锝[99Tc]亚甲基二膦酸盐注射液单药及联合89SrCl2治疗骨转移瘤效果的meta分析

doi:10.19401/j.cnki.1007-3639.2023.08.004

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (8): 751-767.doi: 10.19401/j.cnki.1007-3639.2023.08.004

锝[⁹⁹Tc]亚甲基二膦酸盐注射液单药及联合⁸⁹SrCl₂治疗骨转移瘤效果的meta分析

陈满¹(), 曾飞燕¹, 李青青¹, 李宏丹¹, 林岩松², 冯萍¹()

1.四川大学华西医院临床试验中心/国家药物临床试验机构/国家药品监督管理局创新药物临床研究与评价重点实验室，四川成都，610041
2.中国医学科学院北京协和医院核医学科，北京 100730

收稿日期:2023-03-21 修回日期:2023-06-30 出版日期:2023-08-30 发布日期:2023-09-01
通信作者: 冯萍（ORCID：0000-0001-5488-0814），主任医师，四川大学华西医院临床试验中心副主任。
作者简介:陈满（ORCID：0000-0001-7030-9968），四川大学华西临床医学院在读硕士研究生。

A meta-analysis of the efficacy of ⁹⁹Tc-MDP alone and in combination with ⁸⁹SrCl₂ in the treatment of bone metastases

CHEN Man¹(), ZENG Feiyan¹, LI Qingqing¹, LI Hongdan¹, LIN Yansong², FENG Ping¹()

1. National Medical Products Administration Key Laboratory for Clinical Research and Evaluation of Innovative Drugs, Institute of Clinical Trials, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
2. Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing100730, China

Received:2023-03-21 Revised:2023-06-30 Published:2023-08-30 Online:2023-09-01
Contact: FENG Ping

摘要/Abstract

摘要：

背景与目的：骨转移瘤是常见的肿瘤骨转移疾病，且患者预后较差，常会合并多种严重并发症，包括骨痛、骨折、脊髓压迫等骨相关事件（skeletal-related event，SRE），影响患者的生活质量。放射性核素治疗对骨转移患者具有较好的效果，可以明显地缓解骨痛。本研究旨在评价锝[⁹⁹Tc]亚甲基二膦酸盐注射液（⁹⁹Tc-MDP）单用或联合氯化锶（⁸⁹SrCl₂）治疗骨转移瘤的疗效。方法：数据库检索公开发表在2000年1月—2022年7月的关于⁹⁹Tc-MDP联合⁸⁹SrCl₂及单用⁹⁹Tc-MDP治疗骨转移瘤疗效的研究报道，对所有纳入的文献进行资料提取和质量评价，采用Revman 5.3软件进行meta分析。结果：27篇文献符合纳入标准，共2 564例患者纳入本研究。结果显示，与⁸⁹SrCl₂单药组比较，⁹⁹Tc-MDP联合⁸⁹SrCl₂可提高骨转移瘤患者的骨痛缓解率（RR=1.22，95% CI：1.18~1.27，P<0.001），骨转移灶愈合率（RR=1.35，95% CI：1.25~1.47，P<0.001）；单用⁹⁹Tc-MDP与⁸⁹SrCl₂单药组相比，骨痛缓解率（RR=0.98，95% CI：0.90~1.06，P=0.57）及骨转移灶愈合率（RR=0.93，95% CI：0.82~1.06，P=0.27），差异无统计学意义。⁹⁹Tc-MDP单用或联合⁸⁹SrCl₂治疗的常见不良反应为白细胞、血小板计数降低，但单用或者联合使用不良反应发生率差异无统计学意义（单用⁸⁹SrCl₂ vs ⁹⁹Tc-MDP联合⁸⁹SrCl₂：RR=0.83，95% CI：0.53~1.30，P=0.42；单用⁸⁹SrCl₂ vs 单用⁹⁹Tc-MDP：RR=0.93，95% CI：0.76~1.13，P=0.45）。结论：⁹⁹Tc-MDP联合⁸⁹SrCl₂治疗能够有效地缓解骨转移瘤患者的疼痛，其骨转移瘤的骨痛缓解率及骨转移灶愈合率均优于⁸⁹SrCl₂单药治疗组，且不良反应未明显增加。由于本研究在纳入文献质量及数量等方面存在局限性，故今后需要更高质量的随机对照研究验证。

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

中图分类号:

R730.53

陈满, 曾飞燕, 李青青, 李宏丹, 林岩松, 冯萍. 锝[⁹⁹Tc]亚甲基二膦酸盐注射液单药及联合⁸⁹SrCl₂治疗骨转移瘤效果的meta分析[J]. 中国癌症杂志, 2023, 33(8): 751-767.

CHEN Man, ZENG Feiyan, LI Qingqing, LI Hongdan, LIN Yansong, FENG Ping. A meta-analysis of the efficacy of ⁹⁹Tc-MDP alone and in combination with ⁸⁹SrCl₂ in the treatment of bone metastases[J]. China Oncology, 2023, 33(8): 751-767.

