Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
Pract Radiat Oncol. 2021 May-Jun;11(3):185-192. doi: 10.1016/j.prro.2020.10.009. Epub 2020 Oct 31.
We investigate the time to and clinical factors associated with patient-reported difficulty swallowing in lung cancer patients treated with radiation therapy (RT).
Between October 2016 and October 2019, lung cancer patients treated with conventionally fractionated RT at a tertiary cancer center were identified. Weekly, patients reported difficulty swallowing (patient-reported outcome version of the Common Terminology Criteria for Adverse Events [PRO-CTCAE] v.1: 0-none, 1-mild, 2-moderate, 3-severe, 4-very severe). Physicians graded dysphagia (CTCAE v.4: 0-none, 1-symptoms without altered intake, 2-symptomatic; altered eating/swallowing, 3-severely altered eating/swallowing, 4-life-threatening consequences, 5-death). Tumor-related difficulty swallowing was not recorded at baseline; thus, patients reporting ≥moderate symptoms ≤7 days of RT start were excluded. We evaluated the time to new patient reports of ≥moderate difficulty swallowing and CTCAE grade 2+ dysphagia and development over time using the cumulative incidence method. Multivariable logistic regression evaluated associations between clinical factors, esophageal V60, and development of esophageal symptoms.
Of the 200 patients identified: median age was 69 years, 52% were male, and 89% had stage III+ disease. Patients received a median of 63 Gy with chemotherapy (91.5%). At least moderate difficulty swallowing during RT was reported by 76 of 200 patients (38%); clinicians rated dysphagia as altering oral intake or worse for 26 of 200 (13%). Median time to first report of symptoms was 21 days (interquartile ratio [IQR], 18-34.5) for the 76 patients who reported ≥moderate symptoms and 33 days (IQR, 24-42) in the 26 patients whose provider reported grade 2+ dysphagia. The 30-day incidence of patient-reported ≥moderate swallowing difficulty and provider grade 2+ dysphagia was 26% (95% CI: 20%-32%) and 6% (95% CI: 3%-9%), respectively. Esophageal V60 >7 % was the clinical factor most associated with patient-reported ≥moderate esophageal symptoms (odds ratio 6.1, 95% CI: 3.0-12.3).
Patients report at least moderate difficulty swallowing more often and earlier than providers report grade 2+ dysphagia. Esophageal V60 ≥7% was most associated with development of moderate severity or worse patient-reported swallowing difficulty.
我们研究了肺癌患者接受放射治疗（RT）后出现报告吞咽困难的时间以及与该症状相关的临床因素。
在 2016 年 10 月至 2019 年 10 月期间，在一家三级癌症中心接受常规分割 RT 的肺癌患者被确定为研究对象。每周，患者报告吞咽困难（患者报告的通用不良事件术语标准 [PRO-CTCAE] v.1 版本：0-无，1-轻度，2-中度，3-重度，4-非常严重）。医生对吞咽困难进行分级（CTCAE v.4：0-无，1-有症状但无进食改变，2-有症状；进食/吞咽受影响，3-严重影响进食/吞咽，4-危及生命，5-死亡）。在基线时没有记录与肿瘤相关的吞咽困难；因此，排除了在 RT 开始后 7 天内报告≥中度症状的患者。我们使用累积发生率法评估了新出现的≥中度吞咽困难报告和 CTCAE 2+级吞咽困难的时间，并随时间推移进行了评估。多变量逻辑回归评估了临床因素、食管 V60 与食管症状发展之间的关系。
在 200 名确定的患者中：中位年龄为 69 岁，52%为男性，89%为 III 期及以上疾病。患者接受中位 63 Gy 的放射治疗和化疗（91.5%）。200 名患者中有 76 名（38%）在放射治疗期间报告至少有中度吞咽困难；200 名患者中有 26 名（13%）的医生评估为吞咽困难改变了口服摄入或更严重。报告≥中度症状的 76 名患者首次出现症状的中位时间为 21 天（四分位距 [IQR]，18-34.5），26 名报告医生分级 2+级吞咽困难的患者为 33 天（IQR，24-42）。患者报告的 30 天内≥中度吞咽困难和医生报告的 2+级吞咽困难发生率分别为 26%（95%CI：20%-32%）和 6%（95%CI：3%-9%）。食管 V60＞7%是与患者报告的≥中度食管症状最相关的临床因素（比值比 6.1，95%CI：3.0-12.3）。
患者报告的吞咽困难至少为中度，且比医生报告的 2+级吞咽困难更早。食管 V60≥7%与患者报告的中重度或更严重的吞咽困难的发展最相关。
