Department of Radiation Oncology, University of Western Ontario, London, ON, Canada.
Clin Lung Cancer. 2012 Jan;13(1):1-5. doi: 10.1016/j.cllc.2011.04.004. Epub 2011 Jun 12.
The purpose of this work is to disseminate a consensus statement on palliative radiotherapy (RT) of lung cancer created in conjunction with the Third International Lung Cancer Consensus Workshop. The palliative lung RT workshop committee agreed on 5 questions relating to (1) patient selection, (2) thoracic external-beam radiation therapy (XRT) fractionation, (3) endobronchial brachytherapy (EBB), (4) concurrent chemotherapy (CC), and (5) palliative endpoint definitions. A PubMed search for primary/cross-referenced practice guidelines, consensus statements, meta-analyses, and/or systematic reviews was conducted. Final consensus statements were created after review and discussion of the available evidence. The following summary statements reflect the consensus of the international working group. 1. Key factors involved in the decision to deliver palliative RT include performance status, tumor stage, pulmonary function, XRT volume, symptomatology, weight loss, and patient preference. 2. Palliative thoracic XRT is generally indicated for patients with stage IV disease with current/impending symptoms and for patients with stage III disease treated for palliative intent. 3. There is no evidence to routinely recommend EBB alone or in conjunction with other palliative maneuvers in the initial palliative management of endobronchial obstruction resulting from lung cancer. 4. There is currently no evidence to routinely recommend CC with palliative-intent RT. 5. Standard assessment of symptoms and health-related quality of life (QOL) using validated questionnaires should be carried out in palliative RT lung cancer trials. Despite an expanding literature, continued prospective randomized investigations to better define the role of XRT, EBB, and CC in the context of thoracic palliation of patients with lung cancer is needed.
这项工作的目的是传播与第三届国际肺癌共识研讨会联合制定的关于肺癌姑息性放疗（RT）的共识声明。姑息性肺 RT 研讨会委员会就以下 5 个问题达成一致意见：（1）患者选择，（2）胸部外照射放疗（XRT）分割，（3）支气管内近距离放射治疗（EBB），（4）同步化疗（CC），以及（5）姑息性终点定义。对主要/交叉参考的实践指南、共识声明、荟萃分析和/或系统评价进行了 PubMed 搜索。在审查和讨论现有证据后，制定了最终的共识声明。以下总结陈述反映了国际工作组的共识。1. 决定进行姑息性 RT 的关键因素包括体能状态、肿瘤分期、肺功能、XRT 体积、症状、体重减轻和患者偏好。2. 姑息性胸部 XRT 通常适用于有当前/即将出现症状的 IV 期疾病患者，以及出于姑息治疗目的治疗的 III 期疾病患者。3. 目前没有证据表明在肺癌引起的支气管内阻塞的初始姑息性管理中，常规推荐单独使用 EBB 或与其他姑息性措施联合使用。4. 目前没有证据表明常规推荐 CC 与姑息性 RT 联合使用。5. 在姑息性 RT 肺癌试验中，应使用经过验证的问卷标准评估症状和健康相关生活质量（QOL）。尽管文献不断增加，但仍需要进行前瞻性随机研究，以更好地确定 XRT、EBB 和 CC 在肺癌患者胸部姑息治疗中的作用。
