186铼-羟基亚乙基二膦酸盐对肺癌患者疼痛性播散性骨转移的姑息治疗

Palliative treatment of painful disseminated bone metastases with 186Rhenium-HEDP in patients with lung cancer.

作者信息

Leondi A H, Souvatzoglou M A, Rapti A S, Leontopoulou S A, Papadaki E K, Datseris E I, Anagnostopoulou U S, Zerva C J

机构信息

Department of Nuclear Medicine, Alexandra Hospital, Athens, Greece.

出版信息

Q J Nucl Med Mol Imaging. 2004 Sep;48(3):211-9.

PMID:15499295

Abstract

AIM

The aim of this study was to determine if patients with lung cancer and metastatic bone pain due to disseminated secondary bone disease, can benefit from the treatment with (186)Re-HEDP and to discuss the criteria useful for selecting those patients.

METHODS

Twenty-four patients were included in this study and they received 1295 MBq (186)Re-HEDP. All patients underwent (99m)Tc-MDP bone scan before treatment from which the bone scan index (BSI) was determined (mean=18.7+/-17.1%). Most patients underwent CT scan of the painful areas from which the osteolytic element of their bone lesions as well as possible infiltration of the soft tissues was determined. Patients with predominantly osteolytic metastases at the sites considered to be the origin of pain in the CT scan, were excluded. All patients were under analgesic therapy, 22/24 were taking opiates. Pain was estimated by the visual analogue scale (VAS) before the application of (186)Re-HEDP and over the following 8 weeks. The possible myelotoxicity of (186)Re was assessed.

RESULTS

The mean VAS score was 6.9+/-2.5 before the application and 3.2+/-2.6 after therapy. Pain relief was obtained in 23/24 patients. Sixty-two percent of the patients exhibited clinically significant pain relief of at least 3 VAS score. The dosage of opiates was decreased in 77% of the patients and could be discontinued in 4 of them. Myelotoxicity was observed in 1 patient. Ninety-one percent of our patients showed improvement in the parameters that assess the quality of life.

CONCLUSION

The application of a standard dose of (186)Re-HEDP in patients with lung cancer and painful disseminated bone metastases has a satisfactory pain alleviating effect. The easy application and very low myelotoxicity are important factors in this group of patients. A better analgesic effect of the (186)Re-HEDP application can be expected if combined estimation of the (99m)Tc-MDP bone scan and the CT scan is used.

摘要

目的

本研究旨在确定因播散性继发性骨病导致肺癌并伴有转移性骨痛的患者是否能从（186）铼-羟乙二膦酸盐（（186）Re-HEDP）治疗中获益，并探讨有助于选择这些患者的标准。

方法

本研究纳入了24例患者，他们接受了1295兆贝可（186）Re-HEDP。所有患者在治疗前均接受了（99m）锝-亚甲基二膦酸盐（（99m）Tc-MDP）骨扫描，据此确定骨扫描指数（BSI）（平均值=18.7±17.1%）。大多数患者接受了疼痛部位的CT扫描，据此确定其骨病变的溶骨成分以及软组织可能的浸润情况。在CT扫描中被认为是疼痛起源部位以溶骨性转移为主的患者被排除。所有患者均接受镇痛治疗，24例中有22例服用阿片类药物。在应用（186）Re-HEDP之前及随后8周内，通过视觉模拟评分法（VAS）评估疼痛情况。评估了（186）Re可能的骨髓毒性。