Palm Russell F, Jim Heather S L, Boulware David, Johnstone Peter A S, Naghavi Arash O
Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
Health Outcomes and Behavior Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
Clin Transl Radiat Oncol. 2020 Feb 28;22:22-28. doi: 10.1016/j.ctro.2020.02.007. eCollection 2020 May.
Retroperitoneal sarcoma (RPS) is a rare, complex disease requiring multidisciplinary management. We have previously reported that use of the Revised Edmonton Symptom Assessment Scale (ESAS-r-CSS) allows for proactive symptom management, and we sought to report the results of ESAS-r-CSS screening during pre-operative radiotherapy (RT) for a cadre of patients with RPS.
We reviewed records of 47 patients with RPS evaluated at our institution between 2015 and 2018. Of this group, 29 non-metastatic patients were treated with definitive intent neoadjuvant RT with at least 2 weekly ESAS-r-CSS reports. A generalized estimating equation model was used to compare 13 symptoms during weekly on-treatment visits compared to baseline scores at week 1 of RT. Additionally, covariate effects of age, gender, dose, tumor size and location were assessed.
The population was predominantly male (66%) with median age of 65 years, KPS of 90, and tumor size of 12.8 cm. ESAS scores significantly decreased for anxiety at week 3 ( = 0.01), and pain at week 5 ( = 0.01). Worse constipation was reported at week 2 ( = 0.02). In an exploratory covariate analysis, female gender, age, high dose, and larger tumor size were associated with worse ESAS scores across all time points.
Patient reporting of symptoms during radiotherapy through weekly ESAS-r-CSS facilitates timely management in patients with this unique tumor type. Expectant care during RT offers the opportunity to minimize symptom progression or treatment interruptions in a population that generally has worsening side effects.
腹膜后肉瘤（RPS）是一种罕见的复杂疾病，需要多学科管理。我们之前曾报道，使用修订版埃德蒙顿症状评估量表（ESAS-r-CSS）可实现症状的主动管理，我们试图报告在一组RPS患者术前放疗（RT）期间进行ESAS-r-CSS筛查的结果。
我们回顾了2015年至2018年在我们机构评估的47例RPS患者的记录。在这组患者中，29例非转移性患者接受了根治性新辅助放疗，每周至少有2份ESAS-r-CSS报告。使用广义估计方程模型比较每周治疗期间的13种症状与放疗第1周的基线评分。此外，评估了年龄、性别、剂量、肿瘤大小和位置的协变量效应。
研究人群以男性为主（66%），中位年龄65岁，KPS为90，肿瘤大小为12.8 cm。焦虑症状在第3周时ESAS评分显著下降（P = 0.01），疼痛症状在第5周时显著下降（P = 0.01）。第2周报告便秘情况更严重（P = 0.02）。在探索性协变量分析中，女性、年龄较大、高剂量和较大肿瘤大小在所有时间点均与较差的ESAS评分相关。
通过每周的ESAS-r-CSS让患者报告放疗期间的症状，有助于对这种独特肿瘤类型的患者进行及时管理。放疗期间的预期护理为在通常副作用会加重的人群中尽量减少症状进展或治疗中断提供了机会。
