Lim Fiona M Y, Bobrowski Adam, Agarwal Arnav, Silva Mauricio F
aDepartment of Oncology, Princess Margaret Hospital, Hong Kong bDivision of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Quebec cSchool of Medicine, University of Toronto, Toronto, Ontario, Canada dRadiation Oncology Unit, Hospital de Caridade Astrogildo de Azevedo eRadiation Oncology Unit, Santa Maria Federal University, Santa Maria, Brazil.
Curr Opin Support Palliat Care. 2017 Jun;11(2):78-87. doi: 10.1097/SPC.0000000000000263.
Despite a limited understanding of the exact mechanism, corticosteroids are commonly employed for pain control in patients with bone metastases. The aim of this review was to evaluate the efficacy of corticosteroid-mediated pain control in patients with bone metastases associated with solid cancers.
A literature search was conducted using OVID MEDLINE and Embase databases (from 1946 up to July 19, 2016). Studies involving patients with bone metastases receiving corticosteroids as the primary means of pain control were included. Screening and data extraction were conducted by paired reviewers, with consensus established by discussion, or a third adjudicator. A total of 12 studies were included. Rates of pain relief achieved with corticosteroid use varied from 30 to 70%, but generally reflected moderate pain control. Corticosteroid use significantly reduced the incidence of pain flare alongside radiotherapy, reportedly by almost half of baseline pain severity. Adverse events were not documented consistently across studies, though grade two to three hyperglycemia was noted in approximately 2% of patients by some studies.
Recent evidence suggests that short-term corticosteroid use may provide moderate pain and pain flare control with radiotherapy for patients with bone metastases. The risk of developing adverse effects should be carefully considered prior to therapy initiation on a case-by-case basis.
尽管对确切机制了解有限，但皮质类固醇常用于控制骨转移患者的疼痛。本综述旨在评估皮质类固醇介导的疼痛控制对实体癌相关骨转移患者的疗效。
使用OVID MEDLINE和Embase数据库（从1946年至2016年7月19日）进行文献检索。纳入以皮质类固醇作为主要疼痛控制手段的骨转移患者研究。由配对的审阅者进行筛选和数据提取，通过讨论达成共识，或由第三位裁决者进行判定。共纳入12项研究。使用皮质类固醇实现的疼痛缓解率从30%至70%不等，但总体反映为中度疼痛控制。使用皮质类固醇与放疗同时显著降低了疼痛突发的发生率，据报道几乎降低了基线疼痛严重程度的一半。尽管一些研究指出约2%的患者出现二至三级高血糖，但各研究中不良事件的记录并不一致。
近期证据表明，短期使用皮质类固醇可为骨转移患者放疗时提供中度疼痛及疼痛突发控制。在开始治疗前，应根据具体情况仔细考虑出现不良反应的风险。
