Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Radiat Oncol. 2021 Sep 8;16(1):174. doi: 10.1186/s13014-021-01902-6.
Proton beam therapy is a well-established treatment option for patients with uveal melanoma (UM). The treatment procedure, in general, includes placing radiopaque clips to ensure exact eye-positioning during radiotherapy, followed by the delivery of proton irradiation. The short-term burden associated with proton therapy in patients with UM has rarely been addressed. In this prospective study, we investigated the physiological and psychological aspects of proton therapy that might affect the well-being of patients during the different stages of treatment.
During the treatment procedure, we conducted longitudinal assessments of the Quality of life (QOL), organ-specific symptoms, and psychological aspects in patients with UM with three questionnaires (EORTC QLQ-C30, EORTC QLQ-OPT30, and GAD-7). Patients completed questionnaires before clip surgery (T0), before proton therapy (T1), after completing treatment (T2), and three months after treatment completion (T3). We also collected data on tumor characteristics and socio-demographics to identify potential risk factors associated with high treatment burdens.
We prospectively included 131 consecutive patients. Questionnaire data showed a significant, temporary decline in global QOL and an increase in eye-related symptoms, as a result of the clip surgery (T0-T1). After treatment completion (T2), global QOL improved gradually, and none of the eye-related symptoms significantly deteriorated over the course of proton therapy. The global QOL returned to baseline levels three months after treatment (T3). We identified baseline anxiety as an independent risk factor for experiencing an acute treatment-related burden. Furthermore, we found interactions between GAD7 and patient sex showing that anxiety had a more pronounced effect on QOL outcome in female patients.
The short-term treatment-related burden of ocular proton therapy appeared to be largely associated with the preceding clip surgery, rather than the irradiation procedure. We found that anxiety was strongly associated with experiencing QOL issues during the treatment procedure. Our findings could contribute to the development of future strategies for improving the treatment process and psycho-oncologic patient care.
质子束疗法是治疗葡萄膜黑色素瘤（UM）的一种成熟的治疗选择。一般来说，治疗过程包括放置不透射线的夹子，以确保放射治疗过程中眼球位置精确，然后进行质子照射。UM 患者接受质子治疗的短期负担很少被涉及。在这项前瞻性研究中，我们研究了质子治疗过程中可能影响患者在不同治疗阶段的幸福感的生理和心理方面。
在治疗过程中，我们使用三个问卷（EORTC QLQ-C30、EORTC QLQ-OPT30 和 GAD-7）对 UM 患者进行了生活质量（QOL）、器官特异性症状和心理方面的纵向评估。患者在夹手术前（T0）、质子治疗前（T1）、治疗完成后（T2）和治疗完成后三个月（T3）完成问卷。我们还收集了肿瘤特征和社会人口统计学数据，以确定与高治疗负担相关的潜在风险因素。
我们前瞻性地纳入了 131 例连续患者。问卷数据显示，由于夹手术（T0-T1），整体 QOL 显著暂时下降，眼部相关症状增加。治疗完成后（T2），整体 QOL 逐渐改善，质子治疗过程中没有任何眼部相关症状明显恶化。治疗完成三个月后（T3），全球 QOL 恢复到基线水平。我们发现基线焦虑是经历急性治疗相关负担的独立风险因素。此外，我们发现 GAD7 与患者性别之间存在相互作用，表明焦虑对女性患者的 QOL 结果有更显著的影响。
眼部质子治疗的短期治疗相关负担主要与先前的夹手术有关，而不是与照射过程有关。我们发现焦虑与治疗过程中 QOL 问题密切相关。我们的研究结果可能有助于制定未来改善治疗过程和心理肿瘤患者护理的策略。
