment with 89Sr-chloride or 89Sr plus zoledronic acid showed no statistical significance. Conclusion： Compared with 89Sr-chloride, treatment with 89Sr plus zoledronic acid was more effective in patients with painful bone metastases. The safety of these two treatments are similar.