厄洛替尼联合全脑放疗治疗非小细胞肺癌脑转移临床观察

目的观察厄洛替尼联合全脑放疗（WBRT）治疗非小细胞肺癌（NSCLC）脑转移的有效性和安全性。方法16例均为不能耐受化疗或化疗失败的NSCLC脑转移患者,接受WBRT（40Gy／20次,4周）并同期口服厄洛替尼150mg,每日1次,共计30d。在放疗结束后3个月复查脑MRI,观察肿瘤大小,每3个月一次进行临床疗效评价直至疾病进展,并统计1年生存情况。结果厄洛替尼联合WBRT对NSCLC脑转移的总有效[完全缓解（CR）＋部分缓解（PR）]率为87．5％,临床获益率[CR＋PR＋疾病稳定（SD））]为100％（2例CR,12例PR,2例SD）;临床症状缓解率100％;中位疾病进展时间8．3个月,中位总生存时间10个月。13例（81．3％）出现1—2级皮疹,6例（37．5％）发生轻度腹泻。结论厄洛替尼联合WBRT治疗NSCLC脑转移具有较好疗效,毒副作用轻,可耐受,生存期延长,值得临床进一步推广应用。     

Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases

To prospectively assess patient-rated symptoms in patients with brain metastases treated with whole brain radiotherapy, these patients were asked to rate their symptoms on the Edmonton Symptom Assessment Scale (ESAS) before, and 1, 2, 4, 8, and 12 weeks following the radiation treatment. ESAS evaluates pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath on a scale of 0-10 (0=absence of symptom and 10=worst possible symptom). Patients with a language barrier or significant cognitive impairment were excluded. The mean difference of ESAS symptoms at each follow up were compared with baseline and P < 0.01 was considered statistically significant. One hundred seventy patients (102 female and 68 male) were included between January 1999 and January 2002. Their median age was 66 years (range 33-84) and the median Karnofsky performance score (KPS) at baseline was 60 (range 20-90). The most common primary cancer sites were lung (99; 58%), breast (32; 19%), gastrointestinal (16; 9%), unknown (14; 8%) and others (9; 6%). One-third had significant weight loss (> or =10% over the last 6 months). All patients were prescribed dexamethasone at varying doses during radiotherapy. The dose fractionations were 20 Gy in 5 fractions, 138 (81%); 30 Gy in 10 fractions, 7 (4%); and others, 25 (15%). The baseline mean +/- SD for ESAS scores were: pain 2.4 +/- 2.8, fatigue 5.3 +/- 2.8, nausea 1.3 +/- 2.2, depression 2.8 +/- 2.7, anxiety 3.6 +/- 3.0, drowsiness 3.5 +/- 2.9, appetite 3.0 +/- 3.2, sense of well-being 3.8 +/- 2.7, and shortness of breath 2.3 +/- 2.5. For the entire cohort, after the delivery of palliative radiotherapy for brain metastases, there were statistically significant deteriorations in the mean differences from the baseline for the following ESAS domains: fatigue 1.0 to 1.8; drowsiness 1.2 to 1.8; and appetite 2.2 to 2.4. The data demonstrate that certain parameters of quality of life worsen after whole brain radiotherapy.     

Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review

BACKGROUND: Brain metastases are the most common intracranial tumour in adults, estimated to occur in up to 40% of patients with cancer. Despite being used in clinical practice for 50 years, the effectiveness of whole brain radiotherapy for the treatment of brain metastases remains uncertain. OBJECTIVES: To assess the effectiveness of whole brain radiotherapy (WBRT) on survival and quality of life. To identify whether patient performance status, number of brain metastases, extent of extracranial disease and primary site of cancer are important effect modifiers. DESIGN: Systematic literature review. METHODS: Electronic searches of four databases, augmented by hand searches of the most frequently encountered journal and assessment of the reference lists of consensus statements and all retrieved papers. Included papers underwent structured data extraction, assessment and qualitative synthesis. RESULTS: Thirty-two primary studies were included, with a range of study designs, methodological quality, pre-treatment variables, interventions and outcome measures. From the limited evidence available, survival appeared to increase when patients were selected by performance status (survival increasing from approximately three to seven months in high performance status groups, as defined by Karnofsky performance status or Recursive Partitioning Analysis classification). The evidence suggests no survival benefit when patients with poor performance status were treated with whole brain radiotherapy. No studies undertook direct measurement of patients' quality of life. Surrogate measures of patients' quality of life, such as improvement in neurological function or improvement/maintenance of KPS > or =70, produced response rates ranging from 7 to 90%. CONCLUSION: The heterogeneity of study designs, quality and outcomes necessitates caution in interpreting the review findings. WBRT appears to be of benefit in higher performance status patients but not in low performance status patients. This suggests a basis for current practice, however further robust trial evidence is required.     

全脑加或不加同期推量放疗对大于3个脑转移瘤的疗效

目的  对比全脑放疗（WBRT）与全脑加局部同期推量放疗（WBRT+SIB）在大于3个脑转移病灶患者中的治疗效果及毒副作用。方法  对2011年7月~2020年7月就诊于深圳市人民医院肿瘤放疗科的118例脑转移瘤患者进行回顾性分析,根据放疗方法的不同将患者分为WBRT组（n=62）和WBRT+SIB组（n=56）。分别观察两组的生存率和毒副反应。结果  WBRT+SIB组与WBRT组的中位生存时间分别为10.7月和7.8月,1年生存率分别为32%和13%（P=0.02）;RPA 1分者WBRT+SIB和WBRT中位生存时间分别为13.6月和10.5月,1年生存率分别为51%和28%（P=0.01）;RPA 2分者WBRT+SIB和WBRT中位生存时间分别为9.3月和6.8月,1年生存率分别为18%和11%（P=0.39）。两组各项早期及晚期毒副反应的差异无统计学意义（P>0.05）。结论  对大于3个脑转移瘤的患者,WBRT+SIB生存率优于WBRT,副作用无差异。     

立体定向放射治疗非小细胞肺癌脑转移患者的护理

非小细胞肺癌约占肺癌的75%～80%,脑转移总的发生率为20%,尸检为40%[1]。脑转移是非小细胞肺癌晚期及病情严重的标志之一,如不积极治疗,患者的中位生存时间仅为4周,是导致患者死亡的主要原因[2-3]。随着立体定向放疗技术的不断发展,对于提高非小细胞肺癌脑转移患者的     

Fatigue in patients receiving palliative care

This article discusses fatigue in patients receiving palliative care. The article initially considers the prevalence of fatigue in different groups of palliative care patients, then addresses how it manifests before reviewing how it can be assessed and managed. The focus of the article is on palliative care but it draws on, and has relevance for, chronic disease more widely.     

The impact of RTOG 0614 and RTOG 0933 trials in routine clinical practice: The US Survey of Utilization of Memantine and IMRT planning for hippocampus sparing in patients receiving whole brain radiotherapy for brain metastases

IntroductionTwo recent clinical trials, phase III RTOG 0614 and phase II RTOG 0933, showed some effectiveness of Memantine and IMRT planning for hippocampus sparing, among patients receiving whole brain radiotherapy (WBRT) for brain metastases; however, their use in routine clinical practice is unknown.MethodsA survey was sent to 1933 radiation oncologists in the US. Data collected included utilization of Memantine and hippocampus sparing, reasons for adoption and non-adoption, and demographic variables.ResultsA total of 196 radiation oncologists responded to the survey, with 64% reporting using Memantine in almost none of the patients receiving WBRT for brain metastases, and only 11% considering Memantine for < 10% of their patients. The most common reason for not using Memantine was a poor patient performance status, and limited life expectancy. Likewise, 56% of radiation oncologists would not change their clinical practice to include hippocampus sparing IMRT in patients receiving WBRT based on the results of RTOG 0933. Further validation of hippocampus sparing in a phase III trial was supported by 71% of radiation oncologists, whereas further exploration of Memantine for this purpose in a phase III trial was supported by 42%.ConclusionsAt this time, the majority of surveyed radiation oncologists in the US do not use Memantine, or IMRT planning for hippocampus sparing in patients receiving WBRT. Further validation of the hippocampus sparing concept in a phase III trial was supported, before adopting it in routine clinical practice.     

