Brouns Anita J W M, De Bie Ben H, van den Beuken-van Everdingen Marieke H J, Dingemans Anne-Marie C, Hendriks Lizza E L
Department of Pulmonary Diseases, Zuyderland Medical Center, Sittard-Geleen, Netherlands.
Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands.
Front Oncol. 2020 Oct 22;10:509297. doi: 10.3389/fonc.2020.509297. eCollection 2020.
Cancer induced bone pain (CIBP) is frequent in patients with non-small cell lung cancer (NSCLC). Radiation therapy continues to be the gold standard for treatment of painful bone metastases, however only a limited number of metastases can be irradiated. We evaluated non-radiation based early CIBP relief options in NSCLC through a systematic review.
Systematic review including all prospective articles published between 01-1994 and 06-2020 on Pubmed, Cochrane Library and ClinicalTrials.gov database. Inclusion: non-radiation based trials evaluating CIBP early pain relief options (initially defined as pain score evaluated within two weeks, because of no randomized trials, later inclusion broadened to pain score evaluated within six weeks) in ≥10 NSCLC patients. Radioisotope trials were excluded as these treatments have interactions with systemic anticancer therapy.
188 articles were found; 10 articles (6 randomized controlled (4 double blinded), 1 phase II single-arm, and 3 prospective trials) fulfilled the inclusion criteria. Six of these trials consisted of ≥2 treatment arms, whereas the others were single-arm studies. In total, 554 NSCLC patients were evaluated in these trials. The included trials were very heterogeneous regarding evaluated treatment options, methods of pain measuring, and endpoints. No high-level evidence for specific early pain relief treatment options was found.
Non-radiation based studies evaluating treatment options to rapidly reduce CIBP in NSCLC are scarce. This systematic review shows that there is no high-level evidence to recommend a specific treatment for early pain relief. Future research should focus on early pain relief treatment options for CIBP in NSCLC.
癌症诱发的骨痛（CIBP）在非小细胞肺癌（NSCLC）患者中很常见。放射治疗仍然是治疗疼痛性骨转移的金标准，然而，能够接受照射的转移灶数量有限。我们通过系统评价评估了非放射疗法缓解NSCLC早期CIBP的选择。
系统评价包括1994年1月至2020年6月在PubMed、Cochrane图书馆和ClinicalTrials.gov数据库上发表的所有前瞻性文章。纳入标准：在≥10例NSCLC患者中评估基于非放射疗法的CIBP早期疼痛缓解选择（最初定义为在两周内评估疼痛评分，由于没有随机试验，后来纳入范围扩大到六周内评估疼痛评分）。放射性同位素试验被排除，因为这些治疗与全身抗癌治疗有相互作用。
共检索到188篇文章；10篇文章（6项随机对照试验（4项双盲试验）、1项II期单臂试验和3项前瞻性试验）符合纳入标准。其中6项试验包含≥2个治疗组，其他为单臂研究。这些试验共评估了554例NSCLC患者。纳入试验在评估的治疗选择、疼痛测量方法和终点方面差异很大。未发现关于特定早期疼痛缓解治疗选择的高级别证据。
评估快速减轻NSCLC患者CIBP的非放射疗法的研究很少。本系统评价表明，没有高级别证据推荐特定的早期疼痛缓解治疗方法。未来的研究应聚焦于NSCLC患者CIBP的早期疼痛缓解治疗选择。
