Patterns of Practice in the Prescription of Palliative Radiotherapy for the Treatment of Thoracic Symptoms of Lung Cancer at the Rapid Response Radiotherapy Program between 2006 and 2012
N Thavarajah, K Wong, L Zhang, E Wong, G Bedard, N Lauzon, L Holden, M Tsao, C Danjoux, E Barnes, A Sahgal, E Chow
Hong Kong J Radiol 2013;16:261-9
DOI: 10.12809/hkjr1313171
Objective: Radiation therapy can often be used for palliation of thoracic symptoms in patients presenting with locally advanced lung cancer or lung metastases. The aim of this study was to examine whether patterns of practice in prescription of palliative thoracic radiation therapy have changed over time in the Rapid Response Radiotherapy Program. Secondary outcomes were factors that may have influenced the treatment regimen prescribed, including patient, disease, and organisational factors.
Methods: This study was a retrospective review of a prospective database of patients with locally advanced lung cancer or lung metastases referred to the Rapid Response Radiotherapy Program for thoracic symptoms between 1 July 2006 and 30 April 2012. Patient demographics, and organisational and disease factors were descriptively analysed. Differences in proportions between unordered categorical variables were examined using chi-squared test. Univariate logistic regression analysis and backward stepwise selection procedure were used to determine the most significant factors in prescription practice.
Results: A total of 175 courses of palliative thoracic radiation therapy were prescribed. The median age of the patients was 71 years, and the median Karnofsky Performance Status was 60. The most commonly prescribed treatment regimen was 20 Gy in 5 fractions (20 Gy/5), which made up 64% of all the courses prescribed. There was a significant increase in frequency of the prescription of 20 Gy/5 over time (p = 0.02). The site of radiation (disease factor) and years of certification for independent practice of the treating radiation oncologist (organisational factor) were also significant factors in the prescription of 20 Gy/5 over time (both p = 0.02).
Conclusion: A significant increase in the prescription of 20 Gy/5 was observed over time. However, the prescription of a higher dose fractionation schedule for patients with a higher performance status, as seen in other clinical trials and guidelines, was not observed. Future studies should further explore other possible factors such as patient survival, preference, comorbidities, and disease burden that may influence the dose fractionation prescribed.
中文摘要
2006年至2012年間的「快速反應放射治療計劃」中姑息性放療治療肺癌胸部症狀的實踐模式
N Thavarajah, K Wong, L Zhang, E Wong, G Bedard, N Lauzon, L Holden, M Tsao, C Danjoux, E Barnes, A Sahgal, E Chow
目的：對於局部晚期肺癌或肺轉移患者，放射治療一般可緩解胸部症狀。本文研究在實施「快速反應放射治療計劃」（Rapid Response Radiotherapy Program）期間，姑息性胸部放射治療的模式是否有變化。其次是研究可能會影響治療方案的因素，包括病人、疾病和組織方面。
方法：本研究回顧性分析一前瞻性數據庫中2006年7月1日至2012年4月30日期間局部晚期肺癌或肺轉移病人資料，他們因胸部症狀而被轉介參與「快速反應放射治療計劃」。對病人的人口學資料、組織和疾病因素進行描述性分析。採用卡方檢驗觀察無序性分類變量之間的比例差異。運用單元邏輯回歸分析和後退逐步選擇法來確定治療中最重要的因素。
結果：總計175個姑息性胸部放射治療療程處方給研究病例。患者年齡中位數為71歲，Karnofsky氏體能表現狀態中位數為60。最常用的治療方案為分5次劑量的20 Gy（20 Gy/5），佔所有療程的64%。處方20 Gy/5的頻率隨時間明顯增加（p = 0.02）。放射部位（疾病因子）和放射治療科醫生擁有獨立執業牌照的年期（組織因子）是處方20 Gy/5的重要因素（兩者的p值均為0.02）。
結論：20 Gy/5的放療方案隨時間明顯增加。其他臨床試驗和指引中一般會給予身體功能狀態較好的病人一個較高的劑量，可是這現象並未在本研究中觀察到。未來研究應進一步探討影響劑量分割的其他可能因素，如患者生存率、偏好、合併症和疾病負荷。