Effect and Toxicity of Radiation Therapy in Selected Palliative Indications
Authors:
Z. Pechačová 1; M. Zemanová 1; J. Končeková 2
Authors place of work:
Onkologická klinika 1. LF UK a VFN v Praze
1; Oddělení radiační ochrany, VFN v Praze
2
Published in the journal:
Klin Onkol 2018; 31(6): 439-447
Category:
Original Articles
doi:
https://doi.org/10.14735/amko2018439
Summary
Background:
Radiotherapy (RT) is a mainstay of oncology treatment in both curative and palliative situations. With respect to palliative and supportive care, RT improves local control of disease and relieves symptoms, particularly pain, compression of surrounding structures, and/or bleeding. The aim here was to evaluate the effects and toxicity of palliative RT in our department from April 2015 to April 2018.
Patients and Methods:
During this period, 338 cases received palliative RT, representing approximately one third of indications for this treatment method. We evaluated selected subgroups of patients: those with advanced lung cancer, bone metastases, or soft tissue metastases. Patients were irradiated by the IMRT (intensity modulated radiation therapy) technique using the TomoTherapy HD (Accuray, USA) platform.
Results:
Palliative RT for primary lung cancer was performed for 29 patients. Of these, symptoms were relieved in 22 patients (76%) and local control (confirmed by imaging) was achieved in 19 patients (66%). Treatment-related toxicity was acceptable. Overall, 104 patients received irradiation for bone metastases; pain relief was achieved in more than 75% of cases. Another 71 patients were irradiated to treat soft tissue metastases; symptoms were relieved in 60% of cases. Treatment-related toxicity in our patients was lower than reported previously, suggesting improved quality of life for patients irradiated using modern RT technologies.
Conclusion:
Palliative RT provided excellent symptom control in our patients, with minimal toxicity. Thus, RT is an effective and easy-to-use method for many palliative indications.
Key words:
palliative care – radiotherapy – lung neoplasms – neoplasm metastasis – bone metastases – pain management
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
Submitted: 28. 8. 2018
Accepted: 29. 10. 2018
Zdroje
1. Šlampa P, Petera J et al. Radiační onkologie. Praha: Galén – Karolinum 2007: 377– 389.
2. Vorlíček J, Adam Z, Pospíšilová Y et al. Paliativní medicína. Praha: Grada 2004.
3. Sláma O, Kabelka L, Vorlíček J et al. Paliativní medicína pro praxi. Praha: Galén 2011.
4. Petruželka L. Pokročilý metastazující karcinom prostaty jako chronicky léčitelné onemocnění. Praha: AT Mediprint 2014.
5. Petruželka L et al. Léčba pokročilého hormonálně dependentního karcinomu prsu: Chemoterapie, hormonální léčba nebo bioterapie? Abstr. 020. Onkologie v gynekologii a mammologii. Praha, 2007.
6. Lutz S, Jones J, Chow E. Role of radiation therapy in palliative care of the patient with cancer. J Clin Oncol 2014; 32(26): 2913– 2919. doi: 10.1200/ JCO.2014.55.1143.
7. Skřičková J, Vorlíček J et al. Některé možnosti paliativní léčby u nemocných s rakovinou plic. Klin Onkol 2001; 14(Zvláštní číslo): 1– 5.
8. Rodrigues G, Videtic GM, Sur R et al. Palliative thoracic radiotherapy in lung cancer: an American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol 2011; 1(2): 60– 71. doi: 10.1016/ j.prro.2011.01.005.
9. Petruželka L et al. Nemalobuněčný karcinom plic. Praha: Farmakon Press 2016: 56– 60.
10. Moeller B, Balagamwala EH, Chen A et al. Palliative thoracic radiation therapy for non-small cell lung cancer: 2018 Update of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol 2018; 8(4): 245– 250. doi: 10.1016/ j.prro.2018.02.009.
11. Stevens R, Macbeth F, Toy E et al. Palliative radiotherapy regimens for patients with thoracic symptoms from non-small cell lung cancer. Cochrane Database Syst Rev 2015; 1: CD002143. doi: 10.1002/ 14651858.CD002143.pub4.
12. Zemanová M. Místo radioterapie v léčbě karcinomu plic. Onkologie 2009; 3(5): 281– 284.
13. Strøm HH, Bremnes RM, Sundstrøm SH et al. Concurrent palliative chemoradiation leads to survival and quality of life benefits in poor prognosis stage III non-small--cell lung cancer: a randomised trial by the Norwegian Lung Cancer Study Group. Br J Cancer 2013; 109(6): 1467– 1475. doi: 10.1038/ bjc.2013.466.
14. Falk SJ, Girling DJ, White RJ et al. Immediate versus delayed palliative thoracic radiotherapy in patients with unresectable locally advanced non-small cell lung cancer and minimal thoracic symptoms: randomised controlled trial. BMJ 2002; 325(7362): 465.
15. Čoupek P, Čoupková H. Paliativní radioterapie plicních nádorů. Klin Onkol 2001; 14(Zvláštní číslo): 10– 12.
16. Lutz S, Berk L, Chang E et al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 2011; 79(4): 965– 976. doi: 10.1016/ j.ijrobp.2010.11.026.
17. Lutz S, Balboni T, Jones J et al. Palliative radiation therapy for bone metastases: update of an ASTRO evidence-based guideline. Pract Radiat Oncol 2017; 7(1): 4– 12. doi: 10.1016/ j.prro.2016.08.001.
