Raybin Jennifer L, Donson Andrew, Foreman Nicholas K, Vibhakar Rajeev, Handler Michael H, Liu Arthur K
From Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Radiation Oncology, University of Colorado, Aurora, Colorado.
J Adv Pract Oncol. 2024 Jan;15(1):28-35. doi: 10.6004/jadpro.2024.15.1.3. Epub 2024 Jan 1.
Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol.
An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard.
Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years ( = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI.
APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.
肿瘤学高级从业者（APs）处于治疗不良反应的第一线。在患有脑肿瘤的儿童中，诸如全脑全脊髓放疗（CSI）等治疗会导致神经认知损伤、内分泌疾病和耳毒性。高剂量CSI联合化疗可使高危胚胎性肿瘤（非间变性）获得良好的生存率（70%），但在多学科长期随访中，APs通常会处理显著的痛苦影响。本研究的目的是测试采用由AP主导的方案降低放疗剂量的可行性。
一个跨学科团队开展了这项试点研究，主要结果是10名患者中死亡少于2人（生存率80%）。次要结果是由AP主导的治疗方案的可行性以及治疗的急性/晚期效应。AP作为肿瘤治疗研究的主要研究者发挥了开创性作用。排除标准包括年龄小于3岁和间变性。CSI剂量从36 Gy降至24 Gy。所有其他治疗均为标准治疗。
生存率超过了主要结果阈值（88%）；入组率（80%）和随访神经认知测试率（75%）是可以接受的。招募了8名年龄在3至19岁的儿童（ = 8），其肿瘤具有不同的分子亚型。唯一的死亡发生在诊断多器官功能衰竭2.5年后（无肿瘤证据）。平均生存期为11年，其中两人获得大学学位，一人获得研究生学位。与高剂量CSI相比，急性和晚期效应有所降低。
治疗癌症不良反应的APs也可以开展临床前瞻性研究，以维持生存率并改善生活质量结果。
