神经内分泌肿瘤骨转移的姑息性放射治疗
Palliative Radiation Therapy for Bone Metastases in Neuroendocrine Neoplasms.
作者信息
Guan Michelle, He Ingrid, Luu Michael, David John, Gong Jun, Placencio-Hickok Veronica R, Reznik Robert S, Tuli Richard, Hendifar Andrew E
机构信息
Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
Adv Radiat Oncol. 2019 Apr 10;4(3):513-519. doi: 10.1016/j.adro.2019.03.014. eCollection 2019 Jul-Sep.
PURPOSE
Bone metastases are reported in 10% to 12% of patients with neuroendocrine neoplasms (NENs) and can lead to pain and skeletal-related events (SREs), resulting in diminished quality of life and functional status. In other solid tumors with bone metastases, radiation therapy (RT) is an established treatment approach for SREs, yet few data are available in NENs historically considered to be radioresistant. We hypothesize that RT is effective for pain and other SREs in NENs and aimed to delineate any differences in pain palliation and time until progression of pain between different fractionation and dosing schedules of RT.
METHODS AND MATERIALS
We retrospectively reviewed 686 records of patients with NENs treated at the institution between 2011 and 2018 and identified 28 (4.1%) patients treated with RT for 61 cases of SREs. The primary endpoint was change in patient reported pain scores after RT.
RESULTS
All 28 patients experienced bone pain. Nineteen sites were treated with a single fraction (doses of 800-1800 cGy) and 42 sites with fractionated regimens (doses of 900-3750 cGy over 3-15 fractions). In 55 of 61 cases (90%), patients experienced improvement in pain after RT. The median time to recurrence or progression of pain was 3.5 months. Significant differences were found between primary site and change in performance status ( .024), sex, and reported magnitude of pain score decrease after RT ( .025). There were no differences in the time to the progression of pain, change in performance status, and degree of improvement in pain based on age, chemotherapy received during RT, or radiation site. Outcomes were similar for patients who received single-fraction versus fractionated regimens ( .545) and between those receiving palliative versus ablative RT regimens ( .812).
CONCLUSIONS
Although the majority of cases in this NEN cohort benefited from RT, additional studies on the use of RT in the treatment of painful bone metastases are warranted.
目的
据报道，10%至12%的神经内分泌肿瘤（NENs）患者会发生骨转移，可导致疼痛和骨相关事件（SREs），从而导致生活质量和功能状态下降。在其他发生骨转移的实体瘤中，放射治疗（RT）是治疗SREs的既定方法，但在历史上被认为对放疗耐药的NENs中，相关数据较少。我们假设RT对NENs的疼痛和其他SREs有效，并旨在描述不同分割和剂量方案的RT在疼痛缓解和疼痛进展时间方面的任何差异。
方法和材料
我们回顾性分析了2011年至2018年在该机构接受治疗的686例NENs患者的记录，确定了28例（4.1%）接受RT治疗的患者，共61例SREs。主要终点是RT后患者报告的疼痛评分变化。
结果
所有28例患者均经历骨痛。19个部位接受单次分割治疗（剂量为800-1800 cGy），42个部位接受分割治疗方案（3-15次分割，剂量为900-3750 cGy）。在61例中的55例（90%）中，患者RT后疼痛得到改善。疼痛复发或进展的中位时间为3.5个月。在原发部位与功能状态变化（.024）、性别以及RT后报告的疼痛评分降低幅度（.025）之间发现了显著差异。基于年龄、RT期间接受的化疗或放疗部位，疼痛进展时间、功能状态变化和疼痛改善程度没有差异。接受单次分割与分割治疗方案的患者（.545）以及接受姑息性与根治性RT方案的患者（.812）的结果相似。
结论
尽管该NEN队列中的大多数病例从RT中获益，但仍有必要对RT用于治疗疼痛性骨转移进行更多研究。
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