Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Curr Oncol. 2009 Mar;16(2):16-28. doi: 10.3747/co.v16i2.376.
Approximately 27% of North American cancer deaths are attributable to cancer of the lung. Many lung cancers are found at an advanced stage, rendering the tumours inoperable and the patients palliative. Common symptoms associated with palliative lung cancer include cough, hemoptysis, and dyspnea, all of which can significantly debilitate and diminish quality of life (QOL). In studies of the effects of cancer therapies, the frequent evaluative endpoints are survival and local control; however, it is imperative that clinical trials with palliative patients also have a QOL focus when a cure is unattainable. We conducted a literature review to investigate the use of QOL instrument tools in trials studying QOL or symptom palliation of primary lung cancer or lung metastases through the use of radiotherapy. We identified forty-three studies: nineteen used a QOL tool, and twenty-four examined symptom palliation without the use of a QOL instrument. The European Organization for Research and Treatment of Cancer (eortc) QLQ-C30 survey was the most commonly used QOL questionnaire (in thirteen of twenty trials). Of those thirteen studies, eight also incorporated the lung-specific QOL survey eortc QLQ-LC13 (or the eortc QLQ-LC17). A second lung-specific survey, the Functional Assessment of Cancer Therapy-Lung (fact-L) was used in only two of the twenty trials. In total, only ten of forty-three trials (23%) used a lung-specific QOL tool, suggesting that QOL was of low priority as an endpoint and that measures created for lung cancer patients are underused. We encourage investigators in future trials to include specific QOL instruments such as the eortc QLQ-LC13 or the fact-L for studies in palliative thoracic radiotherapy because those instruments provide a measure of QOL specific to patients with lung cancer or lung metastases.
北美约有 27%的癌症死亡归因于肺癌。许多肺癌发现时已处于晚期，导致肿瘤无法手术，只能进行姑息治疗。与姑息性肺癌相关的常见症状包括咳嗽、咯血和呼吸困难，所有这些都会严重削弱患者的身体状况并降低生活质量 (QOL)。在癌症治疗效果的研究中，常见的评估终点是生存率和局部控制率；然而，当治愈无望时，姑息治疗患者的临床试验也必须关注生活质量。我们进行了文献回顾，以调查在使用放疗治疗原发性肺癌或肺转移的姑息性临床试验中，生活质量工具的使用情况，研究内容包括生活质量或症状缓解。我们共确定了 43 项研究：19 项研究使用了生活质量工具，24 项研究在未使用生活质量仪器的情况下检查了症状缓解情况。欧洲癌症研究与治疗组织 (eortc) 的 QLQ-C30 调查是使用最广泛的生活质量问卷 (20 项试验中的 13 项)。在这 13 项研究中，有 8 项还纳入了针对肺部的特定生活质量问卷 eortc QLQ-LC13（或 eortc QLQ-LC17）。第二项针对肺部的调查，癌症治疗功能评估-肺部 (fact-L)，仅在 20 项试验中的两项中使用。总共，只有 43 项试验中的 10 项（23%）使用了特定于肺部的生活质量工具，这表明生活质量作为终点的优先级较低，并且针对肺癌患者的测量方法使用不足。我们鼓励未来试验的研究人员在姑息性胸部放疗的研究中使用特定的生活质量工具，如 eortc QLQ-LC13 或 fact-L，因为这些工具提供了针对肺癌或肺转移患者的生活质量测量。
