Kemik metastazlı olgularda palyatif radyoterapi uygulamalarının retrospektif değerlendirmesi: tek merkez deneyimi

Amaç: Kanserli hastaların %10-15’inde kemik metastazı ilk bulgudur ve %30-90’ında kemik metastazı görülür. Kemik metastazları kansere bağlı ağrının en sık nedenlerinden birisidir. Radyoterapi (RT) ağrı palyasyonunu kısa bir sürede sağlaması, patolojik fraktür gelişmesini önlemesi ve minimal yan etki oluşturması nedeni ile kemik metastazlarında ilk tercih edilen palyasyon yöntemlerindendir. Çalışmamızda palyatif amaçlı RT almış kemik metastazlı hastalarımızın tanıları, demografik dağılımı ve sayısal durumunun tek merkez deneyimleri yönünden değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2016 – Eylül 2019 yılları arasında Radyasyon Onkolojisi Kliniğinde kemiklere palyatif amaçlı RT uygulanan hastaların tedavi dosyaları ve Hastane Bilgi Yönetim Sistemi geriye dönük taranarak elde edilen kayıtlar kullanıldı. Tüm kayıtlar arşivlerdeki dosyalarla karşılaştırılarak teyit edildi. Palyatif amaçlı RT uygulanan hastaların profilleri, cinsiyet, yaş, histolojik tipi, tedavi şeması ve fraksiyon sayıları retrospektif olarak değerlendirildi. Bulgular: Çalışma sürecinde kliniğimizde radyoterapi uygulanan toplam 10254 hastanın palyatif kemik RT uygulanan 1469(%14)'u değerlendirmeye alındı. Son iki yılda palyatif kemik RT uygulanan hasta sayılarında oransal olarak azalma görülmemiştir.Palyatif kemik RT uygulanan 1469 hastanın %48’i kadın, %52’si erkekdir. Hastalarımızda primer tümöre göre dağılımları; meme kanserleri (%31), prostat kanserleri (%17), primeri bilinmeyen kanserler (%15), akciğer kanseri (%15), GİS kanserleri (%9), mesane kanserleri (%4) ve diğer kanserler (%10) olarak saptanmıştır. Palyatif kemik RT uygulanan kadınlarda medyan yaş 55, erkeklerde medyan yaş 64 olup tüm hastalarda medyan yaş 60 (sınırlar 13-93) bulundu. Son 4 yılda palyatif kemik RT uygulanan en sık 7 kanser tanısında cinsiyet ve yıl bazlı anlamlı değişiklik görülmemiştir. Palyatif kemik RT alan hastaların 888 'ine 2-5 fraksiyonluk tedavi (%60), 420'sine 6-10 fraksiyonlu tedavi (%29) ve 161' hastaya da tek fraksiyonluk (%11) tedavi şemalarının uygulandığı saptandı. Tedavi şemalarında da anlamlı değişiklik görülmemiştir. Çalışmamızdaki farklı doz-fraksiyon şemaları oranı literatürle uyumludur. Sonuç: Kemik metastazlı hastalara palyatif RT doz-fraksiyon şeması seçiminde optimal doz ve fraksiyon şemaları çok değişkendir. Bu sonuçlar ışığında kemik metastazlı hastalara palyatif RT doz-fraksiyon şeması seçiminde karar verirken; hastaya ait özellikler, tedavi etkileşimleri, fiziki şartlar, iş yükü ve ekonomik maliyetler göz önünde bulundurulmalıdır. Palyatif RT, yüksek palyasyon oranı, kısa süreli uygulanma imkanı, toksisitesi az ve tekrar uygulama imkanı olması nedeni ile kemik metastazlı hastaların çoğunda standart uygulamadır.

