Siden Harold
Dept, of Pediatrics, University of British Columbia, and Canuck Place Children's Hospice, Vancouver, British Columbia, Canada.
J Med Case Rep. 2007 Mar 21;1:7. doi: 10.1186/1752-1947-1-7.
Bone pain in malignancy can be challenging to treat. Bisphosphonates have been found to be useful in adults with bone pain, but there are no reports of their use in children for this indication. In pediatric palliative medicine there are hurdles in translating knowledge gained primarily in adult studies into application in children. Obstacles exist in initially determining whether the evidence supports using a drug in children, and once a drug is chosen, then determining the optimal route of delivery. There is very little data to guide pediatric practitioners in this situation.
A 9 year old boy with disseminated Ewing Sarcoma presented with extremity pain not responsive to a combination of opiates, gabapentin and non-steroidal anti-inflammatory drugs. Clodronate, a bisphosphonate, was added to the regimen to treat bone pain. It was given subcutaneously every 4 weeks with a good response and no side effects.
This case report describes the use of a bisphosphonate, clodronate, given subcutaneously to a child with Ewing sarcoma with effective relief of bone pain. It describes how the care team encountered the challenges inherent in translating adult therapy into a pediatric regimen. Furthermore the report details how a regimen was developed to address this child's concerns regarding medication administration. Further effort needs to be made at finding solutions to address the lack of good evidence for pediatric palliative therapies.
恶性肿瘤引起的骨痛治疗颇具挑战性。已发现双膦酸盐类药物对患有骨痛的成年人有用，但尚无关于其用于治疗儿童该适应症的报道。在儿科姑息医学中，将主要在成人研究中获得的知识转化应用于儿童存在障碍。最初确定证据是否支持在儿童中使用某种药物存在障碍，而一旦选择了药物，还要确定最佳给药途径。在这种情况下，几乎没有数据可指导儿科医生。
一名9岁患有播散性尤因肉瘤的男孩出现肢体疼痛，对阿片类药物、加巴喷丁和非甾体抗炎药联合治疗无反应。将双膦酸盐类药物氯膦酸盐添加到治疗方案中以治疗骨痛。每4周皮下注射一次，效果良好且无副作用。
本病例报告描述了对一名患有尤因肉瘤的儿童皮下注射双膦酸盐类药物氯膦酸盐有效缓解骨痛的情况。它描述了护理团队在将成人治疗方法转化为儿科治疗方案时遇到的固有挑战。此外，该报告详细介绍了如何制定一种方案来解决该儿童对药物给药的担忧。需要进一步努力寻找解决方案，以应对儿科姑息治疗缺乏充分证据的问题。
