Westhoff Paulien G, Verdam Mathilde G E, Oort Frans J, Jobsen Jan J, van Vulpen Marco, Leer Jan Willem H, Marijnen Corrie A M, de Graeff Alexander, van der Linden Yvette M
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiotherapy, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Int J Radiat Oncol Biol Phys. 2016 Aug 1;95(5):1391-1398. doi: 10.1016/j.ijrobp.2016.03.032. Epub 2016 Mar 29.
To study the course of quality of life (QoL) after radiation therapy for painful bone metastases.
The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics.
In general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (-0.11 to -0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions.
Although radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.
研究疼痛性骨转移瘤放射治疗后的生活质量（QoL）变化过程。
荷兰骨转移瘤研究在1996年至1998年间，将1157例疼痛性骨转移瘤患者随机分为单次8 Gy照射组和6次每次4 Gy照射组。该研究显示两组的疼痛缓解率相当，均为74%。患者每周填写问卷，共13周，之后2年每月填写一次。在这些分析中，研究了身体、心理社会和功能QoL领域评分以及总体健康评分。采用混合模型对QoL变化过程进行建模，并研究多种特征的影响。
总体而言，QoL在1个月后趋于稳定。心理社会QoL在治疗后有所改善。QoL水平保持稳定，在生命末期急剧恶化。对于大多数QoL领域，高疼痛评分和阿片类药物的使用与较差的QoL相关，效应量较小（-0.11至-0.27）。较差的体能评分与较差的功能QoL相关，效应量中等（0.41）。接受单次8 Gy照射和6次每次4 Gy照射的患者之间，QoL没有差异，除了6次照射后身体QoL会暂时恶化。
尽管疼痛性骨转移瘤的放射治疗能带来有意义的疼痛缓解，但治疗后大多数QoL领域并未改善。只有心理社会QoL在治疗后略有改善。QoL水平与实际生存期相关，在剩余生存期的大部分时间里QoL相当稳定，然后在生命结束前几周开始急剧下降。与单次8 Gy照射相比，6次每次4 Gy照射会导致身体QoL暂时变差。