图/表 14

图 1

表1

纳入文献基本情况"

Study/published year	Cancer	Evaluation	Group	Mean age/year	Gender (female)	Case n	Treatment	AE
Sang S B, et al^[28]2001	Lung cancer, prostate cancer, breast cancer, nasopharyngeal cancer, rectal cancer, and cancers of unknown origin	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	55.0	41.2%	38	⁸⁹SrCl₂ 150 MBq, 5 patients received a second injection, all with an interval of more than 3-6 months	White blood cells and platelets decreased slightly in some patients, most of which occurred 4-8 weeks after treatment, but they all recovered to the pre-treatment level during follow-up. Transient pain intensification occurred in very few patients after treatment, and most of them disappeared after 3 to 7 days of treatment
Sang S B, et al^[28]2001		Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂	55.0	41.2%	30	⁸⁹SrCl₂ 150 MBq, ⁹⁹Tc-MDP 200 mg/d, 5d as a course, 2-3 courses
Zhong G P, et al^[39]2002	Prostate cancer, kidney cancer, bladder cancer, testicular cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	60.9	15.2%	16	⁸⁹SrCl₂ 1.48-2.22 MBq/kg	Transient bone pain was aggravated in some patients after treatment, which was relieved with painkillers and gradually alleviated 2-4 days later. A small number of cases showed hematological grade Ⅰ to Ⅱ toxic reactions. White blood cell count and platelet count decreased 1-2 weeks later, and decreased to the lowest level (lower limit of normal value) in 1 month, then gradually recovered to the pre-treatment level within 2-5 weeks
			⁹⁹Tc-MDP			9	⁹⁹Tc-MDP 200 mg/d, 5 d as a course. The second course of treatment was performed at an interval of 10 d, 4 courses
			⁹⁹Tc-MDP+⁸⁹SrCl₂			8	One course of ⁹⁹Tc-MDP by intravenous drip, followed by one dose of ⁸⁹SrCl₂ by intravenous injection after 3 to 5 d
Mo Y, et al^[24]2004	Breast cancer, lung cancer, prostate cancer and other malignancies	Rate of relief of bone pain	⁸⁹SrCl₂	56.0	41.2%	51	⁸⁹SrCl₂ 111-148 MBq (3-4 mci), every 3 to 6 months	No serious toxic and side effects were observed in both groups. After treatment with ⁸⁹SrCl₂, a small number of patients showed inhibition of bone marrow. hematopoietic function, manifested by decreased white blood cell and platelet counts. It will return to normal in about 4 to 6 weeks. There was no obvious damage to liver and kidney function
	Breast cancer, lung cancer, nasopharyngeal cancer and other malignant tumors		⁹⁹Tc-MDP+⁸⁹SrCl₂	50.0	59.3%	54	⁸⁹SrCl₂ 111-148 MBq (3-4 mci), every 3 to 6 months; ⁹⁹Tc-MDP 200 mg/d, 5 d as a course
Li J G, et al^[20]2004	Breast cancer, lung cancer, prostate cancer, esophageal cancer, cardiac cancer, cervical cancer, nasopharyngeal cancer, rectal cancer, liver cancer and others	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	Male 56.5 Female 50.5	46.2%	55	⁸⁹SrCl₂ 130-174 MBq	In terms of liver function, 14 patients showed increased single index
Li J G, et al^[20]2004		Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂	Male 56.5 Female 50.5	46.2%	51	⁸⁹SrCl₂ 130-174 MBq. After 20 d, injecting ⁹⁹Tc-MDP 200 mg intravenously for more than 3 h, 5 days as a course of treatment; or 3 h intravenously for 10 days as a course of treatment. One course of treatment per month for 2 to 3 consecutive courses.	In terms of liver function, 12 patients showed increased single index
Shi G Q, et al^[30]2006	Prostate cancer, lung cancer, breast cancer, rectal cancer and malignancies of unknown primary	Rate of relief of bone pain	⁸⁹SrCl₂	62.3	33.3%	24	⁸⁹SrCl₂ 2.6 MBq/kg.	In blood images, mildly affected: 18, moderately affected: 4, severely affected: 2
Shi G Q, et al^[30]2006		Rate of relief of bone pain	⁹⁹Tc-MDP+⁸⁹SrCl₂	58.6	20.8%	24	⁸⁹SrCl₂ 2.6 MBq/kg; ⁹⁹Tc-MDP 5 mg/d	In blood images, mildly affected: 17, moderately affected: 4, severely affected: 3
Shi F, et al^[29]2006	Breast cancer, lung cancer, prostate cancer, and other malignancies	Rate of relief of bone pain	⁸⁹SrCl₂	50.0	40.8%	71	⁸⁹SrCl₂ 1.48-2.22 MBq/kg (40-60 uci)	No serious side effects were observed. Bone pain was aggravated in a small number of patients 2-4 days after treatment, but no special treatment was done. A few patients showed inhibition of bone marrow hematopoietic function, leukocyte and platelet decline, about 4-6 weeks later returned to normal, no significant damage to liver and kidney function
Shi F, et al^[29]2006	Breast cancer, lung cancer, nasopharyngeal cancer and other malignant tumors.		⁹⁹Tc-MDP+⁸⁹SrCl₂	47.0	55.4%	74	⁸⁹SrCl₂ 1.48-2.22 MBq/kg (40-60 uci); ⁹⁹Tc-MDP 200 mg/d, 5 days for a course
Ren H, et al^[27]2008	Lung cancer, breast cancer, prostate cancer, rectal cancer, stomach cancer	Rate of relief of bone pain	⁸⁹SrCl₂	67.2	38.7%	31	⁸⁹SrCl₂ 1.48-2.22 MBq/kg, once every 3 months	In the two groups, 22.5% and 24.2% of the cases had grade Ⅰ -Ⅱ leukopenia, and 16.1% and 21.2% of the cases had grade Ⅰ - Ⅱ thrombocytopenia, respectively. There was no statistically significant difference between the two groups. Hematological toxicity usually appears at 4-6 weeks and recovers after 2-3 weeks, mainly as platelet and leukocyte reduction
Ren H, et al^[27]2008	Lung cancer, breast cancer, prostate cancer, rectal cancer, stomach cancer, ovarian cancer.		⁹⁹Tc-MDP+⁸⁹SrCl₂	63.6	48.5%	33	⁸⁹SrCl₂ 1.48-2.22 MBq/kg, once every three months; ⁹⁹Tc-MDP 11mg/d, 7 days for a course of treatment, once a month
Guan R G, et al^[18] 2008	Lung cancer, breast cancer, nasopharyngeal cancer, prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	46.0	48.1%	27	⁸⁹SrCl₂ 111-148 MBq	Only 2 patients developed skeletal depression, transient hypoleucopenia, toxicity evaluation was Ⅱ degree, untreated, spontaneous recovery after 2 weeks
