放射性核素治疗骨转移瘤的研究进展

Research progress in radionuclide therapy for bone metastasis

骨转移瘤性骨痛是晚期癌症患者疼痛中最常见的一种,表现为典型的神经病理性疼痛,它显著降低了患者的生存质量,导致严重的躯体障碍,包括高钙血症、病理性骨折、脊髓压迫症等。以减轻骨痛症状为目的内放射治疗成功的保护了患者骨骼功能及完整性。常用于临床的放射性核素包括89Sr、89Sr Cl2、153Sm、153Sm-EDTMP、223Ra、223Ra Cl2、186Re、188Re、186Re-HEDP及188Re-HEDP,不同核素疗效差异有统计学意义。影响骨转移瘤射线相关性治疗疗效及生存预后的因素包括治疗模式及剂量、联合二膦酸盐或RANKL抑制物、胶合剂塑形、结合抗阻力训练以及PEEK运用于治疗等。评价疗效及生存预后的标准主要有EORTC QLQ-BM22与QOL,以及包括肿瘤原发位点、起始的疼痛强度、治疗总剂量、骨骼转移瘤的局限化等在内的临床预测因子。

Neuropathological pain is the most common symptom for advanced bone metastasis, including burn-ing, stabbing, shooting or electric shock-like sensations. It significantly decreases the patient＆#39;s quality of life and is asso-ciated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. There are several particles used in the radiotherapy： 89Sr, 89SrCl2, 153Sm, 153Sm-EDTMP, 223Ra, 223RaCl2, 186Re, 188Re, 186Re-HEDP and 188Re-HEDP. The influential factors affecting the therapeutic efficacy and survival prognostic factors of bone metastases include pattern or dose of the radionuclide therapy, bisphosphonates or RANK ligand inhibitors, cementoplasty, resis-tance training and PEEK. EORTC QLQ-BM22 and QOL, as well as other predicting factors such as tumor primary site, initial pain intensity, total dose of treatment, limitations of bone metastases are used to evaluate the effect and the pro-found expectation.