Anahtar Kelimeler:

Kemik, Metastaz, Palyatif, Radyoterapi

Retrospective evaluation of palliative radiotherapy in patients with bone metastasis: a single center experience

Introduction: Bone metastasis is the first finding in 10-15% of cancer patients and seen in 30-90% of patients with cancer. Bone metastases are one of the most common causes of cancer-related pain. Radiotherapy (RT) is one of the first preferred palliation methods in bone metastases because it provides pain palliation in a short time, prevents the development of pathological fractures and creates minimal side effects. The aim of this study was to evaluate the diagnosis, demographic distribution and numerical status of patients with bone metastases who received palliative RT in terms of single center experiences. Material and Method: Patients who received palliative bone RT in Radiation Oncology Clinic Between January 2016 and September 2019 were included in the study. The Hospital Information Management System data of these patients were retrospectively scanned and the records obtained were used. All records were compared with the files in the archives and confirmed. The profiles, sex, age, histologic type, treatment schedule and fraction numbers of the patients who underwent radiotherapy for palliative purposes were retrospectively evaluated. Results: In this study, 1469 (14%) palliative bone RT patients of 10254 total radiotherapy patients were evaluated. In the last two years, there was no proportional decrease in the number of patients who received palliative bone RT. 48% of patients were female and 52% were male. According to the primary tumor distributions; breast cancers (31%), prostate cancers (17%), primary unknown cancers (15%), lung cancer (15%), GIS cancers (9%), bladder cancers (4%) and other cancers (10%). The median age of the patients was 60 (range 13-93). In the last 4 years, the most frequent 7 cancer diagnoses didn't show any significant gender and year-based changes. 888 palliative bone RT patients were treated with 2-5 fractions (60%), 420 patients with 6-10 fractions (29%) and 161 patients with single fraction (11%). There were also no significant changes in treatment schemes. The ratio of different dose-fraction schemes in our study is consistent with the literature. Conclusion: Optimal dose and fraction schemes are highly variable for palliative RT in patients with bone metastases. In light of these results, when deciding on palliative RT dose-fraction scheme; patient characteristics, treatment interactions, physical conditions, workload and economic costs should be taken into consideration. Palliative RT is the standard procedure in most patients with bone metastases because of its high palliation rate, short-term application, low toxicity and low re-application.

Keywords:

