Friedl G, Tauss J, Portugaller R H, Welkerling H, Windhager R
Univ.-Klinik für Orthopädie, Graz.
Z Orthop Ihre Grenzgeb. 2004 Nov-Dec;142(6):727-34. doi: 10.1055/s-2004-832322.
The aim of the study was to determine the efficacy of PRFA in the palliative treatment of symptomatic bone metastases in regard to pain reduction, safety, and quality of life.
Over a period of 11 months, ten PRFA were performed in eight patients with painful metastases involving bone, where conventional treatment with radiation therapy, chemotherapy, and treatment with analgesics had failed to reduce the pain efficiently. Pain was measured with the visual analogue scale (VAS: 0 to 10) for the day and night before PRFA was performed, and daily for 7 days after release from the hospital via a dietary book, and at the follow-up periods of 1, 3, 6 weeks and 3 and 6 months after PRFA. Additionally, quality of life was self-assessed by the patient via the health surveys IQOLA SF-36 and EORTC QLQ-C30, and via the Karnofsky Performance Scale (KPS) by the physician at each follow-up. The patients' analgesics use was also recorded at the follow-up intervals and complications were monitored. Analysis of the primary end point was undertaken with paired comparison procedures.
Under conventional therapy, pain was specified by the patients as VAS min of 4.1 and VAS max of 9.3. Due to PRFA a reduction of the preinterventional pain (VAS) from 7.4 (+/- 1.9 SD) and 5.0 (+/- 2.7 SD) for day and night, subsequently, to 1.8 (+/- 1.6 SD, minus 75 percent) and 0.7 (+/- 0.7 SD, minus 86 percent) was achieved within one day after admission to the hospital. This significant reduction did not change during the whole follow-up period, and was also reflected in the ability to reduce analgesics and in the improvement of specific domains of SF-36 and QLQ-C30. However, no significant change was detected in the summary scales for mental and physical health. No serious complications were observed.
PRFA of symptomatic bone metastases is a safe technology to reduce pain intractable to conventional therapy, even in terminally ill patients.
本研究旨在确定经皮射频消融术（PRFA）在对症治疗有症状的骨转移瘤方面，在减轻疼痛、安全性及生活质量方面的疗效。
在11个月的时间里，对8例骨转移瘤引起疼痛的患者进行了10次PRFA治疗，这些患者采用放射治疗、化疗及镇痛药治疗均未能有效减轻疼痛。在进行PRFA治疗前一天的白天和晚上，通过视觉模拟量表（VAS：0至10）测量疼痛程度，出院后7天内每天通过饮食记录测量疼痛程度，并在PRFA治疗后的1、3、6周以及3和6个月的随访期测量。此外，患者通过健康调查IQOLA SF - 36和欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ - C30）进行生活质量自评，医生在每次随访时通过卡氏功能状态评分量表（KPS）进行评估。在随访期间记录患者的镇痛药使用情况，并监测并发症。采用配对比较程序对主要终点进行分析。
在传统治疗下，患者自述疼痛的VAS最小值为4.1，最大值为9.3。由于PRFA治疗，术前白天和晚上的疼痛（VAS）分别从7.4（±1.9标准差）和5.0（±2.7标准差），在入院后一天内分别降至1.8（±1.6标准差，降低75%）和0.7（±0.7标准差，降低86%）。这种显著的疼痛减轻在整个随访期内没有变化，也体现在镇痛药用量的减少以及SF - 36和QLQ - C30特定领域的改善上。然而，在心理健康和身体健康的总结量表中未检测到显著变化。未观察到严重并发症。
有症状骨转移瘤的PRFA是一种安全的技术，即使对于晚期患者，也能减轻传统治疗难以缓解之疼痛。