	Lung cancer, breast cancer, nasopharyngeal cancer, cervical cancer		⁹⁹Tc-MDP+⁸⁹SrCl₂	47.0	58.6%	29	⁸⁹SrCl₂ 111-148 MBq. After 3 d, injecting ⁹⁹Tc-MDP 20 mg intravenously once a day for 5 d, followed by ⁹⁹Tc-MDP 5mg intravenously for 15 d
Wang J F, et al^[31] 2009	61 cases of breast cancer, 52 cases of prostate cancer, 45 cases of lung cancer, thyroid cancer, nasopharyngeal cancer, rectal cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	53.0	41.2%	45	⁸⁹SrCl₂ 148 MBq	After treatment, a small number of patients felt general fatigue, nausea and other symptoms, some patients slightly decreased, a very small number of patients showed transient pain exacerbation after treatment
			⁹⁹Tc-MDP			38	⁹⁹Tc-MDP 200 mg/d, 5 days for a course, once a month, for 2-3 courses
			⁹⁹Tc-MDP+⁸⁹SrCl₂			82	⁸⁹SrCl₂ 148 MBq; ⁹⁹Tc-MDP 200 mg/d, 5 days for a course, once a month, for 2-3 courses
Zhang J H, et al^[35] 2010	Breast cancer, lung cancer, nasopharyngeal cancer, and other tumors	Rate of relief of bone pain	⁸⁹SrCl₂	52.0	61.7%	60	⁸⁹SrCl₂ 111-148 MBq (3-4 mci) every 3-6 months	There was no significant difference between the groups
Zhang J H, et al^[35] 2010		Rate of relief of bone pain	⁹⁹Tc-MDP+⁸⁹SrCl₂	49.0	57.4%	61	⁸⁹SrCl₂ 111-148 MBq (3-4 mci) every 3-6 months; ⁹⁹Tc-MDP 200 mg/d, 5 days for a course	There was no significant difference between the groups
Ning S F, et al^[26] 2010	Lung cancer, breast cancer, prostate cancer, nasopharyngeal cancer, rectal cancer, stomach cancer, uterine cancer	Rate of relief of bone pain	⁸⁹SrCl₂	66.3	44.6%	65	⁸⁹SrCl₂ 1.48-2.22 MBq/kg, every 3 mouths	In the two groups, 20% and 22.6% of the cases showed mild to moderate leukopenia, and 15.4% and 17% of the cases showed mild to moderate thrombocytopenia. Single decline was more common, and one case in both groups had severe leukopenia and thrombocytopenia
Ning S F, et al^[26] 2010	Lung cancer, breast cancer, prostate cancer, nasopharyngeal cancer, rectal cancer, ovarian cancer	Rate of relief of bone pain	⁹⁹Tc-MDP+⁸⁹SrCl₂	61.5	52.8%	53	⁸⁹SrCl₂ 1.48-2.22 MBq/kg, every 3 mouths; ⁹⁹Tc-MDP 15 mg/d, 10 days for a course
Zhu W R, et al^[40] 2011	Prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	63.2±7.6	0.0%	46	⁸⁹SrCl₂ 148-185 MBq	There were no adverse reactions in the two groups
Zhu W R, et al^[40] 2011	Prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂			49	⁸⁹SrCl₂ 148-185 MBq; ⁹⁹Tc-MDP 22 mg/d, 10 days for a course, for 3-5courses	There were no adverse reactions in the two groups
Chen M, et al^[15] 2011	Breast cancer	Rate of relief of bone pain	⁸⁹SrCl₂	43.5	100.0%	45	⁸⁹SrCl₂ 1.48-2.22 MBq/kg (40-60 uCi)/kg	Leukocytosis of grade 1 in 4 cases and grade 2 in 1 case; Grade 1 thrombocytopenia in 5 patients
Chen M, et al^[15] 2011	Breast cancer	Rate of relief of bone pain	⁹⁹Tc-MDP+⁸⁹SrCl₂			42	⁸⁹SrCl₂ 1.48-2.22 MBq/kg (40-60 uCi)/kg; ⁹⁹Tc-MDP 5 mg/d, 15 days for a course	Leukocytosis of grade 1 in 3 cases; 2 cases of grade 1 thrombocytopenia
Dong Z F, et al^[16] 2012	Lung squamous cell carcinoma, lung adenocarcinoma, small cell lung cancer, lung adeno-squamous cell carcinoma	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	50.0	25.7%	33	⁸⁹Sr 1.48 × 10⁸ Bq	Hematotoxic reaction (17 cases of degree 1, 3 cases of degree 2, 0 cases of degree 3)
Dong Z F, et al^[16] 2012		Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂	52.0	33.3%	30	⁸⁹Sr 1.48 × 10⁸ Bq; ⁹⁹Tc-MDP 25 mg/d, 15 days for a course	Hemotoxic reaction (11 cases of degree 1, 2 cases of degree 2, 0 cases of degree 3)
Ning J H, et al^[25] 2014	Lung cancer, breast cancer, prostate cancer, stomach cancer, bladder cancer, nasopharyngeal cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	56.0	44.4%	54	⁸⁹Sr 4 mci	Aggravation of bone pain occurred in 18 cases
			⁹⁹Tc-MDP+⁸⁹SrCl₂			54	⁸⁹Sr 4 mci; ⁹⁹Tc-MDP 22 mg/d, 10 days for a course, for 3 courses	Aggravation of bone pain occurred in 12 cases
Zhu W R, et al^[40] 2015	Breast cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	61.5	Not described	42	⁸⁹SrCl₂ 1.48-2.22 MBq/kg	There were no adverse reactions in the two groups
		Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂			45	⁸⁹SrCl₂ 1.48-2.22 MBq/kg; ⁹⁹Tc-MDP 22 mg/d, 10 days for a course, for 3 courses	There were no adverse reactions in the two groups
Yang J, et al^[34] 2015	Prostate cancer, lung cancer, breast cancer	Rate of relief of bone pain	⁸⁹SrCl₂	56.0±13.3	27.6%	63	⁸⁹SrCl₂ 148 MBq (4 raci)	The bone pain of 3 patients worsened 3-7 days after treatment, and was self-alleviated 1 week later. White blood cells and platelets decreased for 4-6 weeks and recovered to normal. There were no significant changes in liver and kidney function
	Prostate cancer, lung cancer, breast cancer	Rate of relief of bone pain	⁹⁹Tc-MDP+⁸⁹SrCl₂			64	⁸⁹SrCl₂ 148 MBq (4 raci); ⁹⁹Tc-MDP 33 mg/d, for 5 days
Xie C H, et al^[32] 2015	Lung cancer, stomach cancer, breast cancer, and other malignancies	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	55.1±6.3	47.6%	63	⁸⁹SrCl₂ 2.22 MBq/kg	Leukopenia and thrombocytopenia: 5 patients, elevated transaminase: 3 patients, fever, nausea, vomiting and other symptoms: 5 patients
		Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂	56.7±6.9	44.4%	63	⁸⁹SrCl₂ 2.22 MBq/kg; ⁹⁹Tc-MDP 200 mg/d, 5 days for a course, once a month, for 2-3 courses	Leukopenia and thrombocytopenia: 3 patients, elevated transaminase: 4 patients, fever, nausea, vomiting and other symptoms: 9 patients
