肾上腺是晚期癌症患者常见的转移部位,但很少有症状。一部分患者发展为伴有厌食症的复杂疼痛综合征,恶心,背部局部内脏疼痛,侧翼,或上腹部区域。这些症状会影响生活质量,有时难以缓解。姑息性放射治疗(PRT)在这些患者中的作用尚不清楚。这项基于人群的回顾性研究评估了肾上腺转移患者的PRT实践,旨在描述治疗反应和急性毒性。
在省级数据库中确定了1985年至2015年之间接受PRT治疗肾上腺转移的患者。患者人口统计学,肿瘤因素,症状负担,放射治疗处方,并收集对治疗的反应。使用描述性统计对变量进行汇总。使用Kaplan-Meier检验来评估存活率。使用单因素和逻辑回归分析评估与临床反应相关的因素。使用单变量和Cox比例风险模型评估与生存相关的因素。
确定了100名接受103个独立的PRT疗程的患者。大多数患有肺原发性(82%)。最常见的基线症状是疼痛(90%)和胃肠道不适(13%)。处方范围从单个级分的600cGy到25级分的4500cGy。70%的患者经历了疼痛改善(完全或部分反应)。43%的患者从治疗中出现急性毒性。中位生存期为3个月。
与其他解剖部位相比,常规PRT不常用于肾上腺转移。尽管肿瘤组织学和放射治疗处方存在异质性,治疗与70%的总体疼痛反应相关.治疗前需要预防性止吐药以减少辐射引起的恶心。鉴于该人群的预后不良,显示短分馏。
The adrenal gland is a common site of metastasis in patients with advanced cancer, but it is rarely symptomatic. A subset of patients develop a complex pain syndrome with anorexia, nausea, and poorly localized visceral pain in the back, flank, or epigastric region. These symptoms can affect quality of life and are occasionally challenging to palliate. The role of palliative radiation therapy (PRT) in these patients is unclear. This population-based retrospective study evaluates PRT practices for patients with adrenal metastases and aims to describe treatment response and acute toxicity.
Patients who received PRT to an adrenal metastasis between the years of 1985 and 2015 were identified in a provincial database. Patient demographics, tumor factors, symptom burden, radiation therapy prescriptions, and response to treatment were collected. Variables were summarized using descriptive statistics. The Kaplan-Meier test was used to assess survival. Factors associated with clinical response were evaluated using univariate and logistic regression analysis. Factors associated with survival were evaluated using univariate and Cox proportional hazards model.
One hundred patients who received 103 separate courses of PRT were identified. The majority had a lung primary (82%). The most common baseline symptoms were pain (90%) and gastrointestinal upset (13%). Prescriptions ranged from 600 cGy in a single fraction to 4500 cGy in 25 fractions. Seventy percent of patients experienced an improvement in pain (either a complete or partial response). Forty-three percent of patients developed acute toxicity from treatment. Median survival was 3 months.
Compared with other anatomic sites, conventional PRT is uncommonly delivered to adrenal metastases. Despite heterogeneity in tumor histology and radiation therapy prescriptions, treatment was associated with an overall pain response of 70%. Prophylactic antiemetics to decrease radiation-induced nausea are required before treatment. Given the poor prognosis of this population, short fractionations are indicated.