镇痛药联合双膦酸盐治疗恶性肿瘤骨转移的相关进展

Analgesics combined with bisphosphonates in the treatment of bone metastases in malignant tumors

骨转移是晚期恶性肿瘤最常见的并发症之一。最常见的发生骨转移的恶性肿瘤,主要包括肺癌、乳腺癌、前列腺癌、肾癌、胃肠道肿瘤等。晚期肿瘤一旦发生骨转移,会引起局部的骨质破坏,从而引起骨痛、病理性骨折、神经压迫、高钙血症等一系列骨相关事件(SREs),严重影响患者的生活质量,甚至导致患者脊髓压迫,引起截瘫。晚期恶性肿瘤骨转移的患者大多已经失去了手术的机会,针对骨转移瘤引起的相关并发症治疗,除了积极对原发肿瘤进行病因治疗外,骨转移性癌痛应遵循全身药物治疗和局部治疗相结合的模式,局部治疗包括介入治疗和姑息性放疗。而全身药物治疗包括非甾体类药物、弱阿片类药物、阿片类药物、双膦酸盐/地舒单抗、抗抑郁药、抗惊厥药及抗癫痫药、中成类药物等联合应用。通过综合治疗缓解患者的疼痛症状,预防骨相关不良事件的发生,降低治疗不良反应,提高生存质量,更重要的是改善了生存预后。本文就镇痛药联合双膦酸盐治疗晚期肿瘤骨转移的进展进行综述。

Bone metastasis is one of the most common complications of advanced malignant tumors.The most common malignant tumors with bone metastasis mainly include:lung cancer,breast cancer,prostate cancer,kidney cancer,gastrointestinal tumors,etc.Once bone metastasis occurs in advanced tumors,it will cause local bone destruction,which further results in a series of skeletal⁃related events(SREs)such as pain,pathological fractures,nerve compression and hypercalcemia.They will seriously affect the patient′s quality of life,and even lead to spinal cord compression and paraplegia.Most patients with bone metastases in advanced malignant tumors have missed the best timing for surgery.For the treatment of related complications caused by bone metastases,in addition to the active etiological treatments of the primary tumor,the treatment of cancer pain requires a comprehensive strategy that involves with the combination of systemic drug therapy and local therapy,including interventional therapy and palliative radiotherapy.Systemic drug therapy includes non⁃steroidal drugs,weak opioids,opioids,bisphosphonates/desulumab,antidepressants,anticonvulsants or antiepileptics,Chinese traditional medicines and other combined applications.After comprehensive treatments,the patient′s pain symptoms can be significantly relived,bone⁃related adverse events can be also prevented to occur,the curative effect is obvious with less adverse reactions,the quality of life has been significantly improved,and the most of all,patients can have a better prognosis.This paper reviews the progress of analgesics combined with bisphosphonates in the treatment of advanced tumor bone metastasis.