D'angelo G, Sciuto R, Salvatori M, Sperduti I, Mantini G, Maini C L, Mariani G
Nuclear Medicine, Catholic University, Rome, Italy.
Q J Nucl Med Mol Imaging. 2012 Dec;56(6):538-43.
The aim of the study was to assess the state of the art of the use of bone-seeking radiopharmaceuticals for palliation therapy of pain from bone metastases.
A systematic literature search was conducted about therapy with 89Sr-chloride and 153Sm-EDTMP between 2001-2011. The primary outcomes were efficacy and toxicity. Descriptive and quantitative data were extracted from each study, calculating event rates and odds ratio (OR) with 95% confidence intervals (CI) for pooled analysis. Subgroup analyses were performed.
Fifty-seven studies contributed to the systematic review. Forty-six studies used radiopharmaceuticals as a single agent, 15 investigated therapeutic combinations. Most of the studies included patients with prostate cancer. The overall efficacy of bone-seeking radiopharmaceuticals as single agents was 70%, whereas it was 74% when used in combination with other therapies. Complete response was reported in 27% of patients. Efficacy resulted to be 70% for prostate cancer and 79% for breast cancer. The overall toxicity of radiopharmaceuticals was 15%: the toxicity was 11% selecting only studies reporting on the use of radiopharmaceuticals as a single agent. No significant difference was found between bone-seeking radiopharmaceuticals and other oncological treatments regarding efficacy or toxicity. Reports of objective response outcomes suggest that bone-seeking radiopharmaceuticals have some cytotoxic activity, either alone or combination with chemotherapy.
This literature analysis emphasizes multiple evidences of high efficacy and low toxicity of bone seeking radiopharmaceuticals; moreover, this therapy may have a therapeutic potential beyond simple palliation of bone pain.
本研究旨在评估用于骨转移疼痛姑息治疗的亲骨性放射性药物的应用现状。
对2001年至2011年间使用氯化锶-89和依替膦酸二钠-153进行治疗的相关文献进行系统检索。主要结局指标为疗效和毒性。从每项研究中提取描述性和定量数据，计算事件发生率和比值比（OR）以及95%置信区间（CI）用于汇总分析。进行亚组分析。
57项研究纳入了该系统评价。46项研究将放射性药物作为单一药物使用，15项研究调查了治疗组合。大多数研究纳入了前列腺癌患者。亲骨性放射性药物作为单一药物的总体疗效为70%，而与其他疗法联合使用时为74%。27%的患者报告有完全缓解。前列腺癌的疗效为70%，乳腺癌为79%。放射性药物的总体毒性为15%：仅选择报告将放射性药物作为单一药物使用的研究时，毒性为11%。在疗效或毒性方面，亲骨性放射性药物与其他肿瘤治疗方法之间未发现显著差异。客观反应结局的报告表明，亲骨性放射性药物单独或与化疗联合使用具有一定的细胞毒性活性。
该文献分析强调了亲骨性放射性药物具有高效低毒的多项证据；此外，这种治疗可能具有超越单纯缓解骨痛的治疗潜力。
