Abstract
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Objectives Most patients with malignant tumor are sufferd from bone metastases. 89Sr and bisphosphonates are great promising therapeutic strategies at present. Among the three therapy approaches of 89Sr, bisphosphonates and 89Sr plus bisphosphonates(combined therapy), which one is the most powerful strategy of bone metastases? The purpose of this systematic review and meta-analyses is to assess the treatment efficacy of 89Sr, bisphosphonates and combined therapy and determine the most effective treatment among them.
Methods MEDLINE, EMBASE, The Cochrane Library, CBMdisc and CNKI were searched. 4 relevant journals were manually searched. Trials comparatively analyzed the therapy efficacy of 89Sr, bisphosphonates and combined therapy of bone metastases were included. Quality of the studies was evaluated. Meta-analyses were performed by RevMan 5.0 software. P value <0.05 was considered statistically significant.
Results 7 randomized controlled trials, 1 semi-randomized controlled trial and 7 non-randomized controlled trials met our inclusion criterias and enrolled 1196 patients. Comparing with 89Sr and bisphosphonates, combined therapy was stronger in bone pain relief(RR=0.88, 95%CI:0.83-0.94, P<0.0001; RR=0.82, 95%CI:0.76-0.88, P<0.00001), improving life quality(RR=0.77, 95%CI:0.69-0.85, P<0.0001; RR=0.69, 95%CI:0.59-0.81, P<0.00001) and decreasing number or reducing volume of bone metastases(RR=0.60, 95%CI:0.41-0.87, P=0.008; RR=0.48, 95%CI:0.28-0.83, P=0.008). There were no statistically significant differences between 89Sr and bisphosphonates in the three aspects above(all P>0.05).
Conclusions Combined therapy of 89Sr and bisphosphonates can relieve bone pain, improve life quality and decrease number or reduce volume of bone metastases more effectively than 89Sr or bisphosphonates alone.
Research Support This work was supported by the National Natural Science Fund of China (grant 81071184) and Sector Funds of Ministry of Health of China (grant 201002002).