Objective To systematically evaluate the effectiveness and safety of zoledronic acid combined with radiotherapy in treating bone metastasis of malignant tumor. Methods Such databases as PubMed, EMbase, The Cochrane Library (Issue 10, 2012), CBM, CNKI, VIP and WanFang Data were searched to collect randomized clinical trials (RCTs) on bone metastasis of malignant tumor from inception to October, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Twenty nine trials were included involving 2 021 patients. The results of meta-analysis showed that, compared with the radiotherapy alone group, zoledronic acid combined with radiotherapy improved the effectiveness rate of pain relieving at the end of treatment (OR=3.08, 95%CI 2.30 to 4.12, Plt;0.000 01), the effectiveness rate of pain relieving two weeks after treatment (OR=3.39, 95%CI 2.52 to 4.56, Plt;0.000 01), the quality of life (OR=2.74, 95%CI 1.66 to 4.52, Plt;0.000 01) and the ability of movement (OR=2.96, 95%CI 2.16 to 4.05, Plt;0.000 01). Zoledronic acid combined with radiotherapy also reduced the incidence of new bone metastasis (OR=0.21, 95%CI 0.10 to 0.45, Plt;0.000 1) and the incidence rate of bone-related events (OR=0.17, 95%CI 0.03 to 0.92, P=0.04). The adverse reactions of zoledronic acid combined with radiotherapy such as fever (OR=11.92, 95%CI 6.31 to 22.48, Plt;0.000 01) and hypocalcaemia (OR=8.82, 95%CI 1.61 to 48.36, P=0.01), significantly increased. Conclusion Compared with radiotherapy alone, zoledronic acid combined with radiotherapy can relieve bone metastatic pain, effectively enhance patients’ ability of movement, improve quality of life, and decrease new bone metastasis and the occurrence of bone-related events.
目的:为肿瘤骨转移患者压疮预防的方法进行总结评价以达到对临床肿瘤压疮进行指导。方法:采用改良后的诺顿评估表（信度0.80，效度0.84）作为压疮易患患者评估工具。评估内容包括患者年龄、身体状况、意识、活动能力、运动受限情况、疼痛、皮肤情况、大小便失禁、饮食、进食能力、口腔情况、牙齿及患者血色素、蛋白等资料。评估时间从患者入院开始，对30例肿瘤全身多处骨转移患者进行评估，有预见性、计划性，针对性及个体化对患者制订护理计划及措施，并督促实施，对效果进行评价分析。结果:≤25分高危险性患者（难以避免）发生率50％，26～29分中度危险性患者（可避免）发生率0，≥30分低危险性患者发生率14.2％。效果评价:压疮预防评估对肿瘤骨转移患者压疮的预防是有效的，压疮评估有助于规范护理行为和护理管理；通过分析找出护理过程中的薄弱环节，以利于指导临床工作。
Objective To introduce the current studies on bone biochemical markers in breast cancer with bone metastasis. Methods The papers in recent 8 years about the application of bone biochemical markers in the diagnosis and treatment of breast cancer with bone metastasis were reviewed. Results NTX had the best relation with bone metastasis. ICTP was much more worthy than NTX in diagnosis of breast cancer with bone metastasis. Osteogenesis markers were little worthy in diagnosis of breast cancer with bone metastasis. Conclusion Bone biochemical markers can not replace the image exams and biopsy in diagnosing the bone metastasis of breast cancer,but may be one of the factors to get the early diagnosis.
