课件：乳腺癌骨转移及双磷酸盐的应用.ppt

* 可手术乳腺癌口服固令辅助治疗能减少骨转移并改善生存率1069名I-III期乳腺癌患者在进行常规初治后随机分入两组,分别口服固令1600mg/d或安慰剂共两年，５年随诊表明口服固令可降低骨转移的发生，对II/III期患者这一效果尤其显著，骨转移的风险减少了41%。Reduction in bone relapse and improved survival with oral clodronate for adjuvant treatment of operable breast cancer [ISRCTTrevor Powles1 , Alexander Paterson2 , Eugene McCloskey3 , Phil Schein4 , Bobbi Scheffler5 , Alwynne Tidy6, Sue Ashley6 , Ian Smith6 , Lars Ottestad7 and John Kanis31Parkside Oncology, London, UK2Tom Baker Cancer Centre, Calgary, Alberta, Canada3WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK4Department of Clinical Pharmacology, University of Oxford, Oxford, UK5Scheffler Group, Villanova, Pennsylvania, USA6Royal Marsden Hospital, London, UK7Radium Institute, Oslo, Norway Breast Cancer Research 2006, 8:R13  INTRODUCTION: Experimental and clinical data show that the oral bisphosphonate clodronate (Bonefos) can inhibit tumor-induced osteoclastic bone resorption. This randomized, double-blind, placebo-controlled, multicenter trial was designed to determine if the addition of oral clodronate to standard treatment for primary operable breast cancer could reduce the subsequent occurrence of bone metastases and thereby improve overall survival. METHODS: 1,069 patients with primary operable stage I-III breast cancer were randomized to receive oral clodronate (1,600 mg/day) or placebo for 2 years, in conjunction with standard treatment for primary breast cancer including surgery, radiotherapy, adjuvant chemotherapy, and/or tamoxifen. All patients were assessed for bone metastases at two and five years and additionally when clinically indicated. Survival status was determined as of the close of the study on 30 June 2000 with a median follow up of 5.6 years. The treatment arms were compared using the unstratified log-rank test. Hazard ratios (HRs) with 95% confidence intervals were calculated. RESULTS: Oral clodronate significantly reduced th