Liu H C, et al^[32] 2015	Breast cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	56.4±13.8	100.0%	30	⁸⁹SrCl₂ 1.48-1.85 MBq/kg	Leukocyte and/or platelet decreased in 5 cases
			⁹⁹Tc-MDP	51.6±11.7		22	⁹⁹Tc-MDP 16.5 mg/d, 6 days for a course, once a month, for 2-3 courses	No adverse reaction
			⁹⁹Tc-MDP+⁸⁹SrCl₂	54.1±12.1		28	⁸⁹SrCl₂ 1.48-1.85 MBq/kg; ⁹⁹Tc-MDP 16.5 mg/d, 6 days for a course, once a month, for 2-3 courses	Leukocyte and/or platelet decreased in 4 cases
Xu R S, et al^[33] 2016	Prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	71.5	0.0%	47	⁸⁹SrCl₂ 148 MBq	Most of the patients showed transient decrease in WBC and PLT, which could recover to normal by itself. 4 patients showed low white blood cell count, which recovered to normal after symptomatic treatment
	Prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂			50	⁸⁹SrCl₂ 148 MBq; ⁹⁹Tc-MDP 1 time/d for 10 d for 1 cycle. 1 cycle of treatment per month, 3 times in a row for 1 course of treatment
Huang Y, et al^[19]2017	Prostate cancer, lung cancer, breast cancer, endometrial cancer, nasopharyngeal cancer, liver cancer, rectal cancer, and other types of malignant tumors	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	62.1±13.2	35.1%	111	⁸⁹SrCl₂ 4 mci/d, 10 days for a course, for 3 courses	Pain: 18 cases; leukopenia: 22 cases; thrombocytopenia: 17 cases; allergic reaction: 8 cases; gastrointestinal reaction: 2 cases
			⁹⁹Tc-MDP	59.7±13.7	35.4%	130	⁹⁹Tc-MDP 5.5 mg/d, 5 days for a course, for 3 courses	Pain: 22 cases; leukopenia: 28 cases; thrombocytopenia: 20 cases; allergic reaction: 7 cases; gastrointestinal reaction: 5 cases
			⁹⁹Tc-MDP+⁸⁹SrCl₂	62.1±13.2	31.3%	160	⁸⁹SrCl₂ 4 mci/d, 10 days for a course, for 3 courses; ⁹⁹Tc-MDP 22 mg/d, 10 days for a course, for 3 courses	Pain: 13 cases; leukopenia: 14 cases; thrombocytopenia: 10 cases; allergic reaction: 5 cases; gastrointestinal reaction: 1 case
Zhao D D, et al^[38] 2017	Left breast cancer, right breast cancer	Rate of relief of bone pain	⁸⁹SrCl₂	51.1±7.2	Not described	42	⁸⁹SrCl₂ 1.48-1.85 MBq/kg	Thrombocytopenia: 3 cases; leukopenia: 4 cases
	Left breast cancer, right breast cancer, bilateral breast cancer		⁹⁹Tc-MDP+⁸⁹SrCl₂	50.0±6.9		44	⁸⁹SrCl₂ 1.48-1.85 MBq/kg; ⁹⁹Tc-MDP 100 mg/d，6 days for a course, once a month, for 3 courses	Thrombocytopenia: 4 cases; leukopenia: 6 cases
Zhang W, et al^[37]2019	Prostate cancer, lung cancer, breast cancer, endometrial cancer, liver cancer, nasopharyngeal cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	55.6±3.3	42.3%	26	⁸⁹SrCl₂ 4 mci/d, 10 days for a course	4 cases (pain, leukopenia, thrombocytopenia, allergic reaction, gastrointestinal reaction)
			⁹⁹Tc-MDP	56.3±3.5	38.5%	26	⁹⁹Tc-MDP 5.5 mg/d, intravenously, 5 days for a course	3 cases (pain, leukopenia, thrombocytopenia, allergic reaction, gastrointestinal reaction)
			⁹⁹Tc-MDP+⁸⁹SrCl₂	57.6±3.1	42.3%	26	⁸⁹SrCl₂ 4 mci/d, 10 days for a course; ⁹⁹Tc-MDP 5.5 mg/d, intravenously, 5 days for a course	4 cases (pain, leukopenia, thrombocytopenia, allergic reaction, gastrointestinal reaction)
Zhang J Y, et al^[36] 2019	Breast cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	50.48±8.1	100.0%	35	⁸⁹SrCl₂ 48-1.85 MBq/kg.	Fever (2 cases), nausea (1 case), vomiting (1 case), elevated serum creatinine (0 cases), abnormal blood calcium (2 cases), hematotoxicity (6 cases of grade 1, 3 cases of grade 2, and 0 cases of grade 3)
			⁹⁹Tc-MDP+⁸⁹SrCl₂	48.81±8.0		35	⁸⁹SrCl₂ 48-1.85 MBq/kg; ⁹⁹Tc-MDP 11 mg/d, 10 days for a course	Fever (1 case), nausea and vomiting (1 case), elevated serum creatinine (1 case), abnormal blood calcium (3 cases), hematotoxicity (5 cases of grade 1, 2 cases of grade 2, 0 cases of grade 3)
Liu L, et al^[23] 2019	Unspecified	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	56.8±6.7	46.7%	60	⁸⁹SrCl₂ 14.8×10⁷/time	No adverse reaction
Liu L, et al^[23] 2019		Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂	55.9±7.0	43.3%	60	⁸⁹SrCl₂ 14.8×10⁷/time; ⁹⁹Tc-MDP 200 mg/d, 5 days for a course
Liu J G, et al^[22] 2020	Prostate, breast, lung, stomach, and other cancers	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	58.2±12.0	45.9%	37	⁸⁹SrCl₂ 4mci, every 3-6 months	Leukocyte and platelet: 3 patients (with varying degrees), among which 1 patient received radiotherapy before treatment, 1 patient received chemotherapy before treatment, and 1 patient showed mild elevation of alanine aminotransferase in 3-4 weeks, which was reduced to normal after symptomatic treatment
			⁹⁹Tc-MDP	59.3±12.0	48.3%	29	⁹⁹Tc-MDP 22 mg/d, 5 days for a course, once a month, for 2-3 courses	No adverse reaction
			⁹⁹Tc-MDP+⁸⁹SrCl₂	58.9±12.0	48.3%	29	⁹⁹Tc-MDP 22 mg/d, 5 days for a course, once a month, for 2-3 courses; ⁸⁹SrCl₂ 4 mci, every 3 to 6 months	Leukocyte and platelet: 3 patients (with varying degrees), among which 1 patient received radiotherapy before treatment, 1 patient received chemotherapy before treatment, and 1 patient showed mild elevation of alanine aminotransferase in 3-4 weeks, which was reduced to normal after symptomatic treatment
Fu Y J, et al^[17] 2020	Prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁸⁹SrCl₂	68.41±7.2	0.0%	38	⁸⁹SrCl₂ 1.48 MBq/kg	5.26% (2/38): anemic in 1 case; myelosuppression in 1 case
	Prostate cancer	Rate of relief of bone pain and healing of bone metastases	⁹⁹Tc-MDP+⁸⁹SrCl₂	69.04±6.9		39	⁸⁹SrCl₂ 1.48 MBq/kg; ⁹⁹Tc-MDP, 20 days for a course, for 1 course	12.82% (5/39): poor appetite in 2 cases; fatigue in 1 case; phlebitis in 1 case; skin redness and swelling in 1 case

