Dorion Valérie, Lambert Louise, Frazzi Alexandra, Cayer Jean-François, Wong Philip
Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
Unité De Recherche Clinique En Oncologie Et Hématologie, Centre hospitalier de l'Université de Montréal (CHUM).
Cureus. 2017 Nov 22;9(11):e1871. doi: 10.7759/cureus.1871.
Purpose Radiation therapy (RT) has been a frequently used treatment for painful bone metastasis. The aim of this study was to determine the feasibility of using activity trackers (AT) to assess the patient prognosis and the effects of palliative RT. Methods and materials Twelve patients planned to receive palliative RT for axial metastases and were prospectively recruited to participate in this pilot clinical trial. The patients were eligible if there was no intent to change the analgesic medications prior to or within seven days of palliative RT. All the patients were lent a Misfit Flash activity tracker (Misfit, Burlingame, California, United States of America) and were asked to wear it from the time of baseline assessment prior to RT until seven days after RT. The patients completed the European Organisation for Research and Treatment of Cancer quality of life (QOL) questionnaire (EORTC-QLQ C30) and the Short Form Brief Pain Inventory (SF-BPI) before the treatment and at days seven, 30 and 90 after completion of the RT. The patients' Karnofsky Performance Status (KPS) was assessed at each visit. The patients' overall survival at the end of the RT was recorded. Average daily steps before and after RT were compared using paired Wilcoxon signed-rank test. The patients' overall survival was estimated using the Kaplan-Meier curve and analyzed using the Log-Rank test. Results The median age of the patients was 62 years (range: 40-79 years). Of the 12 patients, there were five prostate, three breasts, three lungs, and one colon cancer-related patients. Six patients received 20 Gray (Gy) in five fractions and six received 8 Gy in one fraction. By day seven, post-RT, there was a 30% (p <0.02) reduction in the patients' daily activity level. There was no correlation between improvements in the QOL or with the level of pain and with the number of daily steps. While baseline KPS was not prognostic of the patient survival, the patients who on average took more than 7800 steps per day prior to RT lived significantly (p=0.034) longer than those who were less active. Conclusions The baseline activity level is associated with the patient prognosis. A significant decline in the physical activity was observed at one week after palliative RT. The use of activity trackers was to prognosticate and to monitor the patients' response to the palliative RT and should be evaluated further.
目的 放射治疗（RT）一直是治疗疼痛性骨转移的常用方法。本研究的目的是确定使用活动追踪器（AT）评估患者预后及姑息性放疗效果的可行性。方法与材料 前瞻性招募12例计划接受姑息性放疗以治疗轴向转移瘤的患者参与这项初步临床试验。如果患者在姑息性放疗前或放疗7天内无意更换止痛药物，则符合入选标准。所有患者均获借一个Misfit Flash活动追踪器（Misfit，美国加利福尼亚州伯林盖姆），并被要求从放疗前的基线评估时开始佩戴，直至放疗后7天。患者在治疗前以及放疗完成后的第7天、30天和90天完成欧洲癌症研究与治疗组织生活质量（QOL）问卷（EORTC-QLQ C30）和简明疼痛问卷简表（SF-BPI）。每次就诊时评估患者的卡氏功能状态（KPS）。记录患者放疗结束时的总生存期。使用配对Wilcoxon符号秩检验比较放疗前后的平均每日步数。使用Kaplan-Meier曲线估计患者的总生存期，并使用对数秩检验进行分析。结果 患者的中位年龄为62岁（范围：40 - 79岁）。12例患者中，有5例前列腺癌、3例乳腺癌、3例肺癌和1例结肠癌相关患者。6例患者接受5次分割共20格雷（Gy）的放疗，6例患者接受单次8 Gy的放疗。放疗后第7天，患者的日常活动水平下降了30%（p <0.02）。生活质量的改善、疼痛程度与每日步数之间无相关性。虽然基线KPS不能预测患者的生存期，但放疗前平均每日步数超过7800步的患者的生存期显著（p = 0.034）长于活动量较少的患者。结论 基线活动水平与患者预后相关。姑息性放疗后1周观察到身体活动显著下降。使用活动追踪器对患者进行预后评估和监测其对姑息性放疗的反应，应进一步评估。
