Huang Hui-Qiang, Cai Qing-Qing, Lin Xu-Bin, Wang Bu-Fei, Bu Qing, Gao Yan, Peng Yu-Long
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, PR China.
Ai Zheng. 2007 Apr;26(4):390-3.
BACKGROUND & OBJECTIVE: The incidence of mucositis caused by autologous hematopoietic stem cell transplantation (AHSCT) is relatively high. The severe painful mucositis can reduce the quality of life of patients obviously. Transdermal fentanyl is efficient in treating chronic pain of cancer, and also can relieve the severe pain of mucositis resulted from chemotherapy. This study was to investigate the efficacy and safety of transdermal fentanyl for the severe painful mucositis caused by AHSCT.
A total of 22 malignant tumor patients suffered from severe mucositis caused by high dose chemotherapy combined AHSCT. The analgesic degree before and after treatment was evaluated by the scores of Visual Analogue Scale (VAS) (range 0-10). The median VAS scores of all patients were above 4 (moderate to severe pain) before the administration of transdermal fentanyl. The quality of life before and after treatment was evaluated by the Standard of Quality of Life drew up in China in 1990. The adverse events after treatment were evaluated by Common Toxicity Criteria formulated by National Cancer Institute of the USA.
The median VAS score has been decreased from baseline at 6 (4-9) to 3.5 (0-9) on Day 3, 2 (0-6) on Day 5, 0.5 (0-8) on Day 7, 0 (0-6) on Day 10, and 0 (0-5) on Day 15 after treatment (P<0.001). The overall response rate was 100%, while the complete response rate was 45.5%. The quality of life of the patients was improved significantly (P<0.01). The adverse events after treatment of transdermal fentanyl included dizziness, somnolence, dysuria, mild and transient nausea, vomiting, discomfort of stomach, and so on. All the adverse events disappeared within several days after proper managements. Neither severe adverse event nor drug addiction was found.
Transdermal fentanyl has good analgesic effect on painful severe mucositis induced by AHSCT. It is convenient and well tolerated, and could improve quality of life significantly.
自体造血干细胞移植（AHSCT）所致黏膜炎的发生率相对较高。严重的疼痛性黏膜炎可明显降低患者的生活质量。透皮芬太尼在治疗癌症慢性疼痛方面有效，也可缓解化疗所致黏膜炎的剧痛。本研究旨在探讨透皮芬太尼治疗AHSCT所致严重疼痛性黏膜炎的疗效及安全性。
选取22例因高剂量化疗联合AHSCT导致严重黏膜炎的恶性肿瘤患者。采用视觉模拟评分法（VAS）（范围0 - 10）评估治疗前后的镇痛程度。在给予透皮芬太尼前，所有患者的VAS评分中位数均高于4分（中度至重度疼痛）。采用1990年中国制定的生活质量标准评估治疗前后的生活质量。采用美国国立癌症研究所制定的常见毒性标准评估治疗后的不良事件。
治疗后第3天，VAS评分中位数从基线的6分（4 - 9分）降至3.5分（0 - 9分），第5天降至2分（0 - 6分），第7天降至0.5分（0 - 8分），第10天降至0分（0 - 6分），第15天降至0分（0 - 5分）（P<0.001）。总有效率为100%，完全缓解率为45.5%。患者的生活质量有显著改善（P<0.01）。透皮芬太尼治疗后的不良事件包括头晕、嗜睡、排尿困难、轻度短暂性恶心、呕吐、胃部不适等。经适当处理后，所有不良事件在数天内消失。未发现严重不良事件及药物成瘾情况。
透皮芬太尼对AHSCT所致疼痛性严重黏膜炎有良好的镇痛效果。其使用方便，耐受性良好，可显著提高生活质量。
