Robinson R G, Preston D F, Schiefelbein M, Baxter K G
Department of Radiology, University of Kansas Medical Center, Kansas City 66160-7234, USA.
JAMA. 1995 Aug 2;274(5):420-4.
To present the current state of systemic radiopharmaceutical therapy for the palliation of pain in individuals with metastatic cancer and to evaluate the palliative effect and degree of hemotoxicity of strontium chloride 89 (89Sr) in patients with painful osteoblastic metastases primarily from prostate and breast cancer.
A MEDLINE search through December 1994 was performed to identify English-language studies that met the following criteria. All eligible studies reported treatment of patients with painful osteoblastic bony metastases primarily from prostate or breast cancer treated with intravenous 89Sr. For study eligibility, evaluation of clinical response as assessed by the Karnofsky index, need for pain medication, or changes in mobility or sleep patterns was required. Hemotoxicity data were a requirement. A minimum of 10 prostate cancer cases was necessary for study inclusion. Only those studies assessing clinical response following one injection of 89Sr were included. Preliminary reports of cooperative studies were not included. Doses of 89Sr ranged from 0.6 MBq/kg (16 microCi/kg) to 400 MBq (10.8 mCi) per patient. Evaluation of patients for at least 3 months following 89Sr treatment was required. In addition, two studies examining issues of cost with regard to 89Sr treatment were identified.
Baseline pain assessment and periodic pain estimates as measured by the Karnofsky index, medication diaries, changes in mobility, sleep patterns, and/or ability to work were the basis for assessment of response. Baseline and periodic complete blood cell counts were the basis for hemotoxicity evaluation.
Palliation and hemotoxicity data were analyzed separately for each study. Some improvement occurred in as many as approximately 80% of patients. Several studies demonstrated complete relief of pain in at least 10% of patients The nadir of platelet and white blood cell counts appears at approximately 4 to 8 weeks following injection, with a partial return to baseline by 12 weeks. As many as 10 injections spaced 3 months apart have been given to some patients with repeated palliative effect and without serious hemotoxicity. Reinjection may be limited by a platelet count below 60 x 10(9)/L, a white blood cell count below 2.4 x 10(9)/L, or the absence of osteoblastic skeletal metastasis as seen on bone scan. Studies examining treatment costs suggest that 89Sr may decrease costs associated with palliation of pain due to metastatic disease.
As many as 80% of selected patients with painful osteoblastic bony metastases from prostate or breast cancer may experience some pain relief following 89Sr administration. In addition, as many as 10% or more may become pain free. Duration of clinical response may average 3 to 6 months in some cases. Hemotoxicity is mild. A decrease in treatment costs with administration of 89Sr to patients with painful osteoblastic bony metastases from prostate cancer may occur. These observations reflect the preliminary nature of knowledge in this field and point to the need for larger clinical trials of the use of 89Sr palliation.
介绍用于缓解转移性癌症患者疼痛的全身放射性药物治疗的现状，并评估氯化锶89（89Sr）对主要源于前列腺癌和乳腺癌的成骨性骨转移疼痛患者的姑息治疗效果及血液毒性程度。
对截至1994年12月的MEDLINE进行检索，以确定符合以下标准的英文研究。所有符合条件的研究均报告了主要源于前列腺癌或乳腺癌的成骨性骨转移疼痛患者接受静脉注射89Sr治疗的情况。为符合研究条件，需要通过卡诺夫斯基指数评估临床反应，评估对止痛药物的需求，或评估活动能力或睡眠模式的变化。血液毒性数据是必需的。纳入研究至少需要10例前列腺癌病例。仅纳入那些评估单次注射89Sr后临床反应的研究。不包括合作研究的初步报告。每位患者的89Sr剂量范围为0.6 MBq/kg（16微居里/千克）至400 MBq（10.8毫居里）。要求在89Sr治疗后对患者进行至少3个月的评估。此外，还确定了两项研究89Sr治疗成本问题的研究。
以卡诺夫斯基指数测量的基线疼痛评估和定期疼痛估计、用药日记、活动能力、睡眠模式和/或工作能力的变化作为评估反应的基础。基线和定期全血细胞计数是血液毒性评估的基础。
对每项研究分别分析姑息治疗和血液毒性数据。多达约80%的患者出现了一些改善。几项研究表明至少10%的患者疼痛完全缓解。血小板和白细胞计数最低点出现在注射后约4至8周，到12周时部分恢复至基线水平。一些患者间隔3个月进行了多达10次注射，具有重复的姑息治疗效果且无严重血液毒性。血小板计数低于60×10⁹/L、白细胞计数低于2.4×10⁹/L或骨扫描显示无成骨性骨转移时可能限制再次注射。研究治疗成本的研究表明，89Sr可能降低与转移性疾病疼痛缓解相关的成本。
多达80%的经选择的主要源于前列腺癌或乳腺癌的成骨性骨转移疼痛患者在接受89Sr治疗后可能会有一些疼痛缓解。此外，多达10%或更多的患者可能不再疼痛。在某些情况下，临床反应持续时间平均可能为3至6个月。血液毒性较轻。对主要源于前列腺癌的成骨性骨转移疼痛患者使用89Sr治疗可能会降低治疗成本。这些观察结果反映了该领域知识的初步性质，并表明需要对89Sr姑息治疗进行更大规模的临床试验。
