Table_1_Non-Radiation Based Early Pain Relief Treatment Options for Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: A Systematic Review.docx

IntroductionCancer induced bone pain (CIBP) is frequent in patients with non-small cell lung cancer (NSCLC). Radiation therapy continues to be the gold standard for treatment of painful bone metastases, however only a limited number of metastases can be irradiated. We evaluated non-radiation based early CIBP relief options in NSCLC through a systematic review.
MethodsSystematic review including all prospective articles published between 01-1994 and 06-2020 on Pubmed, Cochrane Library and ClinicalTrials.gov database. Inclusion: non-radiation based trials evaluating CIBP early pain relief options (initially defined as pain score evaluated within two weeks, because of no randomized trials, later inclusion broadened to pain score evaluated within six weeks) in ≥10 NSCLC patients. Radioisotope trials were excluded as these treatments have interactions with systemic anticancer therapy.
Results188 articles were found; 10 articles (6 randomized controlled (4 double blinded), 1 phase II single-arm, and 3 prospective trials) fulfilled the inclusion criteria. Six of these trials consisted of ≥2 treatment arms, whereas the others were single-arm studies. In total, 554 NSCLC patients were evaluated in these trials. The included trials were very heterogeneous regarding evaluated treatment options, methods of pain measuring, and endpoints. No high-level evidence for specific early pain relief treatment options was found.
DiscussionNon-radiation based studies evaluating treatment options to rapidly reduce CIBP in NSCLC are scarce. This systematic review shows that there is no high-level evidence to recommend a specific treatment for early pain relief. Future research should focus on early pain relief treatment options for CIBP in NSCLC.

## 引言
癌症诱导性骨痛（Cancer induced bone pain, CIBP）在非小细胞肺癌（non-small cell lung cancer, NSCLC）患者中发病率较高。放射治疗仍是疼痛性骨转移的金标准治疗手段，但可接受放射治疗的转移灶数量有限。本研究通过系统综述，评估非小细胞肺癌患者中无需放射治疗的早期癌症诱导性骨痛缓解方案。
## 方法
本系统综述检索了1994年1月至2020年6月期间发表于PubMed、Cochrane图书馆及ClinicalTrials.gov数据库的所有前瞻性研究。纳入标准：针对≥10例非小细胞肺癌患者、评估无需放射治疗的早期疼痛缓解方案的非放射治疗临床试验；最初将早期定义为疼痛评分评估于治疗后2周内，因无相关随机对照试验，后将纳入标准放宽至治疗后6周内评估疼痛评分。由于放射性同位素疗法与全身抗肿瘤治疗存在相互作用，故将此类试验排除。
## 结果
共检索到188篇文献；其中10篇符合纳入标准，包括6项随机对照试验（含4项双盲试验）、1项Ⅱ期单臂试验及3项前瞻性试验。其中6项试验包含≥2个治疗组，其余为单臂研究。上述试验共纳入554例非小细胞肺癌患者。纳入的试验在评估的治疗方案、疼痛评估方法及结局指标方面异质性极强。未发现针对特定早期疼痛缓解方案的高级别证据。
## 讨论
针对非小细胞肺癌患者癌症诱导性骨痛的快速缓解方案，无需放射治疗的相关研究较为匮乏。本系统综述显示，目前尚无高级别证据支持推荐某一特定方案用于早期疼痛缓解。未来的研究应聚焦于非小细胞肺癌患者癌症诱导性骨痛的早期疼痛缓解方案。