表1

图 2

图3

图4

图5

图6

图7

图8

图9

图10

图11

图 12

表2

参考文献 41

[1]	YU S Y, JIANG Z F, ZHANG L, et al. Chinese expert consensus statement on clinical diagnosis and treatment of malignant tumor bone metastasis and bone related diseases[J]. Chin -Ger J Clin Oncol, 2010, 9(1): 1-12. doi: 10.1007/s10330-009-0188-2
[2]	CLÉZARDIN P, COLEMAN R, PUPPO M, et al. Bone metastasis: mechanisms, therapies, and biomarkers[J]. Physiol Rev, 2021, 101(3): 797-855. doi: 10.1152/physrev.00012.2019
[3]	MANAFI-FARID R, MASOUMI F, DIVBAND G, et al. Targeted palliative radionuclide therapy for metastatic bone pain[J]. J Clin Med, 2020, 9(8): 2622. doi: 10.3390/jcm9082622
[4]	HANDKIEWICZ-JUNAK D, POEPPEL T D, BODEI, et al. EANM guidelines for radionuclide therapy of bone metastases with beta-emitting radionuclides[J]. Eur J Nucl Med Mol Imaging, 2018, 45(5): 846-859. doi: 10.1007/s00259-018-3947-x
[5]	中华医学会核医学分会转移性骨肿瘤治疗工作委员会. 氯化锶[⁸⁹Sr]治疗转移性骨肿瘤专家共识(2017年版)[J]. 中华核医学与分子影像杂志, 2018, 38(6): 412-415.
	Chinese Medical Association Nuclear Medicine Branch Metastatic Bone Tumor Treatment Working Committee. Expert consensus on strontium-89 chloride treatment of bone metastases (2017)[J]. Chin J Nucl Med Mol Imaging, 2018, 38(6): 412-415.
[6]	中国抗癌协会骨肿瘤和骨转移瘤专业委员会. 乳腺癌骨转移临床诊疗专家共识[J]. 中国肿瘤临床, 2022, 49(13): 660-669.
	Bone Tumor and Bone Metastasis Committee of Chinese Anticancer Association. Expert consensus on the diagnosis and treatment of bone metastasis in patients with breast cancer[J]. Chin J Clin Oncol, 2022, 49(13): 660-669.
[7]	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版)[J]. 中华肝脏病杂志, 2022, 30(4): 51.
	National Health Commission of the People's Republic of China. Standardization for diagnosis and treatment of hepatocellular carcinoma (2022 edition)[J]. Chin J Hepatol, 2022, 30(4): 51.
[8]	CHEN J, LAN Y Y, HE Y, et al. ⁹⁹Tc-MDP-induced human osteoblast proliferation, differentiation and expression of osteoprotegerin[J]. Mol Med Rep, 2017, 16(2): 1801-1809. doi: 10.3892/mmr.2017.6839 pmid: 28656306
[9]	SHEN S Y, WANG W H, YANG C, et al. Effect of technetium-99 conjugated with methylene diphosphonate (⁹⁹Tc-MDP) onOPG/RANKL/RANK system in vitro[J]. J Oral Pathol Med, 2018: jop.12801.
[10]	解朋, 马文华, 唐子都, 等. 云克治疗肿瘤骨转移的系统评价[J]. 中华生物医学工程杂志, 2012, 18(5): 413-417.
	XIE P, MA W H, TANG Z D, et al. ⁹⁹Tc-MDP injection as adjunct therapy for bone metastasis: a systematic review[J]. Chin J Biomed Eng, 2012, 18(5): 413-417.
[11]	王洪良, 肖国有, 李党生, 等. ⁸⁹SrCl₂联合⁹⁹Tc-MDP治疗骨转移瘤疗效的meta分析[J]. 中国癌症防治杂志, 2015, 7(6): 416-420.
	WANG H L, XIAO G Y, LI D S, et al. ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP in patients with bone metastases: a meta-analysis[J]. Chin J Oncol Prevent Treat, 2015, 7(6): 416-420.
[12]	中华人民共和国卫生部医政司. 核医学诊断与治疗规范[M]. 北京: 科学出版社, 1997: 292-295.
	Medical Affairs Department of the Ministry of Health of the People's Republic of China. Diagnostic and therapeutic norms for nuclear medicine[M]. Beijing: Science Press, 1997: 292-295.
[13]	HIGGINS J, THOMAS J, CHANDLER J, et al. Cochrane handbook for systematic reviews of interventions (version 6.3)[EB/OL]. 2022 ed. https://training.cochrane.org/handbook.
[14]	汪洋. Cochrane偏倚风险评估工具简介[J]. 中国全科医学, 2019, 22(11): 1322.
	WANG Y. Introduction to cochrane bias risk assessment tool[J]. Chin Gen Pract, 2019, 22(11): 1322.
[15]	陈明, 刘纯, 彭珍珍, 等. 二氯化锶联合云克治疗乳腺癌骨转移瘤42例[J]. 肿瘤学杂志, 2011, 17(8): 633-634.
	CHEN M, LIU C, PENG Z Z, et al. ⁸⁹Srcl₂ combined with ⁹⁹Tc-MDP in the treatment for 42 cases with bone metastasis from breast cancer[J]. J Oncol, 2011, 17(8): 633-634.
[16]	董占飞, 秦永德, 王新华. ⁸⁹Sr联合⁹⁹Tc-MDP内照射治疗肺癌骨转移疼痛的临床观察[J]. 标记免疫分析与临床, 2012, 19(4): 197-200.
