Saito Tetsuo, Murotani Kenta, Yamaguchi Kohsei, Toya Ryo, Tomitaka Etsushi, Watakabe Takahiro, Oya Natsuo
Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan.
Graduate School of Medicine, Kurume University, Fukuoka, Japan.
Strahlenther Onkol. 2021 Oct;197(10):916-925. doi: 10.1007/s00066-021-01760-x. Epub 2021 Mar 30.
The influence of pre-radiotherapy pain duration on post-treatment outcomes was assessed.
Patients that received palliative radiotherapy were analyzed in a prospective observational study investigating curative and palliative radiotherapy. Brief Pain Inventory data were acquired at baseline and 1, 2, and 3 months after commencing irradiation. The pain response in terms of the index pain (i.e., pain caused by the irradiated tumors) was assessed using the International Consensus Endpoint. Patients were diagnosed with predominance of other pain (POP) if non-index pain of malignant or unknown origin was present and showed a higher pain score than the index pain. Competing risk analyses were performed in which deaths without the pain endpoints were considered as competing events.
Of 229 patients analyzed, 123 (54%) experienced a pain response and 43 (19%) experienced POP. Multivariable analyses using the Fine-Gray model revealed that patients with shorter pain duration (< 1 month) had higher cumulative incidence of pain response (subdistribution hazard ratio, 2.43; 95% confidence interval [CI], 1.35-4.38) and POP (subdistribution hazard ratio, 4.22; 95% CI, 1.30-13.70) compared with patients with longer pain duration (≥ 4 months). For patients with a pain duration of less than 1 month, cumulative incidence of pain response was estimated to be 69% (95% CI, 53-85%) and cumulative incidence of POP was estimated to be 15% (95% CI, 3-28%) at 1‑month follow-up.
Commencing palliative radiotherapy earlier may improve the probability of patients achieving a pain response, although POP may be more frequent.
评估放疗前疼痛持续时间对治疗后结果的影响。
在一项调查根治性和姑息性放疗的前瞻性观察研究中，对接受姑息性放疗的患者进行分析。在基线以及开始放疗后的1、2和3个月获取简明疼痛量表数据。使用国际共识终点评估索引疼痛（即由受照射肿瘤引起的疼痛）方面的疼痛反应。如果存在恶性或不明来源的非索引疼痛且疼痛评分高于索引疼痛，则患者被诊断为其他疼痛为主（POP）。进行了竞争风险分析，其中将无疼痛终点的死亡视为竞争事件。
在分析的229例患者中，123例（54%）出现疼痛反应，43例（19%）出现POP。使用Fine-Gray模型的多变量分析显示，与疼痛持续时间较长（≥4个月）的患者相比，疼痛持续时间较短（<1个月）的患者疼痛反应的累积发生率更高（亚分布风险比，2.43；95%置信区间[CI]，1.35 - 4.38），POP的累积发生率也更高（亚分布风险比，4.22；95%CI，1.30 - 13.70）。对于疼痛持续时间小于1个月的患者，在1个月随访时，疼痛反应的累积发生率估计为69%（95%CI，53 - 85%），POP的累积发生率估计为15%（95%CI，3 - 28%）。
更早开始姑息性放疗可能会提高患者实现疼痛反应的概率，尽管POP可能更频繁。
