Liepe Knut, Runge Roswitha, Kotzerke Jörg
University Hospital Dresden, Department of Nuclear Medicine, Radeberg, Germany.
Am J Hosp Palliat Care. 2005 Nov-Dec;22(6):457-64. doi: 10.1177/104990910502200613.
Several radiopharmaceuticals were investigated to determine their efficacy and toxicity in the palliation of painful bone metastases. Data on the influence of rhenium-188 hydroxyethylidene diphosphonate (188Re-HEDP), rhenium-186 hydroxyethylidene diphosphonate (186Re-HEDP), and strontium-89 (89Sr) on pain symptoms, quality of life, and bone-marrow function were obtained in 64 patients with breast and prostate cancer. Thirty-one patients were treated with 188Re-HEDP (3194 +/- 387 MBq), 15 patients with 186Re-HEDP (1358 +/- 158 MBq), and 18 patients with 89Sr (152 +/- 19 MBq). The 188Re-HEDP group included six breast cancer patients and 25 prostate cancer patients; the 186Re-HEDP group included three breast cancer patients and 12 prostate cancer patients; and the 89Sr group included three breast cancer patients and 15 prostate cancer patients. All subjects participated in an interview using a standardized sets of questions before and after the 12-week term of therapy. Blood counts were taken weekly for six weeks and after 12 weeks. Results showed that 77 percent of patients reported pain relief after treatment with 188Re-HEDP, 67 percent after treatment with 186Re-HEDP, and 72 percent after treatment with 89Sr. Sixteen percent of patients treated with 188Re-HEDP, 13 percent treated with 186Re-HEDP, and 17 percent treated with 89Sr were able to discontinue their analgesics and were pain-free. Patients described an improvement on Karnofsky performance status (KPS) from 73 +/- 7 percent to 85 +/- 8 percent 12 weeks after 188Re-HEDP (p < 0. 05), from 72 +/- 13 percent to 79 +/- 12 percent after 186Re-HEDP (p = 0.251), and from 62 +/- 14 percent to 69 +/- 16 percent after 89Sr (p = 0.415). Only three patients undergoing 188Re-HEDP therapy, one undergoing 186Re-HEDP therapy, and three undergoing 89Sr therapy had thrombocytopenia (platelet count below 100 x 10(3)/microl) following treatment. The maximum nadir of platelet and leukocyte counts was observed between the second and fifth week after treatment for all radionuclides and was reversible within 12 weeks. The nadir was earlier for 188Re-HEDP with a shorter physical half-life compared with 89Sr. There were no significant differences in bone marrow toxicity (p = 0.123-0.421). Results of this study indicate that all evaluated radiopharmaceuticals were effective in pain palliation without induction of severe side effects. The increase in KPS after 188Re-HEDP was the only statistically significant finding (p = 0.001).
研究了几种放射性药物，以确定它们在缓解骨转移疼痛方面的疗效和毒性。在64例乳腺癌和前列腺癌患者中，获得了有关铼-188亚乙基二膦酸盐（188Re-HEDP）、铼-186亚乙基二膦酸盐（186Re-HEDP）和锶-89（89Sr）对疼痛症状、生活质量和骨髓功能影响的数据。31例患者接受188Re-HEDP治疗（3194±387MBq），15例患者接受186Re-HEDP治疗（1358±158MBq），18例患者接受89Sr治疗（152±19MBq）。188Re-HEDP组包括6例乳腺癌患者和25例前列腺癌患者；186Re-HEDP组包括3例乳腺癌患者和12例前列腺癌患者；89Sr组包括3例乳腺癌患者和15例前列腺癌患者。所有受试者在为期12周的治疗前后均参与了使用标准化问题集的访谈。每周进行血常规检查，持续六周，并在12周后再次检查。结果显示，77%的患者在接受188Re-HEDP治疗后报告疼痛缓解，67%在接受186Re-HEDP治疗后疼痛缓解，72%在接受89Sr治疗后疼痛缓解。接受188Re-HEDP治疗的患者中有16%、接受186Re-HEDP治疗的患者中有13%、接受89Sr治疗的患者中有17%能够停用镇痛药且无疼痛。患者描述在接受188Re-HEDP治疗12周后，卡氏功能状态评分（KPS）从73±7%提高到85±8%（p<0.05），接受186Re-HEDP治疗后从72±13%提高到79±12%（p=0.251），接受89Sr治疗后从62±14%提高到69±16%（p=0.415）。仅3例接受188Re-HEDP治疗的患者、1例接受186Re-HEDP治疗的患者和3例接受89Sr治疗的患者在治疗后出现血小板减少（血小板计数低于100×10³/微升）。所有放射性核素在治疗后的第二至第五周观察到血小板和白细胞计数的最低值，且在12周内可恢复。与89Sr相比，188Re-HEDP的物理半衰期较短，其最低值出现得更早。骨髓毒性方面无显著差异（p=0.123-0.421）。本研究结果表明，所有评估的放射性药物在缓解疼痛方面均有效，且未引发严重副作用。188Re-HEDP治疗后KPS的升高是唯一具有统计学意义的发现（p=0.001）。
