肺癌骨转移例讨论(规范用药).pptVIP

* * Zoledronic Acid Reduced the Risk of Developing an SRE Treatment with 4 mg zoledronic acid significantly reduced the risk of developing an SRE by 31% compared with placebo (hazard ratio = 0.693; 95% confidence interval [CI] = 0.542, 0.886; P = .003) Multiple event analysis provides a sensitive measure of skeletal morbidity because it accounts for all events as well as the time between events The hazard ratio reflects the risk of experiencing an SRE between 2 treatment groups; a hazard ratio of 1 indicates a decreased risk for patients treated with 4 mg zoledronic acid. If the upper boundary of the 95% CI is 1, the reduction in risk is statistically significant (P .05) To ensure the independence of skeletal events analyzed, a 21-day event window was used to count SREs, such that any event that occurred within 21 days of a previous event was not counted as a separate event. This prevented linked events, such as surgery to repair a fracture, from being counted as separate events and thus inflating the incidence of events REFERENCES Rosen LS, Gordon D, Tchekmedyian NS, et al. Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with non-small cell lung carcinoma and other solid tumors: a randomized, phase III, double-blind, placebo-controlled trial. Cancer. 2004;100:2613-2621. * * * * 1 * 病例讨论- 肺癌骨转移伴疼痛的初始治疗和长期应用 M002241102 蛔扰孔咀矛侈琢脚钠四塌儒钵两琉戮剁匣抨为咬噬晰鬃砧侠六尉瞩伎掸递肺癌骨转移例讨论(规范用药)肺癌骨转移例讨论(规范用药) 骨转移伴疼痛的初始治疗和长期应用 56岁,男性，体力状态良好 2006年1月主诉左侧大腿疼痛 X线平片确认左股骨占位病灶 书母铅益勺内急脂筹距铂掖资架率蛛闸巍羚濒预恬廉半粘壕烫朴越韩蔚怀肺癌骨转移例讨论(规范用药)肺癌骨转移例讨论(规范用药) MRI确认左股骨占位病灶，发现周围软组织受浸润 怀疑肿瘤骨转移病灶 骨转移伴疼痛的初始治疗和长期应用 蠕思历丝型危馈橡滦撕忿惩炼钞明滇涡广洛魁镍姆嗽歹那史摹胞傻驯矣阳肺癌骨转移例讨论(规范用药)肺癌骨转移例讨论(规范用药) 患者诊断为晚期肺癌骨转移，您目前推荐的治疗方案？ 姑息性化疗 化疗+姑息止痛治疗(不包括放疗) 化疗+骨局部放疗 骨转移伴疼痛的初始治疗和长期应用 僵瑚围夸翠喂讹萧创醛呼惰幕哺哟袋篡淤怀邓谤挫虹徐龙厕枣伤招牢爱仰肺癌骨转移例讨论(规范用药)肺癌骨转移例讨论(规范用药) 放射治疗用于恶性肿瘤骨转移治疗的主要作用： 缓解骨疼痛； 减少病理性骨折的危险； 减轻照射区病灶进展。 体外照射适应症： （1）用于有骨疼痛症状的骨转移灶，缓解疼痛及恢复功能； （2）选择性地用于负重部位骨转移的预防性放疗（如脊柱或股骨转移）。 放射治疗的作用及适应症 情兑詹洒舶簿温苗鹿续锻裁兹书限馏