非小细胞肺癌的分段姑息性胸部放疗——无效还是值得？
Fractionated palliative thoracic radiotherapy in non-small cell lung cancer - futile or worth-while?
机构信息
Department of Oncology, Finsen Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
出版信息
BMC Palliat Care. 2018 Jan 5;17(1):15. doi: 10.1186/s12904-017-0270-4.
BACKGROUND
Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions.
METHODS
Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included. We noted pathology, tumor, node and metastasis (TNM) classification of malignant tumors, stage, indication, start date, schedule for PTR, completed y/n, performance status (PS) and time of death. Analyses were performed as an intention-to-treat using Cox regression, Fishers exact test and Kaplan Meier.
RESULTS
A total of 159 patients were included. Median overall survival (OS) was 4.2 months. Sixteen patients (10%) did either not begin or finish PTR. Of these, eight (5%) died prior to or during PTR. Of the 151 patients receiving PTR, sixteen patients (11%) died within 14 days, thirty-three (22%) within 30 days and fifty (33%) within 2 months. PS 0-1 and squamous cell carcinoma were correlated with a better survival.
CONCLUSIONS
Our study show that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 0-1 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 0-1 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for high dose single fraction only or supportive palliative care.
背景
姑息性胸部放疗（PTR）可以缓解源于胸内疾病的症状。PTR 的最佳时机和分割尚未确定。起效时间为 2 个月。本回顾性研究的主要目的是调查 PTR 后的生存情况，假设相当一部分患者接受了无效的分割 PTR。次要目的是寻找预后因素以指导治疗决策。
方法
纳入了 2010-2011 年哥本哈根大学医院计划接受 PTR 的非小细胞肺癌（NSCLC）患者。我们记录了恶性肿瘤的病理学、肿瘤、淋巴结和转移（TNM）分类、分期、适应证、PTR 开始日期、计划放疗、是否完成、体力状况（PS）和死亡时间。使用 Cox 回归、Fisher 精确检验和 Kaplan-Meier 进行意向治疗分析。
结果
共纳入 159 例患者。中位总生存期（OS）为 4.2 个月。16 例（10%）未开始或未完成 PTR。其中 8 例（5%）在 PTR 前或期间死亡。在接受 PTR 的 151 例患者中，16 例（11%）在 14 天内死亡，33 例（22%）在 30 天内死亡，50 例（33%）在 2 个月内死亡。PS 0-1 和鳞状细胞癌与生存较好相关。
结论
我们的研究表明，相当一部分接受 PTR 的患者在治疗达到最佳效果之前死亡。PS 和组织学是有利于 PS 0-1 和鳞状细胞癌的重要预后因素。基于我们的研究，我们建议 PS 0-1 的患者应考虑接受分割 PTR，而 PS≥2 的患者应考虑仅接受高剂量单次分割或支持性姑息治疗。
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