Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):e337-42. doi: 10.1016/j.ijrobp.2012.05.028. Epub 2012 Jul 3.
Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT.
Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance.
Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019).
Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying responses and are recommended for use in future bone metastasis clinical trials.
放射治疗（RT）是缓解疼痛性骨转移的有效方法，可改善功能并减少镇痛需求。在晚期癌症患者中，生活质量（QOL）是比生存等传统终点更受关注的主要结果。我们的研究目的是比较对姑息性 RT 反应不同的患者的骨转移特异性 QOL 评分。
2010 年 3 月至 2011 年 1 月，在一项验证 QLQ-BM22 的试验中，来自 6 个国家的接受 RT 治疗骨转移的患者前瞻性入组，并在基线和 1 个月后完成了 QLQ-BM22 和核心量表（QLQ-C30）。记录疼痛评分和镇痛药摄入量，并根据最新公布的指南确定 RT 反应。Kruskal-Wallis 非参数和 Wilcoxon 秩和检验比较了反应组之间 QOL 的变化。Bonferroni 校正的 P<.003 表示具有统计学意义。
在接受姑息性 RT 的 79 名患者中，有 59 名可评估。分别观察到 22 例、8 例和 29 例部分缓解、疼痛进展和不确定反应，没有完全缓解的患者。除了身体功能外，所有组的患者在基线 QOL 评分方面相似（进展的患者初始功能更好）。在 RT 后 1 个月，有反应的患者在 4 个 QLQ-BM22 域中的 3 个（疼痛部位，P<.0001；疼痛特征，P<.0001；和功能障碍，P<.0001）和 3 个 QLQ-C30 域（身体功能，P=.0006；角色功能，P=.0026；和疼痛，P<.0001））方面有显著改善。疼痛进展的患者功能障碍（P=.0007）和疼痛（P=.0019）明显更差。
报告姑息性 RT 后疼痛缓解的患者在骨转移特异性问题方面也具有更好的 QOL。QLQ-BM22 和 QLQ-C30 能够区分不同反应的患者，建议在未来的骨转移临床试验中使用。
