Lipton Allan
Pennsylvania State University, Milton S. Hershey Medical Center, Hershey.
Support Cancer Ther. 2007 Jan 1;4(2):92-100. doi: 10.3816/SCT.2007.n.003.
Many solid tumors metastasize to bone, leading to debilitating skeletal complications such as intractable bone pain and pathologic fractures. Patients who experience a skeletal-related event (SRE) are at higher risk for subsequent events. After an SRE such as a pathologic fracture, spinal cord compression, or the requirement for orthopedic surgery or palliative radiation therapy, a patient's quality of life and functional independence could decline substantially. Prevention or delay of skeletal complications provides clinical benefit to patients with bone metastases secondary to solid tumors. Treatment for the prevention of the first SRE might substantially improve patients' quality of life, functional independence, and pain throughout the course of their disease. Bisphosphonates have shown a palliative benefit in this setting. In particular, zoledronic acid is the only bisphosphonate that has provided benefits for patients with bone metastases secondary to a broad range of solid tumors. Among patients with metastatic breast or prostate cancer, zoledronic acid has demonstrated significant reductions in pain and skeletal morbidity compared with placebo. Zoledronic acid has also shown significant reductions in skeletal morbidity in patients with lung cancer or other solid tumors compared with placebo. Pamidronate, oral clodronate, and ibandronate compared with placebo have each shown significant benefits in reductions of pain and skeletal complications for patients with metastatic breast cancer. Further improvements in the management of skeletal health in patients with malignant bone disease could be achieved through ongoing bisphosphonate investigations to optimize dose, timing, and duration of treatment.
许多实体瘤会转移至骨骼，导致诸如顽固性骨痛和病理性骨折等使人衰弱的骨骼并发症。经历骨相关事件（SRE）的患者发生后续事件的风险更高。在发生病理性骨折、脊髓压迫或需要进行骨科手术或姑息性放射治疗等SRE后，患者的生活质量和功能独立性可能会大幅下降。预防或延缓骨骼并发症可为实体瘤继发骨转移的患者带来临床益处。预防首次SRE的治疗可能会在患者整个病程中显著改善其生活质量、功能独立性和疼痛状况。双膦酸盐在这种情况下已显示出姑息性益处。特别是，唑来膦酸是唯一一种对多种实体瘤继发骨转移患者有益的双膦酸盐。在转移性乳腺癌或前列腺癌患者中，与安慰剂相比，唑来膦酸已证明可显著减轻疼痛和降低骨骼发病率。与安慰剂相比，帕米膦酸、口服氯膦酸和伊班膦酸在减轻转移性乳腺癌患者的疼痛和骨骼并发症方面均显示出显著益处。通过持续进行双膦酸盐研究以优化治疗剂量、时间和疗程，恶性骨病患者骨骼健康管理有望进一步改善。
