Roemer-Bécuwe Célia, Vigano Antonio, Romano Fabrizio, Neumann Catherine, Hanson John, Quan Hue K, Walker Paul
Regional Palliative Care Program, Grey Nuns Community Hospital and Health Center, West Edmonton, Alberta, Canada.
J Pain Symptom Manage. 2003 Sep;26(3):843-8. doi: 10.1016/s0885-3924(03)00252-5.
Bisphosphonates have become standard treatment in management of malignancy-induced hypercalcemia and malignant bone pain. One obstacle to the routine use of bisphosphonates in palliative patients is that oral bisphosphonates have low bioavailability and a degree of gastrointestinal toxicity that may explain poor compliance. Intravenous administration can be cumbersome in patients admitted to long-term care settings or at home. We have developed and tested a new way of administering clodronate via subcutaneous infusion. This retrospective cohort study evaluated 150 patients admitted to a tertiary palliative care unit from May 1996 to May 2000 who received 254 subcutaneous infusions of clodronate for hypercalcemia or bony complications. Data were collected by chart review and specifically evaluated site toxicity and biochemistry. There was minimal local toxicity and only 2 infusions needed to be discontinued because of pain at the subcutaneous site. Clodronate showed efficacy in normalizing the serum calcium within 5 days post-infusion in 32 of 43 infusions given for hypercalcemia. This study shows that subcutaneous clodronate is safe and can lower serum calcium levels in malignant hypercalcemia.
双膦酸盐已成为治疗恶性肿瘤引起的高钙血症和恶性骨痛的标准方法。双膦酸盐在姑息治疗患者中常规使用的一个障碍是口服双膦酸盐的生物利用度低，且有一定程度的胃肠道毒性，这可能是依从性差的原因。对于长期住院或居家的患者，静脉给药可能很麻烦。我们研发并测试了一种通过皮下输注给予氯膦酸盐的新方法。这项回顾性队列研究评估了1996年5月至2000年5月入住三级姑息治疗病房的150例患者，这些患者接受了254次皮下输注氯膦酸盐以治疗高钙血症或骨并发症。通过查阅病历收集数据，并特别评估局部毒性和生化指标。局部毒性极小，只有2次输注因皮下部位疼痛而需要中断。在为高钙血症进行的43次输注中，有32次输注后5天内氯膦酸盐使血清钙恢复正常，显示出疗效。这项研究表明，皮下注射氯膦酸盐是安全的，并且可以降低恶性高钙血症患者的血清钙水平。
