Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Palliat Care. 2022 Jul;37(3):317-322. doi: 10.1177/08258597211065676. Epub 2021 Dec 6.
To assess the feasibility and efficacy of palliative radiotherapy dose regimens for patients with locally advanced head and neck cancer. Fifty patients of previously untreated, inoperable, stage IVA and IVB squamous cell carcinoma of the head and neck, deemed unfit for radical treatment, were included in the study from May 2020 to June 2020. Two palliative radiotherapy regimens were used. First was a single fraction radiation with 8 Gy for patients with limited life expectancy and poor performance status, which was repeated after 4 weeks in case of good symptom relief. The second regimen was used for patients with good performance status and consisted of fractionated radiation with 30 Gy in 10 fractions over 2 weeks, which was followed by supplementary radiation with 25 Gy in 10 fractions over 2 weeks in patients with good symptomatic response at 2 weeks. Symptoms were assessed at baseline and at the end of 4 weeks after treatment completion using the numerical rating score. Patients were followed up for a median of 4.5 months and assessed for symptom control and overall survival. Forty-eight patients completed treatment and were included for analysis. Of the 24 patients who received single fraction radiation, 13 (54.2%) were given the second dose. Improvement in pain and dysphagia were reported in 57.9% and 60% patients, respectively. A total of 55.5% noted decrease in size of the neck node. Twenty-four patients received fractionated radiation and 15 (62.5%) were given the second course after 2 weeks. Relief in pain and dysphagia was reported in 68.2% and 63.6% patients, respectively. There were no grade 3/4 toxicities. Symptom control lasted for at least 3 months in 30% of the patients who received single fraction radiation and 54.2% of the patients who received fractionated radiation. The estimated 6-month overall survival of the entire cohort was 51.4%. Judicious use of palliative radiation in advanced incurable head and neck cancers provides effective and durable symptom relief and should be used after careful consideration of patient prognosis, logistics of treatment, and goals of care.
评估姑息性放疗剂量方案在局部晚期头颈部癌症患者中的可行性和疗效。2020 年 5 月至 6 月，纳入 50 例未经治疗、不可切除、IVA 和 IVB 期局部晚期头颈部鳞状细胞癌患者，这些患者预期寿命有限且体能状态不佳，不适合根治性治疗。研究中使用了两种姑息性放疗方案。第一种方案是对预期寿命有限且体能状态不佳的患者单次给予 8 Gy 放疗，如果症状缓解良好，4 周后重复治疗。第二种方案适用于体能状态良好的患者，给予 30 Gy/10 次/2 周的分割放疗，如果 2 周时症状有良好缓解，则给予 25 Gy/10 次/2 周的补充放疗。在治疗结束后 4 周，使用数字评分量表评估基线和治疗结束时的症状。中位随访时间为 4.5 个月，评估症状控制和总生存情况。48 例患者完成治疗并纳入分析。24 例接受单次剂量放疗的患者中，13 例（54.2%）接受了第二次剂量放疗。分别有 57.9%和 60%的患者报告疼痛和吞咽困难得到改善。55.5%的患者颈淋巴结体积缩小。24 例接受分割放疗的患者中，15 例（62.5%）在 2 周后接受了第二疗程放疗。分别有 68.2%和 63.6%的患者报告疼痛和吞咽困难得到缓解。无 3/4 级毒性。单次剂量放疗的患者中有 30%、分割剂量放疗的患者中有 54.2%的症状缓解持续至少 3 个月。整个队列的 6 个月总生存率为 51.4%。在晚期不可治愈的头颈部癌症中，合理使用姑息性放疗可提供有效且持久的症状缓解，应在仔细考虑患者预后、治疗的后勤工作和护理目标后使用。
