^(89)Sr治疗肺癌骨转移疼痛65例疗效分析

Antalgic effects of strontium-89 therapy on bone metastases in 65 patients with lung cancer

目的:探讨89Sr对肺癌骨转移疼痛的治疗效果及毒副作用。方法:肺癌骨转移患者65例,按1.48×108Bq/人/次标准注射89Sr。①随访治疗前后患者的疼痛程度及疼痛发作频率,各赋予量化值并获疼痛评分,疼痛评分的比较采用t检验。②根据治疗前后骨显像显示的病灶大小或数目的变化,对病灶疗效进行分级。③检测血清癌胚抗原(CEA)和神经元特异烯醇化酶(NSE),其治疗前后变化采用t检验。④治疗后白细胞和血小板的变化采用t检验。结果:①治疗后6个月内,疼痛程度缓解的患者占76.9%(50/65),其中15例疼痛消失,占23.1%。疼痛评分由治疗前7.4±3.6下降至治疗后5.2±3.1,降低明显(t=2.927,P<0.01)。②治疗后病灶消退7例,缩小或变浅15例,总有效率为33.8%。③治疗前后CEA由(32±26)μg/L显著下降(t=3.030,P<0.005)至(21±13)μg/L,NSE由(26±21)μg/L显著下降(t=4.272,P<0.001)至(14±8)μg/L。④白细胞及血小板在治疗后1个月降至最低,白细胞降低幅度约28.8%,血小板降低19.8%,3个月时血象正常率为86.1%(56/65)。结论:89Sr对肺癌骨转移止痛效果好,毒副作用轻微,可提高患者生活质量。

AIM:To investigate the therapeutic effects of strontium 89(89Sr) on bone metastases and its side effects in patients with lung cancer. METHODS:Sixty five lung cancer patients with bone metastases received 89Sr by the standard of 1.48×108 Bq in each subject per time.①The analgesic effect was evaluated by changes of pain degree and attack frequency before and after treatment,either was given quantized value and got their scores.The comparison of the pain scores were adopted t test.②The effects were graded according to the focal size and number showed by the bone imaging before and after treatment.③The levels of carcinoembryonic antigen(CEA) and neuron specific enolase(NSE) in serum were measured and compared by t test before and after treatment.④The changes of white blood cell(WBC) and platelets were assessed by t test after treatment. RESULTS:①During 6 months after treatment,the total pain relief rate was 76.9%(50/65) including 23.1%(15/65)of pain vanishing away.Score of pain decreased significantly(t=2.927,P< 0.01) from 7.4±3.6 before treatment to 5.2±3.1 after treatment.②After treatment,focus vanished away in 7 patients and decreased or faded away in 15 patients.The total effective rate was 33.8%.③The level of CEA decreased significantly from(32±26) μg/L to(21±13) μg/L(t=3.030,P< 0.005) and the level of NSE decreased significantly(t=4.272,P< 0.001) from(26±21)μg/L to(14±8)μg/L.④WBC and platelets reached the lowest level at one month,decreasing by 28.8% and 19.8% respectively.But at three months after treatment,WBC and platelets recovered in most patients,which meant a total normal rate of 86.1%(56/65). CONCLUSION:89Sr is effective to relieve pain caused by bone metastases in patients with lung cancer and has slight side effects,so it can be widely used to increase the quality of life in patients.