Saito Tetsuo, Nakamura Naoki, Murotani Kenta, Shikama Naoto, Takahashi Takeo, Yorozu Atsunori, Heianna Joichi, Kubota Hikaru, Tomitaka Etsushi, Toya Ryo, Yamaguchi Kohsei, Oya Natsuo
Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.
Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan.
Adv Radiat Oncol. 2020 Oct 26;5(6):1118-1125. doi: 10.1016/j.adro.2020.09.013. eCollection 2020 Nov-Dec.
Improving pain interference in daily activities, rather than mere pain reduction, is a desirable endpoint for palliative radiation therapy. The association between pain response and pain interference has been studied almost exclusively in patients with painful bone metastases (PBMs), whereas nonindex pain has scarcely been explored in palliative radiation therapy. We investigated whether index and nonindex pain endpoints are associated with pain interference changes in patients with both PBMs and painful non-bone-metastasis tumors (PNTs).
Brief pain inventory data collected at baseline and at 2 months post-treatment were used to calculate differences in pain interference scores. Pain response in terms of the index pain was assessed using the international consensus endpoint. Patients were diagnosed with predominance of other pain (POP) if nonindex pain of malignant or unknown origin was present and had a greater pain score than the index pain.
Of 302 patients, 127 (42%) had PBMs and 175 (58%) had PNTs. The median pain interference score, which is based on the mean of the 7 subscale items, decreased to a greater extent among responders than among nonresponders (PBM group: -3.43 vs -0.57 [ = .005]; PNT group: -2.43 vs -0.29 [ < .001]). Moreover, patients without POP experienced a greater reduction in their median pain interference score than did those with POP (PBM group: -2.71 vs +0.43 [ = .004]; PNT group: -2.00 vs +1.57 [ = .007]). The Jonckheere-Terpstra test showed a significant trend across 4 pain response categories in patients with PBMs and those with PNTs ( < .001 for both).
The index and nonindex pain endpoints were positively and negatively associated with improvement in pain interference, respectively. There was no apparent difference between patients with PBMs and PNTs in terms of the associations of these endpoints with pain interference.
改善疼痛对日常活动的干扰，而非仅仅减轻疼痛，是姑息性放射治疗的理想终点。疼痛反应与疼痛干扰之间的关联几乎仅在伴有疼痛性骨转移（PBM）的患者中进行了研究，而在姑息性放射治疗中，非主要疼痛几乎未被探讨。我们调查了主要疼痛和非主要疼痛终点是否与同时患有PBM和疼痛性非骨转移肿瘤（PNT）的患者的疼痛干扰变化相关。
使用在基线和治疗后2个月收集的简明疼痛状况量表数据来计算疼痛干扰评分的差异。使用国际共识终点评估主要疼痛方面的疼痛反应。如果存在恶性或不明来源的非主要疼痛且疼痛评分高于主要疼痛，则患者被诊断为其他疼痛为主（POP）。
在302例患者中，127例（42%）患有PBM，175例（58%）患有PNT。基于7个分量表项目平均值的中位疼痛干扰评分，在有反应者中比无反应者下降幅度更大（PBM组：-3.43对-0.57[P =.005]；PNT组：-2.43对-0.29[P <.001]）。此外，无POP的患者中位疼痛干扰评分的降低幅度大于有POP的患者（PBM组：-2.71对+0.43[P =.004]；PNT组：-2.00对+1.57[P =.007]）。Jonckheere-Terpstra检验显示，在患有PBM和PNT的患者中，4种疼痛反应类别存在显著趋势（两者P均<.001）。
主要疼痛和非主要疼痛终点分别与疼痛干扰的改善呈正相关和负相关。在这些终点与疼痛干扰的关联方面，患有PBM和PNT的患者之间没有明显差异。
