Nieder Carsten, Haukland Ellinor C, Mannsåker Bård
Oncology, Nordland Hospital Trust, Bodø, NOR.
Translational Cancer Research Group, The University of Tromsø (UiT) - The Arctic University of Norway, Tromsø, NOR.
Cureus. 2022 Jan 25;14(1):e21617. doi: 10.7759/cureus.21617. eCollection 2022 Jan.
Introduction Palliative radiotherapy (PRT) during the last month of life (PRT30) should be avoided because relevant clinical benefits are unlikely to occur. While traditional short-course fractionation regimens are suitable for most patients, a minority may derive gains from higher doses of PRT. Compared to older regimens such as 13 fractions of 3 Gy, more hypofractionated, non-ablative concepts with reduced overall treatment time are not well studied. Methods Retrospective analysis (2017-2020) of 107 patients treated to metastatic lesions (one or two target volumes per patient) with traditional >2 weeks regimens or newer ≤2 weeks regimens, e.g. seven fractions of 5 Gy or five fractions of 6 Gy. Results Failure to complete radiotherapy was registered in 8% of patients (traditional fractionation) and 1%, respectively (p=0.12). Moderate rates of PRT30 were observed (11% and 6%, respectively, p=0.44). PRT30 was more likely in patients irradiated for brain or lymph node metastases. Utilization of newer ≤2 weeks regimens was highest in 2020, presumably as a result of the coronavirus disease 2019 (COVID-19) pandemic. Conclusion The implementation of newer fractionation regimens for selected patients has resulted in acceptable rates of non-completion and PRT30. Optimal selection criteria remain to be determined. Established, guideline-endorsed short-course regimens such as five fractions of 4 Gy and 8-Gy single fractions continue to represent important PRT approaches.
引言 在生命的最后一个月进行姑息性放疗（PRT）（PRT30）应予以避免，因为不太可能产生相关临床益处。虽然传统的短程分割方案适用于大多数患者，但少数患者可能从更高剂量的PRT中获益。与3 Gy分割13次等较旧的方案相比，总治疗时间缩短的超分割、非消融方案尚未得到充分研究。方法 回顾性分析（2017 - 2020年）107例接受转移性病灶治疗（每位患者一个或两个靶区）的患者，采用传统的>2周方案或更新的≤2周方案，如5 Gy分割7次或6 Gy分割5次。结果 分别有8%（传统分割）和1%的患者未完成放疗（p = 0.12）。观察到PRT30的发生率适中（分别为11%和6%，p = 0.44）。接受脑转移或淋巴结转移放疗的患者更有可能发生PRT30。2020年更新的≤2周方案的使用率最高，可能是由于2019冠状病毒病（COVID - 19）大流行。结论 为选定患者实施更新的分割方案导致未完成放疗和PRT30的发生率可接受。最佳选择标准仍有待确定。已确立的、指南认可的短程方案，如4 Gy分割5次和8 Gy单次分割，仍然是重要的PRT方法。