	DONG Z F, QIN Y D, WANG X H. Clinical observation of ⁸⁹Sr combined with ⁹⁹Tc MDP internal irradiation for the treatment of bone metastasis pain in lung cancer[J]. Labeled Immun Clin, 2012, 19(4): 197-200.
[17]	付玉娟, 雷田, 蔚荣豪, 等. 放射性核素氯化锶联合⁹⁹Tc-亚甲基二膦酸盐治疗前列腺癌骨转移患者的疗效观察(附39例)[J]. 现代肿瘤医学, 2020, 28(11): 1917-1921.
	FU Y J, LEI T, WEI R H, et al. The effect of radionuclide strontium chloride combined with ⁹⁹Tc-methylene diphosphonate in the treatment of prostate cancer patients with bone metastasis (36 cases)[J]. J Mod Oncol, 2020, 28(11): 1917-1921.
[18]	官荣光, 李繁, 陈锦超, 等. 氯化锶联合⁹⁹Tc-亚甲基二磷酸盐治疗骨转移癌的疗效观察[J]. 实用医学杂志, 2008, 24(8): 1428-1429.
	GUAN R G, LI F, CHEN J C,et al. Observation on the therapeutic effect of strontium chloride combined with ⁹⁹Tc methylene diphosphate in the treatment of bone metastasis cancer[J]. J Pract Med, 2008, 24(8): 1428-1429.
[19]	黄宇, 荆忍, 潘灵辉. 联合应用放射性核素⁸⁹SrCl₂与云克治疗肿瘤骨转移疗效[J]. 实用医学杂志, 2017, 33(17): 2857-2860.
	HUANG Y, JING R, PAN L H. Efficacy and safety of single or combine using radionuclide ⁸⁹SrCl₂/Yunke in cancer patients with bone me-tastasis[J]. J Pract Med, 2017, 33(17): 2857-2860.
[20]	李建刚, 谭清和, 龚振夏, 等. ⁸⁹SrCl₂加⁹⁹Tc-MDP(云克)联合治疗转移性骨癌骨痛的疗效分析[J]. 同位素, 2004, 17(2): 125-128.
	LI J G, TAN Q H, GONG Z X, et al. The analysis curative efficiency of the painful metastatic bone cancer treated using ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP[J]. J Isot, 2004, 17(2): 125-128.
[21]	刘恒超, 李卫鹏, 申勇, 等. ⁸⁹SrCl₂联合⁹⁹Tc-MDP对乳腺癌骨转移骨痛治疗疗效[J]. 中国肿瘤临床, 2015, 42(5): 297-301.
	LIU H C, LI W P, SHEN Y, et al. Efficacy of ⁸⁹SrCl₂ combined with ⁹⁹Tc MDP in the treatment of bone pain caused by bone metastases from breast cancer[J]. Chin Clin Oncol, 2015, 42(5): 297-301.
[22]	刘建国, 刘晓利, 康进军, 等. 亚甲基二磷酸盐联合氯化锶治疗多发性骨转移癌骨痛的效果观察[J]. 中国基层医药, 2020, 27(7): 855-858.
	LIU J G, LIU X L, KANG J J, et al. Observation on the efficacy of methylene diphosphate combined with strontium chloride in the treatment of bone pain in multiple bone metastasis cancer[J]. Chin J Primary Med Pharm, 2020, 27(7): 855-858.
[23]	刘琳. 用⁸⁹SrCl₂联合⁹⁹Tc-MDP治疗转移性骨癌的效果观察[J]. 当代医药论丛, 2019, 17(9): 16-17.
	LIU L. Observation on the effect of ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP in the treatment of metastatic bone cancer[J]. Contemp Med Symp, 2019, 17(9): 16-17.
[24]	莫逸, 石峰, 易济民. ⁸⁹SrCl₂联合“云克”治疗多发性骨转移癌[J]. 中国医师杂志, 2004, 6(2): 273.
	MO Y, SHI F, YI J. ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP for the treatment of multiple bone metastases[J]. J Chin Physician, 2004, 6(2): 273.
[25]	宁建红, 徐海霞, 李霞. ⁸⁹SrCl₂联合云克治疗恶性肿瘤骨转移的疗效观察与护理[J]. 吉林医学, 2014, 35(36): 8159-8160.
	NING J H, XU H X, LI X. Observation and nursing of ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP for the treatment of malignant tumor bone metastasis[J] Jilin Med, 2014, 35(36): 8159-8160.
[26]	宁尚峰, 马安康. ⁸⁹Sr单用与联合云克治疗肿瘤多发性骨转移癌的临床应用[J]. 航空航天医药, 2010, 21(11): 2018-2019.
	NING S F, MA A K. Clinical application of ⁸⁹Sr alone and combined with Yunke in the treatment of multiple bone metastases from tumors[J] Aerospace Med, 2010, 21(11): 2018-2019.
[27]	任辉, 马宏飞, 刘玉梅. ⁸⁹Sr单用与联合⁹⁹Tc-MDP治疗骨转移癌止痛疗效比较[J]. 中国煤炭工业医学杂志, 2008, 11(1): 53-54.
	REN H, MA H F, LIU Y. Comparison of pain relief efficacy between ⁸⁹Sr alone and combined ⁹⁹Tc MDP in the treatment of bone metastasis cancer[J]. Chin J Coal Ind Med, 2008, 11(1): 53-54.
[28]	桑士标, 吴翼伟, 张玮, 等. ⁸⁹SrCl₂与⁹⁹Tc-MDP联合治疗转移性骨肿瘤疼痛的临床价值[J]. 江苏医药, 2001, 27(8): 573-575.
	SANG S B, WU Y W, ZHANG W, et al. Clinical value of ⁸⁹SrCl₂ and ⁹⁹Tc-MDP in treatment of metastatic bon e cancer pain[J]. Jiangsu Mecical J, 2001, 27(8): 573-575.
[29]	石峰, 莫逸, 邓群力. ⁸⁹SrCl₂联合 “云克” 治疗多发性骨转移癌(附74例报告)[J]. 中国医师杂志, 2006, 8(6): 804.
