目的 對放射性同位素治療腫瘤骨轉(zhuǎn)移疼痛的效果及其副作用進行評價.
方法 計算機檢索MEDLINE(1966～2005.4)、EMBASE (1966～2005.4)、Cochrane圖書館(2005年第1期)及中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(1979～2005.4),收集所有相關(guān)隨機對照試驗,對其質(zhì)量進行評價,而用RevMan 4.2版軟件進行Meta分析.
結(jié)果 共納入4個隨機對照試驗.Meta分析結(jié)果顯示,使用150MBq放射性同位素時,短期內(nèi)(2個月)控制腫瘤骨轉(zhuǎn)移性疼痛的效果不明顯[RR1.13, 95%CI(0.34,3.76)],而使用10.8 mCi劑量時,中期(6個月)完全緩解率的效果顯著[RR 1.90,95%CI(1.23,2.92)];沒有長期(≥1年)效果的報道.與放射性同位素使用有關(guān)的副作用特別是白細胞減少及血小板減少的發(fā)生率均增加[分別為RR 8.28,95%CI(2.24,30.67)和RR 3.70, 95%CI(1.59,9.04)].放射性同位素對由于腫瘤骨轉(zhuǎn)移所致脊髓壓迫的發(fā)生無影響.沒有研究報道有關(guān)高鈣血癥、骨折等骨轉(zhuǎn)移性并發(fā)癥的發(fā)生情況.
結(jié)論 使用一定劑量的放射性同位素在短中期內(nèi)能緩解腫瘤骨轉(zhuǎn)移性疼痛,但白細胞減少與血小板減少的發(fā)生率增加.
引用本文： 王新玲,廖 燚,吳泰相. 放射性同位素治療腫瘤骨轉(zhuǎn)移性疼痛的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2005, 05(6): 455-460. doi: 復(fù)制
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| 2. | Nelson OS, Munro AJ, Tannock IF. Bone metastatic: pathophysiology and management policy[J]. J Clin Oncol, 1991; 9(3):509-524. |
| 3. | Scully SP, Ghert MA, Zurakowski D, Thompson RC, Gebhardt MC. Pathologic fracture in osteosarcoma: prognostic importance and treatment implications[J]. J Bone Joint Surg Am, 2002; 84-A(1):49-57. |
| 4. | Mertens WC, Filipczack LA, Ben-Josef Edgar, Davis LP, Portes AT. Systemic bone-seeking Radionuclides for palliation of painful osseous metastases: Current Concepts[J]. CA Cancer J Clin, 1998; 48(6):361-374. |
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| 10. | Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, Reed NS, Russell JM, Yardley J. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer[J]. Radiotherapy & Oncology, 1994; 31(1): 33-40. |
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| 12. | Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7. |
| 13. | Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7. |
- 1. Portenoy RK. Cancer Pain. Epidemiology and pain syndromes[J]. Cancer, 1989; 63(11 Suppl): 2298-2307.
- 2. Nelson OS, Munro AJ, Tannock IF. Bone metastatic: pathophysiology and management policy[J]. J Clin Oncol, 1991; 9(3):509-524.
- 3. Scully SP, Ghert MA, Zurakowski D, Thompson RC, Gebhardt MC. Pathologic fracture in osteosarcoma: prognostic importance and treatment implications[J]. J Bone Joint Surg Am, 2002; 84-A(1):49-57.
- 4. Mertens WC, Filipczack LA, Ben-Josef Edgar, Davis LP, Portes AT. Systemic bone-seeking Radionuclides for palliation of painful osseous metastases: Current Concepts[J]. CA Cancer J Clin, 1998; 48(6):361-374.
- 5. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003]. Section 6. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
- 6. Lewington VJ, McEwan AJ, Ackery DM, Bayly RJ, Keeling DH, Macleod PM, Porter AT, Zivanovic MA. A prospective, randomised double-blind crossover study to examine the efficacy of strontium-89 in pain palliation in patients with advanced prostate cancer metastatic to bone[J]. European Journal of Cancer, 1991; 27(8):954-958.
- 7. Porter AT, McEwan AJB, Powe JE, Reid R, McGowan DG, Lukka H, Sathyanarayana JR, Yakemchuk VN, Thomas GM, Erlich LE. Results of a randomized Phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer[J]. INT-J-RADIAT-ONCOL-BIOL-PHYS, 1993; 25(5): 805-813.
- 8. Serafini AN, Houston SJ, Resche I, Quick DP, Grund FM, Ell PJ, Bertrand A, Ahmann FR, Orihuela E, Reid RH, Lerski RA, Collier BD, McKillop JH, Purnell GL, Pecking AP, Thomas FD, Harrison KA. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: A double-blind placebo-controlled clinical trial[J]. Journal of Clinical Oncology, 1998; 16(4):1574-1581.
- 9. Buchali K, Correns HJ, Schuerer M, Schnorr D, Lips H, Sydow K. Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma[J]. European Journal of Nuclear Medicine, 1988; 14(7-8):349-351.
- 10. Quilty PM, Kirk D, Bolger JJ, Dearnaley DP, Lewington VJ, Mason MD, Reed NS, Russell JM, Yardley J. A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer[J]. Radiotherapy & Oncology, 1994; 31(1): 33-40.
- 11. Liepe K, Franke WG, Kropp J, Koch R, Runge R, Hliscs R. Vergleich von Rhenium-188-HEDP, Rhenium-186-HEDP und Strontium-89 fur die palliative Schmerztherapie von Skelettmetastasen[J]. Nuklearmedizin, 2000; 39(6): 146-151.
- 12. Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7.
- 13. Tian JH, Zhang JM, Hou QT, Oyang QH, Wang JM, Luan ZS, Chuan L, He YJ. Multicentre trial on the efficacy and toxicity of single-dose samarium-153-ethylene diamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases in China[J]. European Journal of Nuclear Medicine, 1999; 26(1):2-7.