98例鼻咽癌骨转移瘤的放疗效果及相关预后因素分析

目的:观察鼻咽癌骨转移的放疗效果,探讨相关预后因素。方法:对98例鼻咽癌骨转移病例放疗止痛近期疗效、缓解期进行回顾性分析。其中40例采用常规分割照射,200cGY/次,每周5次,DT:3600～5000cGY;58例采用低分割照射,DT:300～500cGY/次,每周3～5次,DT:2000～3000cGY。对性别,骨转移时AKP水平,原发灶控制情况、放疗剂量、骨转移是否伴骨旁软组织及其他脏器转移等因素进行分析。结果:放疗起到了明显的止痛作用,常规分割放疗与低分割放疗组近期止痛效果大致相似,差异无显著性(P>0.05)。原发灶控制情况、放疗剂量、骨转移否伴骨旁软组织及其他脏器转移为影响预后因素(P<0.05)。其余因素与缓解期无明显相关。结论:不同分割剂量放疗时对骨转移镇痛疗效无明显差异。鼻咽癌原发灶控制情况、放疗剂量、骨旁软组织转移和其他脏器转移与预后有关。

Primary investigation of dose-effect relationship of ^(153)Sm-EDTMP in treating multiple bone metastases

Objective:To calculate the focus absorption dose of 153Sm-EDTMP with the Monte Carlo(MC)EGS4 method for treatment of bone metastases from nasopharyngeal carcinoma or breast cancer,and investigate the relationship between the focus absorption dose and painkilling effect of 153Sm-EDTMP.Methods:Four patients with multiple bone metastases from nasopharyngeal or breast carcinoma and suffered from grade IV bone pain were treated with radionuclide internal irradiation of 153Sm-EDTMP.The absorption dose and dose distribution of bone metastases and other targeted organs were calculated with MC EGS4 program based on the time-order SPECT/CT scanning and the measurement of the radioactivity in the urine accumulation.The release of bone pain and the improvement of life quality were observed.Results:Bone pain of the patients was significantly alleviated to grade II for 3–4 weeks after internal 153Sm-EDTMP irradiation.The 3-dimensional absorption dose distribution image of bone metastases and targeted organs showed that the dose distribution in bone metastases was not asymmetrical.After injection of 0.65×37 MBq/kg 153Sm-EDTMP,the highest absorption dose in bone lesions was about 4.9–5.9 Gy,and the dose in the lesion margin was about 2.0 Gy.Using the highest dose as reference dose point,the relative absorption dose values of bone marrow,vertebra and sex organ near lesions were 0.48–1.1 Gy,0.51–0.85 Gy,and 0.01–0.14 Gy,respectively.Conclusion:The absorption dose of bone metastases is significantly lower than treatment dose of 30 Gy after single irradiation of 153Sm-EDTMP.The painkilling effect is limited and in accordance with clinical observation.

Clinical research on zoledronic acid in treatment of pain caused by bone metastasis of malignant tumors

Objective:To evaluate the efficacy and safety of zoledronic acid for the pain caused by metastatic tumor of bone.Methods:52 patients with metastatic tumor of bone were randomly divided into two groups.The zoledronic acid group received 4 mg zoledronic acid infusion for 30 minutes and the control group received 90 mg pamidronate infusion for 6 hours. Results:The effective rates in zoledronic acid group and control group were 73.08%and 69.23%respectively.No significant difference was observed between the two groups.The median pain relief onset at days 5 and 7,respectively,and no significant difference was observed.The ECOG scores on the 7th day after medication:the differences in the zoledronic acid group before and after medication and between the two groups were both significant(P<0.001 and P=0.0448).The adverse reac- tion was no significant difference between the two groups.Conclusion:Zoledronic acid is efficient and safe in the treatment of pain caused by metastatic tumor of bone and it has low adverse reaction rate and convenient shorter using time.

核医学学科新增医疗服务项目定价方法研究

目的:基于以价值为基础的定价方法,计算核医学学科新增医疗服务项目镭[Ra]骨转移瘤治疗的医疗服务价格。为相关新增医疗服务项目的申报和定价打下循证基础,为合理补偿医务人员劳动价值、提升患者服务项目可及性提供依据。方法:采集2021年3—12月使用“镭核素[Ra]骨转移瘤治疗资源投入及费用数据采集表”相关数据,开展专家访谈进行系数赋值和基线对照项目确定,得到镭[Ra]骨转移瘤治疗服务各个环节的成本和新增服务的价值。结果:镭[Ra]骨转移瘤治疗服务按服务特点分为注射前评估、治疗计划、给药、给药后监测、废弃物处理与监测等环节,各环节3地平均人力耗时分别为104分钟、39分钟、25分钟、72分钟和56分钟,中位物耗成本为48.20元,3地总成本(平均人力成本+中位物耗成本)为763.68元。结合系数赋值结果和基线对比项目,得到新增项目的价值为810.19元。结论:运用基于技术难度和风险程度的价值定价理论,计算镭[Ra]骨转移瘤治疗新增医疗服务项目的服务价值,建议以价值作为服务定价依据。该定价公式和研究方法不仅可用于其他核医学学科新增服务项目的定价,还适用于现行医疗服务项目的价格动态调整,为未来学科价格工作提供方法学参考。