目的 探讨影响乳腺癌骨转移发生、发展的因素及治疗方法。 方法 对106例乳腺癌骨转移患者的临床特点及近期疗效进行回顾性总结。 结果 乳腺癌骨转移的发生及发生早晚与腋窝淋巴结的转移数目相关。治疗以全身治疗为主，包括化疗、内分泌治疗、放疗、放射性同位素内照射及二磷酸盐的综合治疗。 结论 乳腺癌患者，特别是伴有较多数目腋窝淋巴结转移者，应进行同位素骨扫描检查，一旦出现骨转移，应积极进行全身治疗，转移局限者，可进行局部外放射治疗。
【Abstract】Objective To introduce three methods of creating the animal model of bone metastasis from breast cancer and the advances in the application of these models. Methods The related literatures were collected and reviewed.Results In summary, breast cancer cells injected through left ventricles was commonly used. Breast cancer cells injected into medullary cavity of shaft of femur was simple and effective, but it was very different from the real condition of bone metastasis of patients. The development of animal model created by surgical orthotopic implantation gives the researchs an ideal instrument similar with the condition of patients to research the mechanism of bone metastasis and the treatment. Conclusion Each animal model of bone metastasis from breast cancer has itself usefulness. Our destination is to create the real model of bone metastasis from breast cancer that is very similar with the patients.
Objective To investigate the therapeutic effects of strontium-89 to prevent bone metastases of lung neoplasms.Methods Thirty patients with bone metastases of lung neoplasms received strontium-89 treatment (89SrCl2) at a dose of 148 MBq through intravenous injection.The analgesic effect was assessed by VAS method and doses or frequency of using analgesic drugs.Other efficacy parameters included changes in the number of osseous lesions and urinary levels of pyridinoline and deoxypyridinoline on the day 28 after therapy.Results The total pain relief rate was 73.3%(22/30)，among which 5(16.6%) cases with pain vanished，suggesting significant alleviation of the pain intensity by the treatment(Plt;0.001) on the day 28 after therapy.The number of lesions decreased in 16 cases with effective rate of 53.3%，showing the bone metastases significantly decreased after the therapy (Plt;0.001).The urinary levels of pyridinoline and deoxypyridinoline on the day 28 after therapy were (62.48±37.25)nmol/mmol Cr and (13.94±8.66)nmol/mmol Cr，respectively，which were decreased significantly compared to the levels before treatment which were (100.15±48.65)nmol/mmol Cr and (31.25±15.32)nmol/mmol Cr，respectively (both Plt;0.001).Conclusion Strontium-89 is effective to relieve pain and prevent bone lesions in patients with bone metastases of the lung neoplasms.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
Objective To use meta-analysis method to assess the efficacy of fluorine-18fluorode-oxyglucose positron emission tomography/computed tomography (PET/CT) (18F-FDG-PET/CT) scan and 99Tcm-methylene diphosphonate (99Tcm-MDP) bone scan (BS) on early diagnosis of bone metastases of cancer. Methods Computer-based retrieval was conducted on MEDLINE, PubMed, EMbase, Ovid, and The Cochrane Library (from their establishment to 2010) to search reports about diagnosing bone metastases of cancer with 18FDG-PET/CT and 99Tcm-MDP Bone Scan. Three reviewers independently selected the studies according to the inclusion and exclusion criteria, collected the data, and evaluated the quality. MetaDisc software was adopted to conduct meta-analyses. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, the summary receiving operating characteristic (SROC) curve was drawn, and the areas under the curve (AUC) and Q were measured. Results Five studies were included. The results of meta-analyses showed that the pooled sensitivity of 18FDG-PET/CT and 99Tcm-MDP BS in the diagnosis of bone metastases was 0.95 (95%CI 0.90 to 0.97) and 0.77 (95%CI 0.71 to 0.83), respectively; the pooled specificity was 0.98 (95%CI 0.97 to 0.99) and 0.90 (95%CI 0.88 to 0.92), respectively; the pooled DOR was 602.81 (95%CI 214.07 to 1697.51) and 41.37 (95%CI 8.15 to 210.05), respectively; the AUC was 0.984 2 and 0.901 7, respectively; and the Q index was 0.945 4 and 0.833 1, respectively. Conclusion The 18F-FDG PET/CT is more effective than the 99Tcm-MDP bone scan in the early diagnosis of bone metastases in cancer.