Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Radiat Oncol. 2022 Sep 7;17(1):153. doi: 10.1186/s13014-022-02122-2.
Accompanied by the demographic change, the number of octogenarian cancer patients with bone metastases will increase in the future. Palliative radiotherapy constitutes an effective analgesic treatment; however, as pain perception and bone metabolism change with increasing age, the analgesic efficacy of radiotherapy may be altered in elderly patients. We therefore investigated the treatment outcomes of palliative radiotherapy for bone metastases in octogenarians.
Patients between 80 and 89 years undergoing radiotherapy for bone metastases between 2009 and 2019 at a tertiary cancer center were analyzed for patterns-of-care, pain response and overall survival (OS). Logistic regression analyses were carried out to examine parameters associated with pain response, and Cox analyses were conducted to reveal prognostic parameters for OS.
A total of 288 patients with 516 irradiated lesions were included in the analysis. The majority (n = 249, 86%) completed all courses of radiotherapy. Radiotherapy led to pain reduction in 176 patients (61%) at the end of treatment. Complete pain relief at the first follow-up was achieved in 84 patients (29%). Bisphosphonate administration was significantly associated with higher rates of pain response at the first follow-up (p < 0.05). Median OS amounted to 9 months, and 1-year, 2-year and 3-year OS were 43%, 28% and 17%. In the multivariate analysis, ECOG (p < 0.001), Mizumoto score (p < 0.01) and Spinal Instability Neoplastic Score (SINS) (p < 0.001) were independent prognosticators for OS.
Palliative radiotherapy for bone metastases constitutes a feasible and effective analgesic treatment in octogenarian patients. ECOG, Mizumoto score and SINS are prognosic variables for survival and may aid treatment decisions regarding radiotherapy fractionation in this patient group. Single-fraction radiotherapy with 8 Gy should be applied for patients with uncomplicated bone metastases and poor prognosis. Prospective trials focusing on quality of life of these very old cancer patients with bone metastases are warranted to reveal the optimal radiotherapeutic management for this vulnerable population.
随着人口结构的变化，未来患有骨转移的 80 岁以上癌症患者数量将会增加。姑息性放疗是一种有效的止痛治疗方法；然而，由于疼痛感知和骨代谢随年龄增长而变化，老年患者的放疗止痛效果可能会发生改变。因此，我们研究了 80 岁以上骨转移患者姑息性放疗的治疗效果。
在一家三级癌症中心，对 2009 年至 2019 年期间因骨转移接受放疗的 80-89 岁患者的治疗模式、疼痛缓解和总生存（OS）进行了分析。采用逻辑回归分析来研究与疼痛缓解相关的参数，采用 Cox 分析来揭示 OS 的预后参数。
共纳入 288 例患者，共 516 个放疗病灶。大多数患者（n=249，86%）完成了所有放疗疗程。放疗结束时，176 例（61%）患者疼痛得到缓解。84 例（29%）患者在第一次随访时完全缓解疼痛。接受双膦酸盐治疗的患者在第一次随访时疼痛缓解率显著更高（p<0.05）。中位 OS 为 9 个月，1 年、2 年和 3 年 OS 分别为 43%、28%和 17%。多变量分析显示，ECOG（p<0.001）、Mizumoto 评分（p<0.01）和脊柱不稳定肿瘤评分（SINS）（p<0.001）是 OS 的独立预后因素。
骨转移姑息性放疗是 80 岁以上患者可行且有效的止痛治疗方法。ECOG、Mizumoto 评分和 SINS 是生存的预后因素，可能有助于为该患者群体制定放疗分割治疗决策。对于单纯性骨转移且预后较差的患者，应采用 8Gy 单次放疗。需要进行关注这些非常高龄骨转移癌症患者生活质量的前瞻性试验，以揭示针对这一脆弱人群的最佳放射治疗管理方法。
