Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):389-393. doi: 10.1016/j.ijrobp.2019.06.2541. Epub 2019 Jul 5.
To investigate the effectiveness of palliative pelvic radiation therapy (PRT) in patients with bladder cancer and identify factors associated with treatment outcome.
Patients with bladder cancer receiving PRT were identified retrospectively from 2 cancer centers between 2014 and 2017. Patients were stratified by age, stage, performance status, comorbidities, previous chemotherapy, previous radiation therapy, and radiation therapy protocol. Patients were followed up at 6 weeks after radiation therapy (RT). Median overall survival (mOS) from the last fraction of RT was calculated. Death within 30 days of RT or noncompletion of treatment were considered as futile treatment.
Two hundred forty-one patients were identified as receiving PRT. A variety of RT protocols were used: 8 Gy in 1 fraction (11%), 21 Gy in 3 fractions (15%), 20 Gy in 5 fractions (18%), 36 Gy in 6 fractions (36%), and 27.5 to 30 Gy in 8 to 10 fractions (18%). Thirty-eight percent of patients were of poor performance status (Eastern Cooperative Oncology Group performance status ≥3), and 46.5% had significant comorbidities (Adult Comorbidity Evaluation-27 ≥2). The mOS from the last fraction of RT was 153 days (0-1289 days). The 30-day mortality after radiation therapy was 18% (n = 44), and the rate of incomplete planned radiation therapy treatment was 14% (n = 33). First follow-up information was available in 62% (n = 150) of patients. Median time to this follow-up was 49 days (14-238 days). At first follow-up at about 6 weeks after the last fraction of radiation therapy, symptoms were reported in 150 of 200 (75%) living patients; 80 of 150 (53%) patients reported improvement in symptoms after treatment. There were significant differences in mOS with stage, performance status, and comorbidities.
One in 4 patients either did not complete the planned RT course or died within 30 days of treatment. These patients were unlikely to have received maximal benefit from treatment but may have experienced side effects, making treatment futile. Patients with good performance status and earlier stage disease survived longer. Patient selection and comprehensive assessment are crucial in selecting appropriate patients for treatment.
探讨姑息性盆腔放疗（PRT）在膀胱癌患者中的疗效，并确定与治疗结果相关的因素。
从 2014 年至 2017 年，我们在 2 家癌症中心回顾性地确定了接受 PRT 的膀胱癌患者。根据年龄、分期、表现状态、合并症、既往化疗、既往放疗和放疗方案对患者进行分层。患者在放疗结束后 6 周进行随访。从最后一次放疗的分数开始计算中位总生存期（mOS）。放疗后 30 天内死亡或治疗未完成被视为无效治疗。
共确定 241 例患者接受 PRT。使用了多种放疗方案：1 次 8 Gy（11%）、3 次 21 Gy（15%）、5 次 20 Gy（18%）、6 次 36 Gy（36%）和 8 至 10 次 27.5 至 30 Gy（18%）。38%的患者表现状态较差（东部肿瘤协作组表现状态≥3），46.5%有显著合并症（成人合并症评估-27≥2）。从最后一次放疗的分数开始，mOS 为 153 天（0-1289 天）。放疗后 30 天死亡率为 18%（n=44），未完成计划放疗治疗的比例为 14%（n=33）。62%（n=150）的患者可获得首次随访信息。首次随访的中位时间为 49 天（14-238 天）。在最后一次放疗结束后约 6 周的首次随访中，200 名存活患者中有 150 名（75%）报告有症状；150 名患者中有 80 名（53%）报告治疗后症状改善。分期、表现状态和合并症与 mOS 存在显著差异。
1/4 的患者要么未完成计划的 RT 疗程，要么在治疗后 30 天内死亡。这些患者不太可能从治疗中获得最大益处，但可能经历了副作用，使治疗无效。表现状态良好和疾病早期的患者存活时间更长。患者选择和全面评估对于选择合适的治疗患者至关重要。
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