Palliative radiotherapy tailored to life expectancy in end‐stage cancer patients

Cancer - Tập 116 Số 13 - Trang 3251-3256 - 2010
Stephan Gripp1, Sibylle Mjartan2, Edwin Boelke1, Reinhardt Willers3
1Department of Radiation Oncology, University Hospital Dusseldorf, Dusseldorf, Germany
2Sana Hospital Dusseldorf-Benrath, Dusseldorf, Germany
3Institute of Biostatistics, University Hospital Dusseldorf at Heinrich‐Heine‐University, Dusseldorf, Germany

Tóm tắt

AbstractBACKGROUND:The purpose of the study was to investigate the adequacy of palliative radiation treatment in end‐stage cancer patients.METHODS:Of 216 patients referred for palliative radiotherapy, 33 died within 30 days and constitute the population of the study. Symptoms, Karnofsky Performance Status (KPS), laboratory tests, and survival estimates were obtained. Treatment course was evaluated by medical records. Univariate analyses were performed by using the 2‐sided chi‐square test. With significant variables, multiple regression analysis was performed.RESULTS:Median age was 65 years, and median survival was 15 days. Prevailing primary cancer types were lung (39%) and breast (18%). Metastases were present in 94% of patients, brain (36%), bone (24%) and lung (18%). In 91%, KPS was <50%. KPS, lactate dehydrogenase, dyspnea, leucocytosis, and brain metastases conveyed a poor prognosis. From 85 survival estimates, only 16% were correct, but 21% expected more than 6 months. Radiotherapy was delivered to 91% of patients. In 90% of radiation treatments, regimens of at least 30 Gy with fractions of 2‐3 Gy were applied. Half of the patients spent greater than 60% of their remaining lifespan on therapy. In only 58% of patients was radiotherapy completed. Progressive complaints were noted in 52% and palliation in 26%.CONCLUSIONS:Radiotherapy was not appropriately customized to these patients considering the median treatment time, which resembles the median survival time. About half of the patients did not benefit despite spending most of their remaining lives on therapy. Prolonged irradiation schedules probably reflect overly optimistic prognoses and unrealistic concerns about late radiation damage. Single‐fraction radiotherapy was too seldom used. Cancer 2010. © 2010 American Cancer Society.

Từ khóa


Tài liệu tham khảo

10.1177/026921639500900404

10.1007/s00520-005-0822-7

10.1007/s001340051350

10.1016/0885-3924(92)90118-2

10.1016/j.jpainsymman.2003.11.008

10.1007/s005200050242

10.1016/S0885-3924(98)00145-6

Yun YH, 2001, Development of terminal cancer prognostic score as an index in terminally ill cancer patients, Oncol Rep, 8, 795

10.1200/JCO.2008.17.1363

10.1200/JCO.2006.10.5411

10.1016/0304-3959(83)90126-4

10.1016/0360-3016(92)90568-3

10.1177/082585970301900403

10.1001/jama.290.1.98

10.1001/archinte.1988.00380120010003

10.1136/bmj.320.7233.469

10.1136/bmj.327.7408.195

10.1016/S0895-4356(96)00316-2

Lynn J, 1997, Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy, New Horiz, 5, 56

10.1200/JCO.2008.16.6074

10.1200/JCO.2005.06.866

10.1016/S0140-6736(85)92876-4

10.1001/archinte.1988.00380070082020

10.1200/JCO.2004.12.056

10.1200/JCO.2005.04.177

10.1053/clon.2001.9256

10.1177/082585979501100305

10.1016/j.ijrobp.2008.03.019

10.1016/j.ijrobp.2008.05.067

10.1093/jnci/95.3.222

10.1016/j.radonc.2004.09.017

10.1093/jnci/dji139

10.1200/JCO.2006.09.5281

10.1046/j.1365-2168.1997.02863.x

10.1016/S0360-3016(02)02989-9

10.1016/S0167-8140(99)00097-3

10.1016/S0167-8140(00)00250-4

10.1016/S0936-6555(89)80036-6

10.1016/j.radonc.2006.02.007

10.1016/0167-8140(91)90062-L

10.1148/radiology.184.2.1377829

10.1016/j.clon.2005.10.002

Thông tin
Thông tin xuất bản

Cancer

Tập 116 Số 13

3251-3256

Thông tin tác giả