Niang U, Kamer S, Ozsaran Z, Haydaroglu A, Kilciksiz S
Ege University, Faculty of Medicine, Clinic of Radiation Oncology, Izmir, Turkey.
J BUON. 2009 Apr-Jun;14(2):245-9.
The objective of this study was to evaluate the palliation of pain of bone metastases with biphosphonates and different radiotherapy protocols in 372 cancer patients.
Patients were treated with one of the 3 different radiotherapy protocols: 30 Gy in 10 fractions (group A), 20 Gy in 5 fractions (group B) and 8 Gy in a single fraction (group C). Two patient groups were studied: one with radiotherapy alone and the second with biphosphonates plus radiotherapy. The severity of pain was recorded before treatment. According to the pain relief, two different groups were defined: palliation rate<50% (limited palliation) and >50% (partial palliation), including complete pain relief.
Overall limited and partial palliation rates were 20.2 and 79.8%, respectively (complete pain palliation 24.2%). In the group treated with both external radiotherapy and biphosphonates, limited and partial palliation rates were 19.5 and 80.4%, respectively (p=0.47). For 244 metastatic lesions treated with palliative radiotherapy alone, limited palliation rate was 20.4% and partial palliation rate 79.5%. No differences were detected between the groups with or without biphosphonates treatment in terms of pain palliation. According to the radiotherapy protocol, limited palliation rates in groups A, B, and C were 17.7, 20.3, and 28.5%, respectively (p=0.19, p=0.38, and p=0.26, respectively). Partial palliation rates were 82.2% in group A, 79.6% in group B and 71.4% in group C (p=0.42, p=0.21, and p=0.11, respectively). Similarly, no statistically significant differences were detected among the 3 radiotherapy schemes in terms of pain palliation.
When combined with palliative radiotherapy, biphosphonates did not have any additive effects on pain palliation in the management of painful bone metastases. In addition, a single radiotherapy fraction provides equal pain palliation as multiple fractions.
本研究的目的是评估双膦酸盐和不同放疗方案对372例癌症患者骨转移疼痛的缓解情况。
患者接受3种不同放疗方案之一的治疗：10次分割给予30 Gy（A组）、5次分割给予20 Gy（B组）和单次分割给予8 Gy（C组）。研究了两组患者：一组仅接受放疗，另一组接受双膦酸盐加放疗。在治疗前记录疼痛的严重程度。根据疼痛缓解情况，定义了两个不同的组：缓解率<50%（缓解有限）和>50%（部分缓解），包括完全疼痛缓解。
总体缓解有限和部分缓解率分别为20.2%和79.8%（完全疼痛缓解率为24.2%）。在接受外照射放疗和双膦酸盐治疗的组中，缓解有限和部分缓解率分别为19.5%和80.4%（p = 0.47）。对于仅接受姑息性放疗的244个转移病灶，缓解有限率为20.4%，部分缓解率为79.5%。在疼痛缓解方面，接受或未接受双膦酸盐治疗的组之间未检测到差异。根据放疗方案，A组、B组和C组的缓解有限率分别为17.7%、20.3%和28.5%（分别为p = 0.19、p = 0.38和p = 0.26）。A组的部分缓解率为82.2%，B组为79.6%，C组为71.4%（分别为p = 0.42、p = 0.21和p = 0.11）。同样，在疼痛缓解方面，3种放疗方案之间未检测到统计学上的显著差异。
在治疗疼痛性骨转移时，双膦酸盐与姑息性放疗联合使用对疼痛缓解没有任何附加作用。此外，单次放疗分割与多次分割提供的疼痛缓解效果相同。
