脊柱转移癌治疗策略.ppt

T1T2T1+C术前MR*I期术后*L2L1L3II期手术*II期手术*II期手术*II期手术*II期手术*II期I期术前****.双膦酸盐可抑制破骨细胞活性，进而阻止骨质的吸收，现已证明有效延缓乳腺癌患者骨转移骨骼相关事件（SREs）的发生。唑来膦酸是双膦酸盐中在治疗前列腺癌骨转移疗效较为肯定。抗RANKL的抗体Denosumab在预防和延缓前列腺癌和乳腺癌患者发生骨转移的SREs方面更有优越性。无论是双膦酸还是Denosumab，对骨转移癌患者总生存期都没有显著影响，而据小规模Ⅰ/Ⅱ期试验报道镭223氯化物对患者的生存期显着的影响，可有效降低去势治疗无效的前列腺癌患者的死亡率。放疗可有效缓解局部疼痛，有利于肿瘤的局部控制，但对于放疗的时机仍有一定的争论，而且放疗不能有效预防椎体的进行性塌陷。全身化疗可以对原发瘤本身进行治疗，同时能有效地消灭亚临床病灶，减少肿瘤复发和转移。目前多主张行多药联合化疗以提高疗效，尽量降低肿瘤耐药性。Skeletal-relatedevents(SREs)areaninevitableconsequenceofbonemetastasiswithadetrimentalimpactonpatients’survivalandqualityoflife..Variousbisphosphonates(first-andsecond-generation)demonstratedefficacyinpreventinganddelayingtheoccurrenceofSREsinbreastcancerpatientswithbonemetastases..Zoledronicacidistheonlybisphosphonateapprovedfortreatmentofprostatecancerpatientswithbonemetastases..Denosumab,ananti-RANKLantibody,demonstratedsuperiorityoverzoledronicacidinpreventinganddelayingSREsinpatientswithprostateandbreastcancerthatdevelopedbonemetastases..Neitherbisphosphonatesnordenosumabdemonstratedasignificantpositiveimpactonoverallsurvivalofcancerpatientswithbonemetastases..Alpharadin(radium-223chloride),abone-seekingalphaemitter,isthefirstbone-modifyingagenttodemonstrateasignificantimpactonsurvivalofpatientswithbonemetastasesfromcastration-resistantprostatecancer.*****骨水泥的价值*PMMA-毒有细胞毒性，杀灭肿瘤细胞和感痛神经末梢与无水酒精类似;PMMA单体对乳腺癌细胞具有细胞毒作用;体外细胞培养，对肝细胞、神经元、单核细胞有毒性作用;DahlOE.Toxiceffectsofmethylmethacrylatemonomeronleukocytesandendothelialcellsinvitro.ActaOrthopScand,1994,65(2):147-153.BereznowskiZ.IntJBiochemCellBiol.1994,26(9):1119-1127RadinEL.Changesinthebonecementinterfaceaftertotalhipreplacement.Aninvivoanimalstudy[J].JBoneJointSurg,1982,64(8):1188-1200.*PMMA-热聚合时放出大量热，可杀灭肿瘤细胞San通过1例骨水泥成形术后6个月尸检病例发现灌注剂填充病灶内的肿瘤细胞几乎全部坏死,灌注剂周缘有3～11mm宽的肿瘤