Bloomfield D J
Department of Medicine, Princess Margaret Comprehensive Cancer Centre and University of Toronto, Canada.
J Clin Oncol. 1998 Mar;16(3):1218-25. doi: 10.1200/JCO.1998.16.3.1218.
To review objectively the evidence for the use of bisphosphonates for the reduction of skeletal events or the management of pain due to multiple myeloma or bone metastases from other types of cancer.
MEDLINE was searched from 1976 onwards using the MeSH terms "exp diphosphonates/," "exp bone neoplasms/," "exp multiple myeloma/," and "bone metastases" as text words. Bibliographies of reports on these topics and major medical and scientific journals were searched. Experts in the field were approached. The question was defined and the evidence stratified in a hierarchical manner according to classification of study design. There were sufficient studies to enable the use of randomized trials only to address the questions. Effectiveness was defined and the evidence reviewed in a systematic manner.
Eighteen randomized trials were identified. No meta-analyses are available. There is level I evidence (defined as an appropriately conducted randomized clinical trial with a statistically significant result) for the use of bisphosphonates to reduce both skeletal events and pain in multiple myeloma and in breast cancer patients with metastatic bone disease. There is also level I evidence for their use as part of a pain management program for bone metastases from carcinoma of the breast, lung, and prostate, and for symptomatic myeloma. The bisphosphonates appear to be well tolerated.
客观回顾使用双膦酸盐类药物减少骨骼相关事件或治疗多发性骨髓瘤或其他类型癌症骨转移所致疼痛的证据。
从1976年起使用医学主题词“双膦酸盐类/”、“骨肿瘤/”、“多发性骨髓瘤/”以及文本词“骨转移”检索MEDLINE。检索了关于这些主题的报告的参考文献以及主要医学和科学期刊。联系了该领域的专家。明确了问题，并根据研究设计分类以分层方式对证据进行了整理。有足够的研究使得仅能使用随机试验来解决这些问题。定义了有效性并以系统方式对证据进行了回顾。
共识别出18项随机试验。尚无荟萃分析。有I级证据（定义为进行得当且结果具有统计学显著性的随机临床试验）表明，双膦酸盐类药物可减少多发性骨髓瘤以及有骨转移的乳腺癌患者的骨骼相关事件和疼痛。也有I级证据表明，双膦酸盐类药物可用作乳腺癌、肺癌和前列腺癌骨转移以及有症状的骨髓瘤疼痛管理方案的一部分。双膦酸盐类药物似乎耐受性良好。
