Stanford University School of Medicine, Stanford, California.
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California.
Pract Radiat Oncol. 2019 Mar;9(2):e203-e209. doi: 10.1016/j.prro.2018.11.008. Epub 2018 Dec 7.
Emergent palliative radiation therapy (PRT) of symptomatic metastases can significantly increase the quality of life of patients with cancer. In some contexts, this treatment may be underused, but in others PRT may represent an excessively aggressive intervention. The characterization of the current use of emergent PRT is warranted for optimized value and patient-centered care.
This study is a cross-sectional retrospective analysis of all emergent PRT courses at a single academic tertiary institution across 1 year.
A total of 214 patients received a total of 238 treatment courses. The most common indications were bone (39%) and brain (14%) metastases. Compared with outpatients, inpatients had lower mean survival rates (2 months vs 6 months; P < .001), higher rates of stopping treatment early (19.1% vs 9.0%; P = .034), and greater involvement of palliative care (44.8% vs 24.1%; P < .001), but the same mean planned fractions (9.10 vs 9.40 fractions; P = .669). In a multiple predictor survival analysis, palliative care involvement (P = .025), male sex (P = .001), ending treatment early (P = .011), and having 1 of 3 serious indications (airway compromise, leptomeningeal disease, and superior/inferior vena cava involvement; P = .007) were significantly associated with worse overall survival.
Survival is particularly poor in patients who receive emergent PRT, and patient characteristics such as functional status and indication should be considered when determining fractionation schedule and dosing. A multi-institutional study of practice patterns and outcomes is warranted.
对有症状转移灶进行紧急姑息性放射治疗（PRT）可显著提高癌症患者的生活质量。在某些情况下，这种治疗可能未得到充分利用，但在其他情况下，PRT 可能代表过度激进的干预措施。为了优化价值和以患者为中心的护理，有必要对紧急 PRT 的当前使用情况进行特征描述。
本研究是对单家学术性三级医院 1 年内所有紧急 PRT 疗程的横断面回顾性分析。
共有 214 例患者接受了 238 次治疗。最常见的适应证是骨（39%）和脑（14%）转移。与门诊患者相比，住院患者的平均生存率较低（2 个月比 6 个月；P<.001），早期停止治疗的比例较高（19.1%比 9.0%；P=.034），姑息治疗的参与度较高（44.8%比 24.1%；P<.001），但计划的平均分割次数相同（9.10 次比 9.40 次；P=.669）。在多因素生存分析中，姑息治疗的参与（P=.025）、男性（P=.001）、早期停止治疗（P=.011）以及存在 3 种严重适应证之一（气道压迫、软脑膜疾病和上/下腔静脉受累；P=.007）与总体生存显著相关。
接受紧急 PRT 的患者生存情况特别差，在确定分割方案和剂量时应考虑患者的特征，如功能状态和适应证。有必要对实践模式和结果进行多机构研究。
