Xu Yang, Trach Celestee, Tessier Tracey, Sinha Rishi, Skarsgard David
Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, T2N 4N2, Alberta, Canada.
Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, T2N 1N4, Alberta, Canada.
BMC Palliat Care. 2024 Dec 21;23(1):296. doi: 10.1186/s12904-024-01628-8.
There is considerable variability in the management of patients with advanced lung cancer referred for palliative radiotherapy owing to uncertainties in prognosis and the benefit of treatment. This study presents the outcomes of patients seen in the Fast Track Lung Clinic, an urgent access palliative radiotherapy clinic, and aims to identify factors associated with treatment response and survival.
Consecutive patients with advanced lung cancer seen in the Fast Track Lung Clinic between January 2014 and July 2020 were included. Patients who underwent radiotherapy were contacted beginning 30 days after radiotherapy to evaluate treatment response. Cluster bootstraps were used to compute confidence intervals for treatment response rate. Prognostic factors for treatment response and overall survival were identified using multivariable generalized estimating equations and Cox regression models, respectively.
A total of 558 patients were included, of whom 459 (82.3%) consented to palliative radiotherapy for 1053 indications. The overall treatment response rate was 70.0% (95% CI, 65.8-74.2) for indications with follow-up (70.8%). Higher response rates were observed in patients with better ECOG performance status (OR per point, 0.71; 95% CI, 0.55-0.93; ) and EGFR-mutant non-small cell lung cancer (OR vs wild-type, 2.46; 95% CI, 1.35-4.51; ), whereas patients treated for neurological symptoms had lower response rates (OR, 0.27; 95% CI, 0.16-0.45; ). There was no difference in response rate between patients who died within 30 days of starting radiotherapy and those who survived longer (OR, 0.83; 95% CI, 0.42-1.67; ). Age; ECOG performance status; smoking history; pathology; EGFR or ALK mutation status; and the presence of liver, adrenal, or brain metastases were associated with overall survival.
Palliative radiotherapy was effective for patients with advanced lung cancer, although response rates varied by patient characteristics and treatment indication. This study identified prognostic factors for radiotherapy response and overall survival that can inform treatment decisions in this population.
由于预后和治疗获益存在不确定性，晚期肺癌患者姑息性放疗的管理存在很大差异。本研究介绍了在快速通道肺癌诊所（一个紧急接入的姑息性放疗诊所）就诊患者的治疗结果，旨在确定与治疗反应和生存相关的因素。
纳入2014年1月至2020年7月期间在快速通道肺癌诊所就诊的连续晚期肺癌患者。放疗开始30天后联系接受放疗的患者，评估治疗反应。采用聚类自抽样法计算治疗反应率的置信区间。分别使用多变量广义估计方程和Cox回归模型确定治疗反应和总生存的预后因素。
共纳入558例患者，其中459例（82.3%）因1053个适应证同意接受姑息性放疗。有随访的适应证的总体治疗反应率为70.0%（95%CI，65.8 - 74.2）（70.8%）。在ECOG体能状态较好的患者中观察到更高的反应率（每增加1分的OR，0.71；95%CI，0.55 - 0.93；）以及表皮生长因子受体（EGFR）突变的非小细胞肺癌患者（与野生型相比的OR，2.46；95%CI，1.35 - 4.51；），而因神经症状接受治疗的患者反应率较低（OR，0.27；95%CI，0.16 - 0.45；）。放疗开始后30天内死亡的患者与存活时间较长的患者之间反应率无差异（OR，0.83；95%CI，0.42 - 1.67；）。年龄、ECOG体能状态、吸烟史、病理、EGFR或间变性淋巴瘤激酶（ALK）突变状态以及肝、肾上腺或脑转移的存在与总生存相关。
姑息性放疗对晚期肺癌患者有效，尽管反应率因患者特征和治疗适应证而异。本研究确定了放疗反应和总生存的预后因素，可为该人群的治疗决策提供参考。
