关键词: 骨转移瘤, 锝[⁹⁹Tc]亚甲基二膦酸盐注射液, 氯化锶, Meta分析

Abstract:

Background and purpose: Bone metastatic tumor is a common disease of tumor bone metastasis, and the prognosis of patients is poor, with a variety of serious complications, including bone pain, fracture, spinal cord compression and other skeletal related events, affecting the quality of life of patients. At present, radionuclide therapy still has positive clinical effects in patients with bone metastasis, and it still plays an important role in relieving bone pain. This study aimed to evaluate the efficacy of technetium [⁹⁹Tc] methylene diphosphonate injection (⁹⁹Tc-MDP) alone or in combination with strontium chloride (⁸⁹SrCl₂) in the treatment of bone metastases. Methods: Databases were used to search for studies published between January 2000 and July 2022 on the efficacy of ⁹⁹Tc-MDP in combination with ⁸⁹SrCl₂ and ⁹⁹Tc-MDP alone in the treatment of bone metastases. All included literature was extracted and evaluated for quality, and Meta-analysis was performed using RevMan 5.3 software. Results: Twenty-seven publications met the inclusion criteria, and a total of 2564 patients were included in this study. The results demonstrated that ⁹⁹Tc-MDP combined with ⁸⁹SrCl₂ improved bone pain relief (RR=1.22, 95% CI: 1.18-1.27, P<0.001) and bone metastasis healing (RR=1.35, 95% CI: 1.25-1.47, P<0.001). However, when compared with ⁸⁹SrCl₂ alone, it could not be concluded that ⁹⁹Tc-MDP alone increased the rate of bone pain relief (RR=0.98, 95% CI: 0.90-1.06, P=0.57) and bone metastasis healing (RR=0.93, 95% CI: 0.82-1.06, P=0.27), and the difference between the two groups was not statistically significant. The common adverse effects of ⁹⁹Tc-MDP treatment alone or in combination with ⁸⁹SrCl₂ were decreased leukocyte and platelet counts, however, the difference in the incidence of adverse effects between ⁹⁹Tc-MDP treatment alone and in combination with ⁸⁹SrCl₂ was not statistically significant (⁸⁹SrCl₂ vs ⁹⁹Tc-MDP in combination with ⁸⁹SrCl₂: RR=0.83, 95% CI: 0.53-1.30, P=0.42; ⁸⁹SrCl₂ vs ⁹⁹Tc-MDP: RR=0.93, 95% CI: 0.76-1.13, P=0.45). Conclusion: ⁹⁹Tc-MDP combined with ⁸⁹SrCl₂ treatment was effective in relieving pain in patients with bone metastases, and the bone pain relief rate and bone metastasis healing rate of ⁹⁹Tc-MDP combined with ⁸⁹SrCl₂ treatment for bone metastases were better compared with the ⁸⁹SrCl₂ monotherapy group, with no significant increase in adverse reactions after typical dosing. Due to the limitations of the quality and quantity of literature included in this study, higher quality randomized controlled studies are needed.

Key words: Bone metastasis, ⁹⁹Tc-MDP, ⁸⁹SrCl₂, Meta-analysis