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骨轉移癌不同治療方式之比較

The Comparison of Different Radiotherapeutic Methods for Bone Metastatic Cancer

摘要


對於大部分癌病之轉移位置以骨骼組織為多且其牽涉到病人的生活品質至鉅,故對骨轉移癌之疼痛治療就顯得格外重要。以放射線作為治療主要方式而言主要有:(l)利用加速器作體外照射,其包括局部照射(local irradiation)與大範圍照射或半身照射(hemibody irradiation)。(2)以放射性藥物治療(radiopharmaceutical therapy)注射。以放射性藥物治療之藥物分屬許多,本文僅以鍶-89作討論。在目前臨床上主要是使用合適能量之光子或電子射束對病灶作治療,希望於短時間內給予高劑量以達疼痛紓解之效。半身照射為對於多處轉移病變而設計的治療方式,其為使患者接受上半身或下半身的大範圍照射。許多實驗顯示半身照射對骨轉移癌的抒解較局部照射來得好,然而其最大之缺點為造成患者的副作用過大。鍶-89為鈣之類似物(analog),可為骨轉移處所吸收。接受鍶-89治療可能造成骨髓或脊髓的毒性(marrow toxicity),故於治療時有條件上的限制。然而,與體外照射比較起來,鍶-89具有較小的副作用與較大的效果。本文對骨轉移癌之局部照射、半身照射與鍶-89治療作了一些比較,由於每一實驗的情況參數條件、觀察終點(endpoints)不盡相同,且每一患者臨床條件狀況皆不同,就臨床上而言,在治療之前應需審慎地評估患者之狀況而選擇最適合之方法作處置。

關鍵字

放射治療 鍶-89 骨轉移

並列摘要


The bone metastatic cancer and bone pain is great majority problem of the patients of latter cancer, and it will affect life quality of the patients. Hence how to improve the cases is very important. The majority way of radiation to improve the cases is: (1) Using external beam radiation therapy, included local and lager field irradiation (half-body), (2) Raiopharmaceutical therapy. We discussed with only Strontium-89 in this paper In clinical cases, the doctors select suitable energy beam to treat it, and hope give high dose in short time slot to attain pain relief The lager field irradiation was the majority way to treat multiped bone metastases, the patients could accept upper or lower half-body irradiation. The half-body irradiation was more effect of pain relief than local irradiation, but it caused more radiation side effect. Strontium-89 is analog of calcium, and greater uptake occurs in sites of bone metastases, Using strontium-89 could cause marrow toxicity. Hence there are some limits of conditions of accept strontium-89 therapy. However, Strontium-89 was lesser radiation side effect than external beam irradiation. In this paper, we discussed the relationship and different between external beam irradiation and radiophamiaceutical therapy from paper reviews. Since of the endpoints and conditions of each study were different. Hence, before to treat the patients of bone metastases should evaluate carefully the clinical conditions to select most suitable way.

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