89锶、唑来膦酸及99锝-亚甲基二膦酸盐治疗老年前列腺癌骨转移的临床观察

A clinical study of 89Sr,zoledronic acid and 99Tc-MDP on the eldly patients with bone metastases of prostate cancer

目的观察和比较89Sr、唑来膦酸及99锝-亚甲基二膦酸盐(云克)在老年前列腺癌骨转移患者治疗中的临床价值。方法回顾性分析2017年01月至2018年01月我科收治的老年前列腺癌骨转移患者,分为89Sr治疗组、唑来膦酸治疗组及云克治疗组。比较三组患者治疗后骨痛缓解、骨转移灶控制及不良反应情况,并行统计学分析。结果本研究共纳入53例患者,镇痛疗效:89Sr组较唑来膦酸组、云克组治疗早期止痛效果好,差异有统计学意义(P<0.05),但治疗6个月后差异减小,12个月后三组间差异无明显统计学意义(P>0.05)。89Sr组及唑来膦酸组对重度疼痛组缓解优于中度疼痛组,无明显统计学差异(P>0.05),云克组对重度疼痛组缓解明显差于中度疼痛组,有统计学差异(P<0.05)。转移灶疗效:89Sr组较唑来膦酸组、云克组治疗效果好,但无明显统计学差异。骨转移灶数目,89Sr组及唑来膦酸组、云克组对≥10组的治疗效果优于<10组,但均无明显统计学差异。不良反应:89Sr的骨髓抑制、唑来膦酸的发热反应,较另两种药物有明显统计学差异(P<0.05),其余不良反应无明显统计学差异(P>0.05)。结论89Sr、唑来膦酸、云克均有较好的缓解骨痛、控制骨进展作用。89Sr针对老年患者,易出现骨髓抑制,需密切随访。云克不良反应少,连续长期静脉输液,增加老年患者的痛苦。唑来膦酸易出现发热,但给予对症后可缓解。

Objective To evaluate the clinical efficacy and safety of 89Sr,zoledronic acid and 99Tc-MDP for treating the elderly patients with prostate cancer and bone metastases.Methods A total of 53 elderly patients with prostate cancer and bone metastases from January 2017 to January 2018 were included in the study for a retrospective analysis.The patients were divided into three groups:89Sr group(A group),zoledronic acid group(B group)and 99Tc-MDPgroup(C group).The clinical value about three-way therapy were evaluated on bone pain relief rate,number of bone metastases and adverse events.Results In early stage of treatment,patients with bone pain relief got more benefit form group A.However,the differences between the three groups decreased after 6 months of treatment,and there was no significant difference among the three groups after 12 months(P>0.05).The relief of severe pain in A and B group looked better than that of moderate pain on extreme pain,which was not statistically significant(P>0.05).Group C was more efficient for moderate pain.Elimination of bone lesions:Group A was higher than group B,and Group B was higher than group C,but there were no significant difference(P>0.05).The three groups were more efficient in the patients of bone-lesion number≥10,which had no statistical difference(P>0.05).Adverse events:Myelosuppression of 89Sr and fever of zoledronic acid in elderly patients had difference(P<0.05)from other groups.Anther adverse reactions did not significantly.Conclusion 89Sr,zoledronic acid and 99Tc-MDP were effectively improve pain palliation and could obviously repair the bone destruction caused by metastases.To be extra careful about myelosuppression of 89Sr in elderly patients.The elderly patients had more suffering by use of long-time intravenous for 99Tc-MDP.Although treatment by zoledronic acid would cause fever,it could self-relief.zoledronic acid was clinical recommendation.