	SHI F, MO Y, DENG Q L. ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP in the treatment of multiple bone metastases (report of 74 cases)[J]. Chin J Physic, 2006, 8(6): 804.
[30]	石光清, 曹培国, 刘建新, 等. 放射性核素⁸⁹Sr联合⁹⁹Tc-MDP治疗肿瘤多发性骨转移灶的疗效[J]. 医学临床研究, 2006, 23(8): 1232-1233.
	SHI G Q, CAO P G, LIU J X, et al The efficacy of radioactive nuclide ⁸⁹Sr combined with ⁹⁹Tc MDP in the treatment of multiple bone metastases of tumors[J]. Med Clin Res, 2006, 23(8): 1232-1233.
[31]	王锦锋, 曹晓征. ⁸⁹SrCl₂联合云克治疗肿瘤转移性骨痛的疗效评价[J]. 中国社区医师(医学专业半月刊), 2009, 11(23): 68-69.
	WANG J F, CAO X Z. Clinical evaluation of ⁸⁹SrCl₂ combined with Yunke in the treatment of metastatic bone pain caused by tumor[J]. Chin Community Dr, 2009, 11(23): 68-69.
[32]	谢楚海, 吴波以, 史群伟, 等. ⁸⁹SrCl₂与⁹⁹Tc-MDP联合治疗转移性骨肿瘤的临床研究[J]. 现代肿瘤医学, 2015, 23(22): 3333-3335.
	XIE C H, WU B Y, SHI Q W, et al. Clinical study on the combination of ⁸⁹SrCl₂ and ⁹⁹Tc-MDP in the treatment of metastatic bone tumors[J]. Mod Oncol Med, 2015, 23(22): 3333-3335.
[33]	徐蓉生, 何文果, 梅艳, 等. ⁸⁹SrCl₂联合⁹⁹Tc-MDP治疗50例前列腺癌骨转移的临床研究[J]. 武警后勤学院学报(医学版), 2016, 25(9): 731-734.
	XU R S, HE W G, MEI Y, et al. Clinical study on ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP in the treatment for bone metastases from prostate cancer[J]. J Logist Univ PAP Med Sci, 2016, 25(9): 731-734.
[34]	杨俊. 氯化锶(⁸⁹Sr)、云克(⁹⁹Tc-MDP)联合治疗多发性骨转移癌临床观察[J]. 医学信息, 2015, 28(4): 132-133.
	YANG J. Clinical observation on the combination of strontium chloride ⁸⁹Sr and ⁹⁹Tc MDP in the treatment of multiple bone metastasis cancer[J]. Med Inform, 2015, 28(4): 132-133.
[35]	张继华, 刘敬东, 李克田, 等. 思痛宁联合⁹⁹Tc-MDP治疗多发性骨转移癌疗效观察[J]. 黑龙江医药科学, 2010, 33(3): 37-38.
	ZHANG J H, LIU J D, LI K T, et al. Observation on the therapeutic effect of Sitongning combined with ⁹⁹Tc-MDP in the treatment of multiple bone metastases[J]. Heilongjiang Med Pharm, 2010, 33(3): 37-38.
[36]	张建媛, 席永昌, 尤立强, 等. 二氯化锶联合锝[⁹⁹Tc]亚甲基二膦酸盐治疗乳腺癌骨转移患者的临床疗效评估[J]. 临床药物治疗杂志, 2019, 17(9): 56-60.
	ZHANG J Y, XI Y C, YOU L Q, et al. Evaluation of the clinical efficacy of strontium dichloride combined with technetium [⁹⁹Tc] methylene diphosphonate in the treatment of bone metastases from breast cancer[J]. J Clin Pharmacother, 2019, 17 (9): 56-60.
[37]	张伟. 联合放射性核素与锝[⁹⁹Tc]亚甲基二膦酸盐治疗肿瘤骨转移疗效[J]. 中国卫生标准管理, 2019, 10(23): 76-78.
	ZHANG W. The efficacy of combined radionuclides and technetium [⁹⁹Tc] methylene diphosphate in the treatment of tumor bone metastasis[J]. China Health Standards Management, 2019, 10 (23): 76-78.
[38]	赵丹丹, 李春雨. ⁸⁹SrCl₂联合⁹⁹Tc-MDP治疗乳腺癌骨转移骨痛的疗效观察[J]. 中国现代普通外科进展, 2017, 20(2): 137-139.
	ZHAO D D, LI C Y. Clinical observation on ⁸⁹SrCl₂ combined with ⁹⁹Tc-MDP treatment of bone pain caused by bone metastases from breast cancer[J] Progress Mod General Surg China, 2017, 20 (2): 137-139.
[39]	钟甘平, 陈雪红, 王正江. 氯化锶和⁹⁹Tc-亚甲基二膦酸盐治疗泌尿系肿瘤骨转移癌的临床观察[J]. 临床泌尿外科杂志, 2002, 17(9): 463-464.
	ZHONG G P, CHEN X H, WANG Z J. Clinical observation of strontium chloride and ⁹⁹Tc methylene diphosphate in the treatment of urinary system tumors with bone metastasis[J]. J Clin Urol, 2002, 17(9): 463-464.
[40]	朱文茹, 戴锦朝, 李进英, 等. ⁸⁹SrCl₂联合 “云克” 治疗乳腺癌骨转移的临床价值[J]. 中外女性健康研究, 2015, 13(7): 1-2.
	ZHU W R, DAI J Z, LI J Y, et al. The clinical value of strontium-89 combined with ⁹⁹Tc-MDP in treatment of patients with bone metastases of breast cancer[J]. Women's Health Res, 2015, 13(7): 1-2.
[41]	朱文茹, 郑飞波, 柳炳吉, 等. ⁸⁹SrCl₂联合“云克”治疗前列腺癌骨转移的临床价值[J]. 标记免疫分析与临床, 2011, 18(4): 241-243.
	ZHU W R, ZHENG F B, LIU B J, et al. Clinical value of strontium-89 combined with ⁹⁹Tc-MDP in treatment of bone metastases of prostate cancer[J]. Labeled Immunoass Clin Med, 2011, 18(4): 241-243.

