89Sr联合唑来膦酸治疗骨转移瘤骨痛的安全性及疗效评价

摘要

目的：评价89Sr及89Sr联合唑来膦酸治疗骨转移瘤骨痛的安全性及疗效。方法：回顾性分析确诊为恶性肿瘤骨转移患者87例，分为89Sr治疗组53例，89Sr联合唑来膦酸34例（其中4例未入组、再分为89Sr治疗优先组17例、唑来膦酸优先组13例）；89Sr联合唑来膦酸亚组分组标准为89Sr治疗后2～14天行唑来膦酸治疗，或唑来膦酸治疗后4～7天行89Sr治疗。通过χ2检验、连续校正χ2检验或Fisher精确概率检验方法比较不同治疗方法止痛有效率及KPS变化。通过独立样本Kruskal-Wallis 检验比较不同原发肿瘤行89Sr及89Sr联合唑来膦酸治疗后止痛有效率及KPS变化。结果：全部病例均未出现较严重不良反应。89Sr及89Sr联合唑来膦酸治疗后，患者均表现疼痛评分减低，KPS评分提高，其中以89Sr联合唑来膦酸治疗疼痛评分及KPS评分变化更明显，差异有统计学意义（P=0.047；P=0.036）。比较唑来膦酸治疗优先组与89Sr治疗优先组止痛有效率和KPS提高率（P=1.000和P=0.667），差异无统计学意义。不同原发肿瘤89Sr治疗（P=0.837和P=0.074）及89Sr联合唑来膦酸治疗（P=0.321和P=0.118）后骨痛及KPS评分变化比较未见明显差异。结论：89Sr及89Sr联合唑来膦酸治疗骨转移瘤均有较好疗效，其中，两者联合治疗较89Sr治疗安全性无差异，但疗效更佳。%Objective: To evaluate and compare the safety and efficiency of the combined therapy of 89Sr plus zoledronic acid and those of 89Sr-chloride alone, in patients with painful bone metastases. Methods: A total of 87 patients with osseous metastasis were ran-domly divided into treatment groups of 89Sr-chloride alone (group A, 53 patients) and 89Sr plus zoledronic acid (group B, 34 patients). A total of 17 patients in group B received zoledronic acid 2-14 days after 89Sr therapy, and 13 other patients in the group received 89Sr 4-7 days after zoledronic-acid therapy. Pain response and KPS score were evaluated after the different treatments. Results: No obvious bone marrow suppression and liver damage were found in all cases. All patients who received both 89Sr-chloride and 89Sr plus zoledronic acid showed reduced bone pain and total discomfort, as well as improved KPS score, but the response was more pronounced in group B (P=0.047; P=0.036). No statistical differences in pain score and KPS scores were observed between the groups treated with zoledronic acid first and 89Sr therapy first (P=1.000; P=0.667). Comparison of bone pain relief and changes in the KPS score of different primary tumors after treatment with 89Sr-chloride or 89Sr plus zoledronic acid showed no statistical significance. Conclusion: Compared with 89Sr-chloride, treatment with 89Sr plus zoledronic acid was more effective in patients with painful bone metastases. The safety of these two treatments are similar.