Mendez Lucas C, Raman Srinivas, Wan Bo Angela, da Silva José Luiz Padilha, Moraes Fábio Y, Lima Kennya M L B, Silva Maurício F, Diz Maria Del Pilar Estevez, Chow Edward, Marta Gustavo Nader
Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada.
Radiation Oncology Unit, Santa Maria Federal University, Hospital de Caridade Astrogildo de Azevedo, Santa Maria, Brazil.
Ann Palliat Med. 2017 Aug;6(Suppl 1):S65-S70. doi: 10.21037/apm.2017.04.06. Epub 2017 May 17.
Bone metastases cause pain, suffering and impaired quality of life (QoL). Palliative radiotherapy (RT) and/or chemotherapy are effective methods in controlling pain, reducing analgesics use and improving QoL. This study goal was to investigate the changes in QoL scores among patients who responded to palliative treatment.
A prospective study evaluating the role of radiation therapy in a public academic hospital in São Paulo-Brazil recorded patients' opioid use, pain score, Portuguese version of QLQ-BM22 and QLQ-C30 before and 2 months after radiotherapy. Analgesic use and pain score were used to calculate international pain response category. Overall response was defined as the sum of complete response (CR) and partial response (PR). CR was defined as pain score of 0 with no increase in analgesic intake whereas PR was defined as pain reduction ≥2 without analgesic increase or analgesic reduction in ≥25% without increase in pain at the treated site.
From September 2014 to October 2015, 25 patients with bone metastases responded to RT or chemotherapy (1 CR, 24 PR). There were 8 male and 17 female patients. The median age of the 25 patients was 59 (range, 22 to 80) years old. Patient's primary cancer site was breast [11], prostate [5], lung [2], others [7]. For QLQ-BM 22, the mean scores of 4 categories at baseline were: pain site (PS) 39, pain characteristics (PC) 61, function interference (FI) 49 and psycho-social aspects (PA) 57. At 2 month follow up, the scores were PS 27, PC 37, FI 70 and PA 59. Statistical significant improvement (P<0.05) was seen in PS, PC, FI but not PA. In the QLQ-C30, the scores were not statistically different for all categories, except for pain that demonstrated a 33 point decrease in the median pain score domain (66 to 33).
Responders to RT at 2 months presented improvement in BM22 and C30 pain domains, and also improvement in functional interference domain of the BM22 questionnaire.
骨转移会导致疼痛、痛苦并损害生活质量（QoL）。姑息性放疗（RT）和/或化疗是控制疼痛、减少镇痛药使用及改善生活质量的有效方法。本研究的目的是调查对姑息治疗有反应的患者生活质量评分的变化。
一项前瞻性研究评估了巴西圣保罗一家公立学术医院放疗的作用，记录了患者放疗前及放疗后2个月的阿片类药物使用情况、疼痛评分、葡萄牙语版QLQ-BM22和QLQ-C30。镇痛药使用情况和疼痛评分用于计算国际疼痛反应类别。总体反应定义为完全缓解（CR）和部分缓解（PR）的总和。CR定义为疼痛评分为0且镇痛药摄入量无增加，而PR定义为疼痛减轻≥2分且镇痛药未增加，或镇痛药减少≥25%且治疗部位疼痛未增加。
2014年9月至2015年10月，25例骨转移患者对放疗或化疗有反应（1例CR，24例PR）。有8例男性和17例女性患者。25例患者的中位年龄为59岁（范围22至80岁）。患者的原发癌部位为乳腺癌[11例]、前列腺癌[5例]、肺癌[2例]、其他[7例]。对于QLQ-BM 22，基线时4个类别的平均评分为：疼痛部位（PS）39分、疼痛特征（PC）61分、功能干扰（FI）49分和心理社会方面（PA）57分。在2个月随访时，评分分别为PS 27分、PC 37分、FI 70分和PA 59分。PS、PC、FI有统计学显著改善（P<0.05），而PA无改善。在QLQ-C30中，除疼痛外，所有类别的评分无统计学差异，疼痛在中位疼痛评分领域下降了33分（从66分降至33分）。
放疗2个月时有反应的患者在BM22和C30疼痛领域有改善，在BM22问卷的功能干扰领域也有改善。