18. Franco P, Migliaccio F, Angelini V et al. Palliative radiotherapy for painful bone metastases from solid tumors delivered with static ports of tomotherapy (TomoDirect): feasibility and clinical results. Cancer Invest 2014; 32(9): 458– 463. doi: 10.3109/ 07357907.2014.958495.
19. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31(5): 1341– 1346. doi: 10.1016/ 0360-3016(95)00060-C.
20. Pechačová Z, Zemanová M, Končeková J et al. Tomoterapie – zkušenosti prvního roku klinického provozu ve Všeobecné fakultní nemocnici v Praze. In: Radiační onkologie 2016, sborník příspěvků. 12. Konference Společnosti radiační onkologie, biologie a fyziky. Hradec Králové, 23.– 25. června 2016: 56– 63.
21. Končeková J, Jelénková K, Pejchal O et al. Fyzikální a technické aspekty tomoterapeutického ozařovače a systém zajištění jakosti. In: Radiační onkologie 2016, sborník příspěvků. 12. Konference Společnosti radiační onkologie, biologie a fyziky. Hradec Králové, 23.– 25. června 2016: 50– 55.
22. Sláma O, Špinková M, Kabelka L. Standardy paliativní péče 2013. Brno: Česká společnost paliativní medicíny ČLS JEP 2013.
23. Sochor M, Sláma O, Loučka M. Časná integrace paliativní péče do standardní onkologické péče – benefit, limitace, bariéry a druhy paliativní péče. Klin Onkol 2015; 28(3): 171– 176. doi: 10.14735/ amko2015171.
24. Haun MW et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017; 6: CD011129. doi: 10.1002/ 14651858.CD011129.pub2.
25. Kain DA, Eisenhauer EA: Early integration of palliative care into standard oncology care: evidence and overcoming barriers to implementation. Curr Oncol 2016; 23(6): 374– 377. doi: 10.3747/ co.23.3404.
26. Temel JS, Greer JA, Muzikansky A et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363(8): 733– 742. doi: 10.1056/ NEJMoa1000678.
27. Vorlíček J, Skřičková J. Paliativní léčba u onkologických nemocných. Klin Onkol 1993; 6(4): 119– 122.
28. Sláma O, Sochor M. Paliativní péče jako součást komplexní onkologické péče. Postgradual Med: odborný časopis pro lékaře 2014; 16(3): 335– 337.
29. Von Roenn JH, Temel J. The integration of palliative care and oncology: the evidence. Oncology (Williston Park) 2011; 25(13): 1258– 1260, 1262, 1264– 1265.
30. Osman H, Shrestha S, Temin S et al. Palliative care in the global setting: ASCO resource-stratified practice guideline summary. J Oncol Pract 2018; 14(7): 431– 436. doi: 10.1200/ JOP.18.00087.
31. Joiner MC, van der Kogel A. Basic clinical radiobiology. Abingdon, Oxon: CRC Press 2009: 102– 148.
32. Feltl D, Cvek J. Klinická radiobiologie. Havlíčkův Brod: Tobiáš 2008: 60– 64.
33. Pospíšil P, Kazda T, Procházka T. Příznivý efekt paliativní radioterapie u maligního melanomu vlasaté části hlavy. Klin Onkol 2014; 27(6): 452.
34. Spencer K, Parrish R, Barton R et al. Palliative radiotherapy. BMJ 2018; 360: k821. doi: 10.1136/ bmj.k821.
35. Meeuse JJ, van der Linden YM, van Tienhoven G et al. Efficacy of radiotherapy for painful bone metastases during the last 12 weeks of life: results from the Dutch Bone Metastasis Study. Cancer 2010; 116: 2716– 2725. doi: 10.1002/ cncr.25062.
36. Jones JA, Lutz ST, Chow E et al. Palliative radiotherapy at the end of life: a critical review. CA Cancer J Clin 2014; 64(5): 296– 310. doi: 10.3322/ caac.21242.
37. Navrátilová P, Hynková L, Šlampa P. Role paliativní radioterapie při krvácení lokálně pokročilých nádorů gastrointestinálního traktu. Klin Onkol 2017; 30(6): 433– 436. doi: 10.14735/ amko2017433.
38. Lutz S, Spence C, Chow E et al. Survey on use of palliative radiotherapy in hospice care. J Clin Oncol 2004; 22(17): 3581– 3586. doi: 10.1200/ JCO.2004.11.151.
39. Novotvary 2015. Cancer incidence in the Czech Republic. Praha: ÚZIS ČR 2015.
Štítky
Paediatric clinical oncology Surgery Clinical oncologyČlánok vyšiel v časopise
Clinical Oncology
2018 Číslo 6
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
- Current Insights into the Antispasmodic and Analgesic Effects of Metamizole on the Gastrointestinal Tract
- Obstacle Called Vasospasm: Which Solution Is Most Effective in Microsurgery and How to Pharmacologically Assist It?
Najčítanejšie v tomto čísle
- Undifferentiated Carcinoma of the Pancreas – a Case Report
- Effect and Toxicity of Radiation Therapy in Selected Palliative Indications
- Consequences of Hypoacidity Induced by Proton Pump Inhibitors – a Practical Approach
- Diagnostic Challenges and Extraordinary Treatment Response in Rare Malignant PEComa Tumor of the Kidney