Department of Radiation Oncology, University Hospital Dusseldorf, Dusseldorf, Germany.
Cancer. 2010 Jul 1;116(13):3251-6. doi: 10.1002/cncr.25112.
The purpose of the study was to investigate the adequacy of palliative radiation treatment in end-stage cancer patients.
Of 216 patients referred for palliative radiotherapy, 33 died within 30 days and constitute the population of the study. Symptoms, Karnofsky Performance Status (KPS), laboratory tests, and survival estimates were obtained. Treatment course was evaluated by medical records. Univariate analyses were performed by using the 2-sided chi-square test. With significant variables, multiple regression analysis was performed.
Median age was 65 years, and median survival was 15 days. Prevailing primary cancer types were lung (39%) and breast (18%). Metastases were present in 94% of patients, brain (36%), bone (24%) and lung (18%). In 91%, KPS was < 0%. KPS, lactate dehydrogenase, dyspnea, leucocytosis, and brain metastases conveyed a poor prognosis. From 85 survival estimates, only 16% were correct, but 21% expected more than 6 months. Radiotherapy was delivered to 91% of patients. In 90% of radiation treatments, regimens of at least 30 Gy with fractions of 2-3 Gy were applied. Half of the patients spent greater than 60% of their remaining lifespan on therapy. In only 58% of patients was radiotherapy completed. Progressive complaints were noted in 52% and palliation in 26%.
Radiotherapy was not appropriately customized to these patients considering the median treatment time, which resembles the median survival time. About half of the patients did not benefit despite spending most of their remaining lives on therapy. Prolonged irradiation schedules probably reflect overly optimistic prognoses and unrealistic concerns about late radiation damage. Single-fraction radiotherapy was too seldom used.
本研究旨在探讨终末期癌症患者姑息性放疗的充分性。
在 216 例接受姑息性放疗的患者中，33 例在 30 天内死亡，构成了本研究的人群。收集症状、卡氏功能状态（KPS）、实验室检查和生存估计值。通过病历评估治疗过程。采用双侧卡方检验进行单变量分析。对有显著意义的变量进行多元回归分析。
中位年龄为 65 岁，中位生存时间为 15 天。主要原发癌类型为肺癌（39%）和乳腺癌（18%）。94%的患者有转移，脑转移（36%）、骨转移（24%）和肺转移（18%）。91%的患者 KPS<0%。KPS、乳酸脱氢酶、呼吸困难、白细胞增多和脑转移提示预后不良。从 85 个生存估计值中，只有 16%是正确的，但 21%预计超过 6 个月。91%的患者接受了放疗。在 90%的放射治疗中，采用了至少 30Gy、分割剂量为 2-3Gy 的方案。一半的患者在治疗上花费了超过 60%的剩余寿命。只有 58%的患者完成了放疗。52%的患者出现进行性投诉，26%的患者出现缓解。
考虑到中位治疗时间与中位生存时间相似，放疗并没有根据这些患者的具体情况进行适当调整。尽管一半以上的患者在治疗上花费了大部分剩余生命，但仍未受益。延长放疗计划可能反映出过于乐观的预后和对晚期放射损伤的不切实际的担忧。单次分割放疗应用过少。
