Ahmadsei Maiwand, Christ Sebastian M, Seiler Annina, Vlaskou Badra Eugenia, Willmann Jonas, Hertler Caroline, Guckenberger Matthias
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Clin Transl Radiat Oncol. 2022 Mar 15;34:23-29. doi: 10.1016/j.ctro.2022.03.006. eCollection 2022 May.
Treatment of metastatic cancer patients with multiple repeat courses of radiotherapy has become more frequent due to their improved overall survival. However, very little is known about their long-term outcome. This analysis reports on the quality-of-life, hematologic toxicity, patient-reported experiences and satisfaction, and psychological distress of cancer patients treated with multiple repeat radiotherapy.
All patients treated with ≥5 courses of radiotherapy between 2011 and 2019 at the Department of Radiation Oncology, University Hospital Zurich (USZ) were screened for this study. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. All patients completed two questionnaires: EORTC QLQ-C30 questionnaire for quality-of-life and a questionnaire evaluating psychological distress and patient-reported experiences. Hematologic toxicities were assessed via a recent blood sample.
Of n = 33 patients treated with ≥5 radiotherapy courses and being alive, 20 (60.6%) participated in this study. The most common primary tumor was non-small cell lung cancer (n = 14, 42.4%). The most common sites of irradiation were brain (n = 78, 37.1%) and bone metastases (n = 59, 28.1%). All participating patients reported that they had experienced a subjective benefit from multiple repeat radiotherapy and denied increased side effects in later radiotherapy courses. Yet, 45% (n = 9) of the patients reported an increase of psychological distress with increasing numbers of radiotherapy treatments. While global health status was stable, patients having received multiple repeat radiotherapy reported increased fatigue (p = <0.006). Blood analysis showed significantly reduced hemoglobin and lymphocyte levels compared to the healthy population (p = <0.03).
Patient-reported experiences and satisfaction of long-term cancer patients treated with multiple repeat radiotherapy are positive. However, increased levels of fatigue and significantly reduced hemoglobin and lymphocyte levels were observed. These data indicate the need to further investigate the effects of multiple courses of radiotherapy in chronic cancer patients.
由于转移性癌症患者的总生存期有所改善，多次重复放疗疗程对其进行治疗的情况越来越普遍。然而，对于他们的长期预后却知之甚少。本分析报告了接受多次重复放疗的癌症患者的生活质量、血液学毒性、患者报告的经历与满意度以及心理困扰情况。
对2011年至2019年期间在苏黎世大学医院（USZ）放射肿瘤学系接受≥5个放疗疗程的所有患者进行了本研究筛查。一个放疗疗程被定义为在一个医学指征下针对一个解剖部位的所有治疗疗程。所有患者均完成了两份问卷：用于评估生活质量的欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）以及一份评估心理困扰和患者报告经历的问卷。通过近期的血液样本评估血液学毒性。
在接受≥5个放疗疗程且仍存活的n = 33例患者中，20例（60.6%）参与了本研究。最常见的原发性肿瘤是非小细胞肺癌（n = 14，42.4%）。最常见的照射部位是脑（n = 78，37.1%）和骨转移（n = 59，28.1%）。所有参与研究的患者均报告称他们从多次重复放疗中获得了主观益处，并且否认在后续放疗疗程中副作用有所增加。然而，45%（n = 9）的患者报告随着放疗次数的增加，心理困扰也有所增加。虽然总体健康状况稳定，但接受多次重复放疗的患者报告疲劳感增加（p = <0.006）。血液分析显示，与健康人群相比，血红蛋白和淋巴细胞水平显著降低（p = <0.03）。
患者报告的接受多次重复放疗的长期癌症患者的经历与满意度是积极的。然而，观察到疲劳水平增加以及血红蛋白和淋巴细胞水平显著降低。这些数据表明有必要进一步研究多疗程放疗对慢性癌症患者的影响。