Bone, Metastasis, Palliative, Radiotherapy,

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Referans1 Li Z,Zhixin G. Clinical Characteristics and Prognostic Factors in Bone Metastases from Lung Cancer.Med Sci Monit. 2017; 23: 4087–4094.
Referans2 Sprave T , Hees K , Bruckner, T et al . The influence of fractionated radiotherapy on the stability of spinal bone metastases: a retrospective analysis from 1047 cases, Radiat Oncol. 2018; 13: 134.
Referans3 Rougraff BT. Evaluation of the patient with carcinoma of unknown origin metastatic to bone. Clin Orthop. 415 (Supl) :S105-9, 2003.
Referans4 Kong W, Zhang-Salomons J, Hanna TP, Mackillop WJ. A population-based study of the fractionation of palliative radiotherapy for bone metastasis in Ontario. Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1209-17.)
Referans15 Vassilis K, Zoi L, Anna Z, Kyriaki M ve John R. K. Bone Density as a Marker of Response to Radiotherapy in Bone Metastatic Lesions: A Review of the Published Data. Int J Mol Sci. 2016 Sep; 17(9): 1391
Referans6 Lim FMY, Bobrowski A, Agarwal A, Silva MF. Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review. Curr Opin Support Palliat Care. 2017 Jun;11(2):78-87
Referans7 Ranki Sheli: Bone Metastases diagnoses and treatment. Radiology 1.st edition (Ed: Rubens R.D and Folgeman I.). London , Springer-Verlang Lmt :63-82, 1991.
Referans8 Payne R. Orthopedic surgical management of skeletal complications of malignancy. Cancer 80: 1614-27, 1997.
Referans9 Lipton A, Theriault RL, Hortobágyi GN et al. Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases: long term follow-up of two randomized, placebo-controlled trials. Cancer, 88:1082–1090, 2000.
Referans10 Regine WF, Tibbs PA, Young A, et al. Metastatic spinal cord compression: A randomized trial of direct decompressive surgical resection plus radiotherapy vs. radiotherapy alone. Int J Radiat Oncol Biol Phys 57(Suppl. 2):S125, 2003
Referans11 Francesca De F, Andrea P, Daniela M, and Vincenzo T. The role of radiation therapy in bone metastases management. Oncotarget. 2017 Apr 11; 8(15): 25691–25699
Referans12 Ben-Josef E, Shamsa F, Youssef E, Porter AT. External beam radiotherapy for painful osseous metastases: pooled data dose response analysis Int J Radiat Oncol Biol Phys, 1;45(3):715-9, 1999.
Referans13 Wu JSY, Wong R, Johnston M, Bezjak A, Whelan T.Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases Int J Radiat Oncol Biol Phys, 55(3):594-605, 2003
Referans14 Blitzer PH: Reanalysis of the RTOC study of the palliation of symptomatic osseous metastases. Cancer 55: 1468-72, 1985
Referans15 TC Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu, Türkiye Kanser İstatistikleri 2014.
Referans16 Chow E, Holden L, Rubenstein J,.Computed tomography (CT) evaluation of breast cancer patients with osteolytic bone metastases undergoing palliative radiotherapy--a feasibility study. Radiother Oncol, 70(3):291-4. 2004.
Referans17 Van der Linden YM, Kroon HM, Dijkstra SP, Lok JJ, Noordijk .Simple radiographic parameter predicts fracturing in metastatic femoral bone lesions: results from a randomised trial.; Dutch Bone Metastasis Study Group. Radiother Oncol, 69(1):21-31, 2003
Referans18 Steenland E, Leer JW, van Houwelingen H, et al.The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 52(2):101-9. 1999.
Referans19 Vit JP, Ohara PT, Tien DA, el al, Jasmin L. The analgesic effect of low dose focal irradiation in a mouse model of bone cancer is associated with spinal changes in neuro-mediators of nociception. Pain. 2006 Jan;120(1-2):188-201.
Referans20 Tong D, Gillick L, Hendrickson FR. The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group. Cancer. Sep 1;50(5):893-9, 1982
Referans21 Shakespeare TP, Lu JJ, Back M, et al. Patients’ preference for radiotherapy fractionation schedule in the palliation of painful bone metastases. J Clin Oncol 2003;21:2156–2162
Referans22 Kachnic L, Berk L. Palliative single-fraction radiation therapy: How much more evidence is needed? J Natl Cancer Inst 2005; 97:786–788
Referans23 Nielsen OS, Bentzen SM, Sandberg E, Gadeberg CC, Timothy AR. Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol.;47(3):233-40, 1998.
Referans24 Van der Linden YM, Steenland E, van Houwelingen HC, Post WJ, Oei B, Marijnen CA, Leer JW. Patients with a favourable prognosis are equally palliated with single and multiple fraction radiotherapy: Results on survival in the Dutch Bone Metastasis Study. Radiother Oncol, 78(3):245-53, 2006.
Referans25 Haddad P, Wong RK, Pond GR, Soban F, Williams D, McLean M, Levin W, Bezjak A. Factors influencing the use of single vs multiple fractions of palliative radiotherapy for bone metastases: a 5-year review .Clin Oncol (R Coll Radiol),17(6):430-4, 2005.
Referans26 Koswing S, Budach V. Remineralization and pain relief bone metastases after differrent radiotherapy fraction. Srahlenther Onkol 175: 500-8, 1999.
Referans27 Fili S, Karalaki M, Schaller B. Mechanism of bone metastasis: the role of osteoprotegerin and of the host-tissue microenvironment-related survival factors. Cancer Lett. 2009 Sep 28;283(1):10-9. doi: 10.1016/j.canlet.2009.01.011. Epub 2009 Feb 6.
Referans28 Noguchi M, Kikuchi H, Ishibashi M, Noda S. Percentage of the positive area of bone metastasis is an independent predictor of disease death in advanced prostate cancer. Br J Cancer. 2003 Jan 27;88(2):195-201