Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK.
Department of Orthopaedics, University Hospitals of Leicester, Leicester, UK.
Clin Oncol (R Coll Radiol). 2020 Nov;32(11):728-744. doi: 10.1016/j.clon.2020.07.010. Epub 2020 Aug 1.
Bone is a common site of metastases in advanced cancers. The main symptom is pain, which increases morbidity and reduces quality of life. The treatment of bone metastases needs a multidisciplinary approach, with the main aim of relieving pain and improving quality of life. Apart from systemic anticancer therapy (hormonal therapy, chemotherapy or immunotherapy), there are several therapeutic options available to achieve palliation, including analgesics, surgery, local radiotherapy, bone-seeking radioisotopes and bone-modifying agents. Long-term use of non-steroidal analgesics and opiates is associated with significant side-effects, and tachyphylaxis. Radiotherapy is effective mainly in localised disease sites. Bone-targeting radionuclides are useful in patients with multiple metastatic lesions. Bone-modifying agents are beneficial in reducing skeletal-related events. This overview focuses on the role of surgery, including minimally invasive treatments, conventional radiotherapy in spinal and non-spinal bone metastases, bone-targeting radionuclides and bone-modifying agents in achieving palliation. We present the clinical data and their associated toxicity. Recent advances are also discussed.
骨是晚期癌症转移的常见部位。主要症状是疼痛，这增加了发病率并降低了生活质量。骨转移的治疗需要多学科方法，主要目的是缓解疼痛和提高生活质量。除了全身抗癌治疗（激素治疗、化疗或免疫治疗）外，还有多种治疗选择可实现缓解，包括镇痛药、手术、局部放疗、骨靶向放射性同位素和骨修饰剂。长期使用非甾体类镇痛药和阿片类药物会产生严重的副作用和快速耐受。放疗主要对局部病变部位有效。骨靶向放射性核素对多发性转移病灶患者有用。骨修饰剂可减少与骨骼相关的事件。本综述重点介绍了手术的作用，包括微创治疗、脊柱和非脊柱骨转移的常规放疗、骨靶向放射性同位素和骨修饰剂在缓解疼痛方面的作用。我们介绍了临床数据及其相关毒性。还讨论了最近的进展。
