Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
Memorial Radiation Oncology Medical Group, Long Beach, CA.
Brachytherapy. 2022 Nov-Dec;21(6):912-932. doi: 10.1016/j.brachy.2022.07.008. Epub 2022 Sep 7.
Brachytherapy is most often applied in the curative or salvage setting, but many forms of brachytherapy can be helpful for symptom palliation. Declining utilization is seen, for multiple reasons, such as lack of awareness, insufficient expertise, or poor access to equipment. High level evidence for many types of palliative brachytherapy has been lacking. The objective of the current study was to review the evidence for utilization and efficacy of brachytherapy to palliate symptoms from cancer.
We performed a systematic search in EMBASE and MEDLINE for English-language articles published from January 1980 to May 2022 that described brachytherapy used for a palliative indication in adults with a diagnosis of cancer (any subtype) and at least one symptom related outcome. Individual case reports and conference abstracts were excluded. All publications were independently screened by two investigators for eligibility.
The initial search identified 3637 abstracts of which 129 were selected for in-depth review. The number of studies (total number of patients) included in the final analysis varied widely by tumor site with the majority (68.2%) involving either lung or esophageal cancer. Despite a limited number of prospective trials that assessed the efficacy of brachytherapy for symptom management, there was a positive effect on palliation of symptoms across all tumor types. There was no clear trend in the number of publications over time. The most commonly cited symptom indications for palliation by brachytherapy were dysphagia, dyspnea, pain and bleeding.
Brachytherapy can provide palliation for patients with advanced cancer, across different tumor sites and clinical scenarios. However, high level evidence in the literature to support palliative applications of brachytherapy is lacking or limited for many tumor sites. There appears to be a strong publication bias towards positive studies in favor of brachytherapy. Beyond anecdotal reports and individual practices, outcomes research can further our understanding of the role of brachytherapy in palliating advanced cancers of all types, and should be encouraged.
近距离放射治疗通常应用于治疗或挽救性治疗，但许多形式的近距离放射治疗对缓解症状也有帮助。由于多种原因，如缺乏认识、专业知识不足或设备获取途径有限，近距离放射治疗的应用正在减少。许多类型的姑息性近距离放射治疗缺乏高级别证据。本研究的目的是回顾用于缓解癌症相关症状的近距离放射治疗的应用和疗效证据。
我们在 EMBASE 和 MEDLINE 中进行了系统检索，以查找 1980 年 1 月至 2022 年 5 月期间发表的描述用于缓解成人癌症（任何亚型）诊断并至少有一项与症状相关结局的姑息性适应证的近距离放射治疗的英文文章。排除了个案报告和会议摘要。所有出版物均由两名研究人员独立筛选以确定其是否符合入选标准。
最初的搜索确定了 3637 篇摘要，其中 129 篇被选为深入审查。最终分析中纳入的研究数量（患者总数）因肿瘤部位而异，其中大多数（68.2%）涉及肺癌或食管癌。尽管有少数前瞻性试验评估了近距离放射治疗对症状管理的疗效，但所有肿瘤类型的症状缓解均有积极效果。随着时间的推移，出版物数量没有明显的趋势。最常被引用的姑息性近距离放射治疗的症状指征是吞咽困难、呼吸困难、疼痛和出血。
近距离放射治疗可以为不同肿瘤部位和临床情况下的晚期癌症患者提供缓解。然而，在文献中，缺乏或有限的高级别证据支持近距离放射治疗的姑息性应用。似乎存在对阳性研究的强烈发表偏倚，有利于近距离放射治疗。除了轶事报道和个别实践外，结果研究可以进一步了解近距离放射治疗在缓解所有类型晚期癌症中的作用，并应受到鼓励。
