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香港,中国 - Media OutReach - 2019年10月4日 - 癌症患者无故持续骨痛,小心可能出现骨转移。临床肿瘤科专科陈颖乐医生表示,本地最常见发生骨转移的原发癌,包括乳腺癌、前列腺癌、肺癌、肾癌和多发性骨髓瘤,如不及早诊断并接受适当治疗,有可能造成与骨骼相关的并发症,严重影响患者的癌症治疗进程、生活质量甚至生存率。

补骨针有助缓解疼痛 防骨转移并发症风险

临床肿瘤科专科陈颖乐医生

一般在癌症的中晚期,癌细胞会通过血液及淋巴系统,转移到原发部位之外的身体其他地方,并会在转移的位置重新增生,而骨骼正是癌症最常见的转移部位,一般多发生在脊椎骨,包括颈椎、胸椎及腰椎,另外还有肋骨、盘骨、头盖骨、大腿骨和上臂骨。至于肘关节及膝关节以下,则较少发生骨转移。

减痛 防骨骼并发症为目标

当癌症发生骨转移,临床表现多为无故的持续骨痛,但有些患者却会因癌细胞转移到头盖骨而出现头痛,或转移到肋骨而胸痛,又或转移至脊椎造成背痛。陈颖乐医生称癌症骨转移的治疗目的主要是减轻痛楚,以及防止「骨骼相关事件」(skeletal-related events, SREs)发生,当中包括:患者因病理性骨折而失去活动能力,脊椎受压迫引致剧痛、颈背麻痹和肢体无力没有感觉,以及需要做骨骼手术或骨骼放疗。

打补骨针 助预防及减少骨骼并发症

为避免妨碍患者整体的癌症治疗进程,预防及减低骨转移引致的骨骼并发症是必须的。陈医生表示,现时预防骨骼相关事件的药物(俗称补骨针),包括双膦酸盐类药物(bisphosphonates)以及RANKL抑制剂地舒单抗(denosumab),两种选择的功效,均备受肯定。

双膦酸盐类药物是每三至四周一次的静脉注射剂,地舒单抗则是每四周一次的皮下注射剂,两者各有优胜之处,例如双膦酸盐类药物費用較相宜,但肾功能较差的患者不适合服用;至于地舒单抗可用于肾功能较差的患者上,并且有研究显示相较于双膦酸盐类药物,更能延缓骨骼相关事件的发生时间,或减少发生的风险。

混合疗法 可减依赖止痛药

无论双膦酸盐类药物或地舒单抗,均可与止痛药、放疗、激素治疗、化疗或其他癌症治疗药物合并使用。陈医生表示,本地多采用补骨针加并止痛药和放疗的综合治疗,以医治癌症骨转移,临床所见,当中约七成患者能减少疼痛,约五成可减服止痛药。

虽然如无引起其他并发症,两种补骨针均可长时间服用,但陈医生提醒,少部份患者有可能出现血钙过低,需要同时服用钙片及维生素D补充剂以作补充。另有极少数长期服用的患者,颞下颌关节(又称牙骹)可能出现缺血性骨坏死(又称骨枯)现象,建议应保持口腔清洁、定期到牙医检查,可减低相关风险。

资料来源:

健康研究所

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