乳腺癌术后骨转移的治疗方法的循证医学研究

1、乳腺癌术后骨转移的治疗方法的循证医学研究同济大学在职研究生（宁波） 章丽丽 一. 疾病案例例 女性患者，43岁，左乳癌术后一年余，发现L1椎体转移一月。一年余前行“左乳癌改良根治术”，术后病理诊断：浸润性导管癌，T1N0MO，ER/PR (+),HERB-2 (-)。未经化疗及放疗。一月前因“腰痛”入院，行腰椎MRI及全身骨扫描发现L1椎体转移。诊断：左乳癌术后，伴骨转移。二.提出问题根据患者主诉、病史、检查结果，诊断明确。在化疗、放疗、内分泌治疗、磷酸盐治疗等众多治疗方法中，如何选择有效的、耐受性好的治疗方案是我们所要关注的。本案的问题是：乳腺癌术后单纯骨转移（无肺、肝等内脏转移证据）如何治

2、疗？ 检索词： breast and cancer / Metastatic Tumor Of Bone/ Theraphy OR Treatment三.证据的检索与评价（一）证据检索：这里采用COCHRANE LIBRARY和PUBMED两个数据库加以检索。(1)采用COCHRANE LIBRARY检索，检索词（Breast OR Cancer）AND (Metastatic Tumor Of Bone)AND (Theraphy OR Treatment),共检出26篇，密切相关10篇：1. The use of bone markers in a 6-week study to asse

3、ss the efficacy of oral clodronate in patients with metastatic bone disease. Brown JE, McCloskey EV, Dewar JA, Body JJ, Cameron DA, Harnett AN, Ruutu M, Purohit OP, T鋒tel?R, Coleman REYear: 2007 2. A randomized, double-blind, placebo-controlled, phase 3 trial comparing SMS 201-995 pa LAR plus tamoxi

4、fen versus tamoxifen plus placebo in women with locally recurrent or metastatic breast cancer Sommer H, Pr鰄l-Steimer B, Bajetta E, Haus U, Janni W, Kay AYear: 20013. A double blind randomized study of oral clodronate in the treatment of bone metastases from tumors poorly responsive to chemotherapy.

5、Piga A, Bracci R, Ferretti B, Sandri P, Nortilli R, Acito L, Pancotti A, Di Furia L, Carle F, Cellerino RYear: 19984. Reduction in new metastases in breast cancer with adjuvant clodronate treatment. Diel IJ, Solomayer EF, Costa SD, Gollan C, Goerner R, Wallwiener D, Kaufmann M, Bastert GYear: 19985.

6、 Predictive value of serum medroxyprogesterone acetate concentration for response in advanced or recurrent breast cancer. Nishimura R, Nagao K, Matsuda M, Baba K, Matsuoka Y, Yamashita H, Fukuda M, Higuchi A, Ikeda KYear: 19976. Antiestrogens: a new endocrine treatment possibility in metastasizing b

7、reast neoplasms. Experiences of the Swiss Cooperative Cancer Study Group with tamoxifen Jungi WF, Alberto P, Wagenknecht L, Cavalli F, Martz G, Brunner KWYear: 19787. Randomized trial of aminoglutethimide versus tamoxifen in metastatic breast cancer. Lipton A, Harvey HA, Santen RJ, Boucher A, White

8、D, Bernath A, Dixon R, Richards G, Shafik AYear: 19828. The effect of tamoxifen on bone mineral content in premenopausal women with breast cancer. Gotfredsen A, Christiansen C, Palshof TYear: 19849. Treatment of skeletal disease in breast cancer with clodronate. Paterson AH, Ernst DS, Powles TJ, Ash

9、ley S, McCloskey EV, Kanis JAYear: 199110Double-blind controlled trial of oral clodronate in patients with bone metastases from breast cancer. Paterson AH, Powles TJ, Kanis JA, McCloskey E, Hanson J, Ashley SYear: 1993(2). 采用PUBMED检索，检索：（Breast OR Cancer）AND (Metastatic Tumor Of Bone)AND (Theraphy O

10、R Treatment)，限定年限为2003.1.1到2008.12.31，共检出14篇，密切相关5篇：1. On the horizon: can bisphosphonates prevent bone metastases?Coleman R.Breast. 2007 Dec;16 Suppl 3:S21-7. Epub 2007 Nov 7. Review.2. Meta-analysis of clodronate and breast cancer survival.Ha TC, Li H.Br J Cancer. 2007 Jun 18;96(12):1796-801. Epub

11、 2007 Feb 27.3. Off-trial evaluation of bisphosphonates in patients with metastatic breast cancer.Liauw W, Segelov E, Lih A, Dunleavy R, Links M, Ward R.BMC Cancer. 2005 Jul 28;5:89.4. Increased serum interleukin-8 in patients with early and metastatic breast cancer correlates with early disseminati

12、on and survival.Benoy IH, Salgado R, Van Dam P, Geboers K, Van Marck E, Scharp S, Vermeulen PB, Dirix LY.Clin Cancer Res. 2004 Nov 1;10(21):7157-62.5. A systematic overview of radiation therapy effects in skeletal metastases.Falkmer U, Jrhult J, Wersll P, Cavallin-Sthl E.（二）证据评价： PubMed 是提供免费的MEDLINE、PREMEDLINE与其他相关数据库接入服务，MEDLINE是一个拥有1亿字条的巨大数据库。Cochrane Liberary收集了各专业小组在统一工作手册指导下完成的对各种健康干预措施所作的系统综述。分全文和研究方案。目前主要是对随机对照试验进行的系统综述。并将随着新临床试验的出现不断补充、更新。检索资料来源可靠，有很高的医学价值，并且有很多的临床验证，根据证据的类型、研究的设计、方案实施严谨性和生物学统计学的应用评价文献的可靠性，并将文献分为不同的等级。在检索时，选择PubMed和Cochr