Harris K, Li K, Flynn C, Chow E
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2007 Sep;19(7):523-7. doi: 10.1016/j.clon.2007.04.007. Epub 2007 Jun 12.
To determine which pain intensity scale in the Brief Pain Inventory correlates best with functional interference and should be used to calculate the response to palliative radiotherapy. To determine the differences in functional interference scores for patients classified as responders and non-responders to palliative radiotherapy.
All patients referred to the Rapid Response Radiotherapy Program for palliative radiotherapy of symptomatic bone metastases were considered for the study. Patients rated the intensity and functional interference of their pain at the irradiated sites according to the Brief Pain Inventory before and 2 months after radiotherapy. Worst, average and current pain scores were correlated with functional interference scores using Spearman rank coefficients. Responders and non-responders to palliative radiotherapy were defined for each pain intensity scale according to the end points specified by the International Bone Metastases Consensus Working Party. Average differences between responders and non-responders were compared using a Wilcoxon rank sum test.
Between May 2003 and June 2005, 199 patients enrolled in the study (102 men and 97 women). Ninety-five patients returned complete questionnaires at 2 months of follow-up. All pain intensity and interference scores for evaluable patients were significantly lower at 2 months (P<0.0021). Response rates differed depending on the definition of pain intensity. An overall response rate was observed in 66, 58 and 54% of patients for worst, average and current pain, respectively. Worst pain showed the best correlation with functional interference. Responders reported significantly larger decreases in functional interference scores at follow-up in general activity, normal work, enjoyment of life and average functional interference.
Worst pain intensity had higher correlations with all functional interference scores except relationships with others. Therefore, we recommend an 11-point scale measuring worst pain to evaluate response rates in future radiotherapy trials. The mean difference from baseline to follow-up in functional interference scores was significantly larger in patients who responded to radiotherapy treatment.
确定简明疼痛量表中哪种疼痛强度量表与功能障碍的相关性最佳，以及应使用该量表来计算姑息性放疗的反应。确定被分类为姑息性放疗反应者和无反应者的患者在功能障碍评分上的差异。
所有因有症状的骨转移而被转介至快速反应放疗项目接受姑息性放疗的患者均纳入本研究。患者在放疗前及放疗后2个月，根据简明疼痛量表对其照射部位的疼痛强度和功能障碍进行评分。使用Spearman等级系数将最严重、平均和当前疼痛评分与功能障碍评分进行相关性分析。根据国际骨转移瘤共识工作组指定的终点，为每种疼痛强度量表定义姑息性放疗的反应者和无反应者。使用Wilcoxon秩和检验比较反应者和无反应者之间的平均差异。
2003年5月至2005年6月期间，199名患者纳入本研究（102名男性和97名女性）。95名患者在随访2个月时返回了完整问卷。可评估患者的所有疼痛强度和干扰评分在2个月时均显著降低（P<0.0021）。反应率因疼痛强度的定义而异。最严重、平均和当前疼痛的患者总体反应率分别为66%、58%和54%。最严重疼痛与功能障碍显示出最佳相关性。反应者在随访时报告在一般活动、正常工作、生活乐趣和平均功能障碍方面的功能障碍评分下降幅度明显更大。
除与他人关系外，最严重疼痛强度与所有功能障碍评分的相关性更高。因此，我们建议在未来的放疗试验中使用11点量表测量最严重疼痛以评估反应率。放疗治疗有反应的患者从基线到随访的功能障碍评分平均差异显著更大。
