Macklis R M, Cornelli H, Lasher J
Department of Radiation Oncology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Clin Oncol. 1998 Dec;21(6):617-22. doi: 10.1097/00000421-199812000-00019.
The use of radiotherapy to treat metastatic bone pain is being challenged by claims of high cost and by more readily available, noninvasive treatment approaches. The authors assessed the effectiveness of brief courses of radiotherapy in reducing pain and estimated cost data for a pilot comparison between radiotherapy and narcotic analgesics in patients with cancer. A representative group of outpatients undergoing brief courses of radiotherapy with Karnofsky scores above 70 and without serious comorbidities were recruited from 1995 through 1996. Patients indicated their pain at rest and with movement on a scale of from 1 to 10 both before and up to 12 months after radiotherapy. Radiotherapy costs were estimated from Medicare-allowable charges. Narcotic analgesia costs were estimated from published values. In 66 patients with 131 individually treated sites, median at rest pain score decreased by about 4 points after treatment (5.58 [-/+3.28] before treatment vs. 1.55 [-/+1.8] after treatment; p < 0.05). Median with movement pain score was about 5 points lower after treatment (7.32 [-/+2.72] before treatment vs. 1.94 [-/+2.07] after treatment; p < 0.05). No differences were found when stratifying by type of pain, tumor histologic type, or skeletal site. The estimated cost per patient ranged from $1,200 to $2,500 for radiotherapy. This compares with an estimated cost of $9,000 to $36,000 for 9 months of narcotics. In this pilot study, a brief course of radiotherapy significantly reduced pain and appeared to be cost effective when compared with narcotic analgesia. A full economic evaluation is warranted.
放射疗法用于治疗转移性骨痛正面临着成本高昂以及有更易获得的非侵入性治疗方法的挑战。作者评估了短疗程放射疗法在减轻疼痛方面的有效性，并估算了癌症患者放射疗法与麻醉性镇痛药进行初步比较的成本数据。从1995年至1996年招募了一组具有代表性的门诊患者，这些患者接受短疗程放射治疗，卡诺夫斯基评分高于70分且无严重合并症。患者在放射治疗前及治疗后长达12个月内，以1至10分的量表表明其静息和活动时的疼痛程度。放射治疗成本根据医疗保险允许的费用估算。麻醉性镇痛成本根据已公布的值估算。在66例患者的131个单独治疗部位中，治疗后静息疼痛评分中位数下降了约4分（治疗前为5.58[±3.28]，治疗后为1.55[±1.8]；p<0.05）。治疗后活动疼痛评分中位数降低了约5分（治疗前为7.32[±2.72]，治疗后为1.94[±2.07]；p<0.05）。按疼痛类型、肿瘤组织学类型或骨骼部位分层时未发现差异。放射疗法每位患者的估计成本为1200美元至2500美元。相比之下，9个月麻醉药的估计成本为9000美元至36000美元。在这项初步研究中，短疗程放射疗法显著减轻了疼痛，与麻醉性镇痛药相比似乎具有成本效益。有必要进行全面的经济评估。
