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

Year 2020, Volume: 3 Issue: 1, 62 - 66, 15.01.2020

Fatih Göksel

https://doi.org/10.32322/jhsm.663772

Abstract

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.

Keywords

Kemik, Metastaz, Palyatif, Radyoterapi

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

Abstract

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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