海马保护性全脑放疗研究进展

本文提供了有关海马保护性全脑放疗的讨论,主要从海马保护性全脑放疗必要性、安全性和可行性方面进行,参阅了海马与神经认知功能相关基础研究,探讨海马保护必要性,从海马及环海马区肿瘤发生率证实海马保护性全脑放疗安全性以及现代放疗新技术的发展并论述其可行性,同时对比近年来RTOG及国内外有关海马保护性全脑放疗临床研究,对存在的争议、问题进行总结,展望海马保护性全脑放疗未来研究方向。     

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

AimTo analyse the use of radiotherapy (RT) and factors affecting overall survival (OS) after RT in breast cancer patients with brain metastases.MethodsBreast cancer patients treated from 2008 to 2018 with whole brain RT (WBRT) or stereotactic radiosurgery (SRS) at a large regional cancer referral center were identified from the hospital's RT register. Clinical variables were extracted from medical records. OS was calculated from date of first RT until death or last follow up. Potential factors affecting OS were analyzed.Results255 females with WBRT (n = 206) or SRS (n = 49) as first RT were included. An increased use of initial SRS was observed in the second half of the study period. The most common WBRT fractionation regimen was 3 Gy × 10. SRS was most often single fractions; 18 or 25 Gy between 2009 and 2016, while fractionated SRS was mostly used in 2017 and 2018. Median OS in the WBRT group was 6 months (CI 1–73) relative to 23 (CI 0–78) in the SRS group. Age, performance status, initial RT technique, extracranial disease, brain metastasis surgery, number of brain metastases and DS-GPA score had significant impact on OS. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis.ConclusionWBRT was the most frequent primary RT. An increased use of initial SRS was observed in the second half of the study period. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis.     

Predictors of self-care in cancer patients receiving radiotherapy

The purpose of this study was to examine, within a theoretical framework derived from Orem's conceptual model of nursing, whether self-care can be predicted jointly by social support and the selected basic conditioning factors of age, marital and socioeconomic status, living arrangements, and stage and site of cancer. A convenience sample of 112 adult cervical and head/neck cancer patients receiving radiotherapy was obtained from radiotherapy outpatient clinics in three hospitals located in Bangkok, Thailand. Multiple regression was used to analyze the data. Socioeconomic status and social support were significant predictors of self-care, whereas stage and site of cancer seemed to predict self-care indirectly through social support. The findings are discussed in terms of the validity of Orem's self-care model. Implications for practice and further study are explored.     

Skin care for patients receiving radiotherapy.

Radiotherapy can cause significant skin reactions. Research suggests that skin care practices are diverse for patients receiving radiotherapy. Standardised practice enables nurses to evaluate interventions.     

培美曲塞化疗联合放疗治疗肺腺癌脑转移的临床观察

目的 观察培美曲塞化疗联合放疗在肺腺癌脑转移患者治疗中的临床疗效.方法 选择病理诊断为肺腺癌并且出现脑转移的患者资料进行回顾性诊断分析,采用分层区组随机化方法分为观察组26例和对照组25例,观察组采用培美曲塞化疗联合放疗,对照组采用单纯放疗,对比观察患者的颅内转移瘤、生活质量、近期疗效、不良反应和患者的生存期情况.结果 患者的近期疗效和生存质量明显改善,相比差异显著,不良反应轻微,生存期差异不显著.结论 培美曲塞联合放射治疗应用于肺腺癌脑转移的治疗中,有效改善患者的近期疗效与生活质量,不良反应轻微,在肺腺癌脑转移的治疗中,具有较大的推广应用价值.