Portmann L, Häfliger J M, Bill G, Burckhardt P
Schweiz Med Wochenschr. 1983 Dec 24;113(51):1960-3.
The treatment of tumour-induced hypercalcemia (HCa) by diphosphonates appears to be safe and reliable with very mild side effects. We have tested APD as sole treatment in 14 patients with cancer and symptomatic HCa. APD was given i.v. in a dose of 0.38 +/- 0.03 mg/kg BW/day until two subsequent normal plasma calcium (Ca) levels were obtained (Ca determined daily). The mean duration of treatment was 5.56 +/- 1.9 (4 to 11 days). As expected, there was a significant correlation between initial Ca and duration of therapy (p less than 0.001). Mean Ca fell from 3.38 +/- 0.19 mmol/l before APD to 2.43 +/- 0.09 after 4 days of treatment and remained normal four weeks after the start of treatment. Four patients relapsed 11 to 31 days after the end of treatment during a one-month follow-up. This recurrence did not depend on initial Ca, length of treatment and duration of remission. Two of these patients were treated successfully with a second course of APD, while in the other two no further treatment was undertaken. Both mean UCa and UHydroxyproline decreased significantly when measured seven days after the beginning of the treatment. Plasma PTH values remained in the normal range, while NcAMP rose significantly after a week of treatment from low to normal values. Plasma phosphorus decreased significantly (p less than 0.005) during the treatment while TRP % increased, suggesting a positive phosphorus balance. We conclude that short treatments with APD of tumour-induced HCa are effective and sufficiently sustained, even if they are interrupted as soon as normal Ca is obtained.
双膦酸盐治疗肿瘤引起的高钙血症（HCa）似乎安全可靠，副作用非常轻微。我们对14例患有癌症且有症状性HCa的患者进行了单独使用氨羟二磷酸二钠（APD）的治疗测试。APD通过静脉注射给药，剂量为0.38±0.03mg/kg体重/天，直至获得两次连续的正常血浆钙（Ca）水平（每天测定Ca）。平均治疗持续时间为5.56±1.9（4至11天）。正如预期的那样，初始Ca与治疗持续时间之间存在显著相关性（p<0.001）。平均Ca在APD治疗前为3.38±0.19mmol/l，治疗4天后降至2.43±0.09，治疗开始四周后仍保持正常。4例患者在治疗结束后的11至31天的1个月随访期间复发。这种复发不取决于初始Ca、治疗时间和缓解持续时间。其中2例患者通过第二疗程的APD成功治疗，而另外2例未进行进一步治疗。治疗开始7天后测量时，平均尿钙（UCa）和尿羟脯氨酸均显著下降。血浆甲状旁腺激素（PTH）值保持在正常范围内，而治疗一周后，尿环磷腺苷（NcAMP）从低值显著升至正常值。治疗期间血浆磷显著下降（p<0.005），而肾小管磷重吸收率（TRP%）增加，提示磷平衡为正。我们得出结论，即使一旦获得正常Ca就立即中断治疗，用APD短期治疗肿瘤诱导的HCa也是有效的且维持时间足够。
