Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.
Radiother Oncol. 2012 Jul;104(1):39-44. doi: 10.1016/j.radonc.2012.05.006. Epub 2012 Jun 23.
In non-small cell lung cancer (NSCLC) stage III, data on patient reported health-related quality of life (HRQL) are scarce, especially regarding concurrent chemoradiotherapy.
To evaluate HRQL in patients treated with high dose radiotherapy combined with concurrent chemotherapy or the antibody cetuximab.
The study population comprised all patients enroled in either of two phase II trials in locally advanced NSCLC performed in Sweden 2002-2007. The RAKET trial investigated three different ways of increasing local control (accelerated hyperfractionated treatment or concurrent daily or weekly chemotherapy). The Satellite trial evaluated the addition of cetuximab to thoracic irradiation. HRQL was measured at four time points: At baseline, before radiotherapy, 4-6 weeks after radiotherapy and at 3 months follow-up, using the EORTC QLQ-C30 and LC14 set of questionnaires.
154/220 patients (65%) who completed HRQL assessments at all time points were included in the longitudinal study. There was a significant decline over time regarding most functioning measures. Dyspnoea and fatigue gradually deteriorated without recovery after completed treatment. Chemotherapy related symptoms showed a transient deterioration, whereas radiotherapy related esophagitis had not fully recovered at 3 months. Patients with stage IIIA disease tended to recover better regarding global QL, fatigue and dyspnoea compared to patients with stage IIIB. Patients with WHO performance status (PS) 0 reported improved global QL and less fatigue over time compared with PS 1. Concurrent chemotherapy was associated with more pronounced fatigue and dysphagia, and worse global QL compared with concurrent cetuximab. Baseline physical functioning was an independent predictor of overall survival.
Patients undergoing high dose thoracic radiotherapy combined with chemotherapy or cetuximab reported a gradual deterioration in functioning, dyspnoea and fatigue, while treatment related side effects were transient. Radiotherapy with concurrent cetuximab had less negative impact on HRQL than concurrent chemoradiation.
在非小细胞肺癌（NSCLC）III 期，关于患者报告的健康相关生活质量（HRQL）的数据很少，特别是关于同期放化疗的情况。
评估接受高剂量放疗联合同期化疗或抗体西妥昔单抗治疗的患者的 HRQL。
研究人群包括 2002-2007 年在瑞典进行的两项局部晚期 NSCLC 二期试验中的所有入组患者。RAKET 试验研究了三种不同的方法来提高局部控制率（加速超分割治疗或同期每日或每周化疗）。卫星试验评估了西妥昔单抗联合胸部放疗的效果。HRQL 在四个时间点进行测量：基线时、放疗前、放疗后 4-6 周和 3 个月随访时，使用 EORTC QLQ-C30 和 LC14 问卷集。
154/220 名（65%）完成所有时间点 HRQL 评估的患者被纳入纵向研究。大多数功能测量指标随时间显著下降。呼吸困难和疲劳逐渐恶化，治疗结束后无法恢复。化疗相关症状短暂恶化，而放疗相关食管炎在 3 个月时尚未完全恢复。与 IIIB 期患者相比，IIIA 期疾病患者的全球 QL、疲劳和呼吸困难恢复较好。与 PS1 相比，PS0 的患者随着时间的推移，全球 QL 和疲劳感改善，PS0 的患者的生活质量和体力状况更差。与同期西妥昔单抗相比，同期化疗与更明显的疲劳和吞咽困难以及更差的全球 QL 相关。基线身体功能是总生存的独立预测因素。
接受高剂量胸部放疗联合化疗或西妥昔单抗治疗的患者报告功能、呼吸困难和疲劳逐渐恶化，而治疗相关副作用是短暂的。与同期放化疗相比，同期西妥昔单抗放疗对 HRQL 的负面影响较小。
