Finlay Ilora G, Mason Malcolm D, Shelley Mike
Department of Palliative Medicine, Velindre NHS Trust, Velindre Hospital, Whitchurch, Cardiff, Wales, UK.
Lancet Oncol. 2005 Jun;6(6):392-400. doi: 10.1016/S1470-2045(05)70206-0.
Strontium-89 and samarium-153 are radioisotopes that are approved in the USA and Europe for the palliation of pain from metastatic bone cancer, whereas rhenium-186 and rhenium-188 are investigational. Radioisotopes are effective in providing pain relief with response rates of between 40% and 95%. Pain relief starts 1-4 weeks after the initiation of treatment, continues for up to 18 months, and is associated with a reduction in analgesic use in many patients. Thrombocytopenia and neutropenia are the most common toxic effects, but they are generally mild and reversible. Repeat doses are effective in providing pain relief in many patients. The effectiveness of radioisotopes can be greater when they are combined with chemotherapeutic agents such as cisplatin. Some studies with 89Sr and 153Sm indicate a reduction of hot spots on bone scans in up to 70% of patients, and suggest a possible tumoricidal action. Further studies are needed to address the questions of which isotope to use, what dose and schedule to use, and which patients will respond.
锶 - 89和钐 - 153是放射性同位素，在美国和欧洲被批准用于缓解转移性骨癌引起的疼痛，而铼 - 186和铼 - 188仍处于研究阶段。放射性同位素在缓解疼痛方面有效，有效率在40%至95%之间。疼痛缓解在治疗开始后1 - 4周开始，持续长达18个月，并且许多患者的止痛药物使用量会减少。血小板减少症和中性粒细胞减少症是最常见的毒副作用，但通常较轻且可逆。重复给药对许多患者缓解疼痛有效。当放射性同位素与顺铂等化疗药物联合使用时，其效果可能会更好。一些关于锶 - 89和钐 - 153的研究表明，高达70%的患者骨扫描上的热点减少，并提示可能存在杀肿瘤作用。需要进一步研究来解决使用哪种同位素、使用何种剂量和方案以及哪些患者会有反应等问题。
