Background: The efficacy of disodium pamidronate (APD) in tumour-induced hypercalcaemia is well documented. A growing evidence is observed for the effectiveness of pamidronate in tumour-associated bone disease with regard to quality of life and bone remineralisation. Only little is known about the palliative effect of an intra-patient dose escalation in patients with osteolytic bone disease and unsatisfactory pain control after pretreatment with pamidronate. Patients and Method: The palliative effect of 23 intra-patient dose escalations with intravenous pamidronate was studied in 18 individuals with malignancy-related osteolytic bone disease and insufficient pain control. For the measurement of a palliative effect three factors were used: the pain score (WHO), the analgesic intake (WHO) and the performance status Zubrod. The palliative effect before and after the escalation was assessed by the treating physician using a 6-point scale. The Wilcoxon signed-rank test was used for comparing the noncontinuous values of the palliative effect before and after dose escalation. Results: A significant improvement of the palliative effect was seen in the group of patients with an escalation of dose intensity > 9 mg pamidronate per week, whereas patients treated with an escalation of dose intensity < 9 mg pamidronate per week did not benefit. Conclusions: An increase of dose intensity with at least 10 mg pamidronate per week seems to be necessary for a relevant improvement of the palliative effect in patients pretreated with pamidronate and unsatisfactory pain control.

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