Nair N
Radiation Medicine Center, Bhabha Atomic Research Center, Tata Hospital Annex, Parel, Bombay, India.
J Nucl Med. 1999 Feb;40(2):256-61.
32p and 89Sr have been shown to produce significant pain relief in patients with skeletal metastases from advanced cancer. Clinically significant pancytopenia has not been reported in doses up to 12 mCi (444 MBq) of either radionuclide. To date, no reports comparing the relative efficacy and toxicity of the two radionuclides in comparable patient populations have been available. Although a cure has not been reported, both treatments have achieved substantial pain relief. However, several studies have used semiquantitative measures such as "slight," "fair," "partial" and "dramatic" responses, which lend themselves to subjective bias. This report examines the responses to treatment with 32P or 89Sr by attempting a quantification of pain relief and quality of life using the patients as their own controls and compares toxicity in terms of hematological parameters.
Thirty-one patients with skeletal metastases were treated for pain relief with either 32P (16 patients) or 89Sr (15 patients). Inclusion criteria were pain from bone scan-positive sites above a subjective score of 5 of 10 despite analgesic therapy with narcotic or non-narcotic medication, limitation of movement related to the performance of routine daily activity and a predicted life expectancy of at least 4 mo. The patients had not had chemotherapy or radiotherapy during the previous 6 wk and had normal serum creatinine, white cell and platelet counts. 32P was given orally as a 12 mCi dose, and 89Sr was given intravenously as a 4 mCi (148 MBq) dose. The patients were monitored for 4 mo.
Complete absence of pain was seen in 7 of 16 patients who were given 32P and in 7 of 15 patients who were given 89Sr. Pain scores fell by at least 50% of the pretreatment score in 14 of 16 patients who were given 32P and 14 of 15 patients who were given 89Sr. Mean duration of pain relief was 9.6 wk with 32P and 10 wk with 89Sr. Analgesic scores fell along with the drop in pain scores. A fall in total white cell, absolute granulocyte and platelet counts occurred in all patients. Subnormal values of white cells and platelets were seen in 5 and 7 patients, respectively, with 32P, and in 0 and 4 patients, respectively, after 89Sr therapy. The decrease in platelet count (but not absolute granulocyte count) was statistically significant when 32P patients were compared with 89Sr patients. However, in no instance did the fall in blood counts require treatment. Absolute granulocyte counts did not fall below 1000 in any patient. There was no significant difference between the two treatments in terms of either efficacy or toxicity.
No justification has been found in this study for the recommendation of 89Sr over the considerably less expensive oral 32P for the palliation of skeletal pain from metastases of advanced cancer.
已证实32P和89Sr可使晚期癌症骨转移患者的疼痛得到显著缓解。两种放射性核素剂量高达12 mCi（444 MBq）时，均未报告有临床意义的全血细胞减少。迄今为止，尚无关于这两种放射性核素在可比患者群体中的相对疗效和毒性比较的报告。尽管尚未有治愈的报道，但两种治疗均已实现了显著的疼痛缓解。然而，多项研究使用了“轻微”“尚可”“部分”和“显著”反应等半定量指标，这些指标容易产生主观偏差。本报告通过以患者自身作为对照来量化疼痛缓解程度和生活质量，研究了32P或89Sr治疗的反应，并比较了血液学参数方面的毒性。
31例骨转移患者接受了32P（16例患者）或89Sr（15例患者）治疗以缓解疼痛。纳入标准为尽管使用了麻醉或非麻醉药物进行镇痛治疗，但骨扫描阳性部位的疼痛主观评分仍高于10分中的5分，与日常活动表现相关的活动受限，以及预计生存期至少4个月。患者在过去6周内未接受过化疗或放疗，血清肌酐、白细胞和血小板计数正常。32P以12 mCi剂量口服给药，89Sr以4 mCi（148 MBq）剂量静脉给药。对患者进行了4个月的监测。
接受32P治疗的16例患者中有7例完全无痛，接受89Sr治疗的15例患者中有7例完全无痛。接受32P治疗的16例患者中有14例、接受89Sr治疗的15例患者中有14例的疼痛评分下降至少50%。32P治疗的疼痛缓解平均持续时间为9.6周，89Sr治疗为10周。镇痛评分随疼痛评分下降而下降。所有患者的白细胞、绝对粒细胞和血小板计数均下降。接受32P治疗的患者中分别有5例和7例白细胞和血小板值低于正常，接受89Sr治疗后分别为0例和4例。与89Sr治疗的患者相比，32P治疗的患者血小板计数下降（但绝对粒细胞计数未下降）具有统计学意义。然而，在任何情况下，血细胞计数下降均无需治疗。任何患者的绝对粒细胞计数均未降至1000以下。两种治疗在疗效和毒性方面均无显著差异。
本研究未发现有理由推荐使用价格昂贵得多的89Sr而非口服的32P来缓解晚期癌症转移引起的骨痛。
