Bone health in cancer patients: ESMO Clinical Practice Guidelines
Bone health in cancer patients: ESMO Clinical Practice Guidelines
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DOI：
10.1093/annonc/mdu103
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发表时间：
2014-09-01
影响因子：
50.5
通讯作者：
Herrstedt, J.
中科院分区：
文献类型：
--
作者：
Coleman, R.;Body, J. J.;Herrstedt, J.
癌症管理的三个不同领域使得癌症患者的骨骼健康具有越来越重要的临床意义。首先，骨转移在许多实体肿瘤中很常见，尤其是那些来自乳腺、前列腺和肺部的肿瘤，以及多发性骨髓瘤，并可能导致严重的疾病，包括骨折、剧烈疼痛、神经压迫和高钙血症。通过对骨转移患者进行最佳的多学科管理，包括使用骨靶向治疗，如强效双膦酸盐或denosumab，已经有可能改变许多晚期癌症患者的病程，从而大大减少骨骼并发症，减少骨痛，提高生活质量。其次，我们用于治疗癌症患者的许多治疗方法都会对生殖激素产生影响，而生殖激素对于维持正常的骨骼重塑至关重要。这种内分泌失调导致骨质流失加速，骨质疏松和骨折的风险增加，这对迅速增加的长期癌症幸存者的生活产生重大的负面影响。最后，骨髓微环境也密切参与癌症传播所需的转移过程，并且有新出现的数据显示，至少在某些临床情况下，骨靶向治疗的使用可以减少骨转移并对患者生存有潜在影响。
There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major morbidity including fractures, severe pain, nerve compression and hypercalcaemia. Through optimum multidisciplinary management of patients with bone metastases, including the use of bone-targeted treatments such as potent bisphosphonates or denosumab, it has been possible to transform the course of advanced cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling. This endocrine disturbance results in accelerated bone loss and an increased risk of osteoporosis and fractures that can have a significant negative impact on the lives of the rapidly expanding number of long-term cancer survivors. Finally, the bone marrow micro-environment is also intimately involved in the metastatic processes required for cancer dissemination, and there are emerging data showing that, at least in some clinical situations, the use of bone-targeted treatments can reduce metastasis to bone and has potential impact on patient survival.