Fairchild Alysa, Chow Edward
Department of Radiation Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.
Curr Opin Support Palliat Care. 2007 Oct;1(3):169-73. doi: 10.1097/SPC.0b013e3282efd70b.
Bone metastases remain the most common cause of cancer-related pain. Palliative radiotherapy and radiopharmaceuticals are effective for symptom control, but continue to be underutilized. We review recent literature for the treatment of bone metastases and spinal cord compression, and address new developments in the prevention of adverse effects secondary to radiotherapy.
Evidence continues to mount in support of the efficacy of short-course radiation schedules. Emerging data support the use of single fractions. While radiotherapy is relatively nontoxic, pain flare can be a distressing side effect. Recent reports suggest that traditional and more innovative radiopharmaceuticals are well tolerated, with effects comparable with external beam radiation and the added advantage of addressing multiple, widespread painful sites simultaneously.
There is an urgent need for more randomized controlled trials in the radiotherapy of complicated bone metastases, such as the settings of spinal cord compression and neuropathic pain. Additional study of radiopharmaceuticals as adjuvants to external beam radiotherapy would also serve to further elucidate the optimal treatment for these patients.
骨转移仍然是癌症相关疼痛最常见的原因。姑息性放疗和放射性药物对症状控制有效，但仍未得到充分利用。我们回顾了近期关于骨转移和脊髓压迫治疗的文献，并探讨了预防放疗继发不良反应的新进展。
支持短程放疗方案疗效的证据不断增加。新出现的数据支持单次分割放疗的应用。虽然放疗相对无毒，但疼痛加剧可能是一种令人痛苦的副作用。最近的报告表明，传统和更具创新性的放射性药物耐受性良好，其效果与外照射相当，并且具有同时处理多个广泛疼痛部位的额外优势。
迫切需要针对复杂骨转移（如脊髓压迫和神经性疼痛情况）的放疗开展更多随机对照试验。对放射性药物作为外照射放疗辅助剂的进一步研究也将有助于进一步阐明这些患者的最佳治疗方法。