Outcome	Before exclusion			After exclusion^*
Outcome	RR	95% CI	P value	RR	95% CI	P value
⁹⁹Tc-MDP+⁸⁹SrCl₂ vs ⁸⁹SrCl₂
Bone pain relief rate	1.22	1.18-1.27	<0.001	1.22-1.25	1.17-1.31	<0.001
Bone metastases healing rate	1.35	1.25-1.47	<0.001	1.33-1.42	1.22-1.58	<0.001
Adverse reaction rate	0.83	0.53-1.30	0.42	0.76-0.89	0.47-1.41	0.08-0.59
⁹⁹Tc-MDP vs ⁸⁹SrCl₂
Bone pain relief rate	0.98	0.90-1.06	0.57	0.95-0.99	0.82-1.10	0.40-0.76
Bone metastases healing rate	0.93	0.82-1.06	0.27	0.80-0.97	0.57-1.12	0.19-0.63
Adverse reaction rate	0.93	0.76-1.13	0.45	0.29-0.98	0.10-1.20	0.03-0.82

锝[⁹⁹Tc]亚甲基二膦酸盐注射液单药及联合⁸⁹SrCl₂治疗骨转移瘤效果的meta分析

A meta-analysis of the efficacy of ⁹⁹Tc-MDP alone and in combination with ⁸⁹SrCl₂ in the treatment of bone metastases

RichHTML

PDF