- 作者：Paulien G. Westhoff ; MD&lowast ; ; &dagger ; ; p.g.westhoff@umcutrecht.nl" class="auth_mail" title="E-mail the corresponding author ; Mathilde G.E. Verdam ; MSc&Dagger ; ; Frans J. Oort ; PhD§ ; ; Jan J. Jobsen ; MD ; PhD‖ ; Marco van Vulpen ; MD ; PhD&lowast ; ; Jan Willem H. Leer ; MD ; PhD&dagger ; ; Corrie A.M. Marijnen ; MD ; PhD¶ ; ; Alexander de Graeff ; MD ; PhD# ; Yvette M. van der Linden ; MD ; PhD¶ ; ; for the Dutch Bone Metastasis Study Group
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2016
- 出版时间：1 August 2016
- 年：2016
- 卷：95
- 期：5
- 页码：1391-1398
- 全文大小：503 K
Patients and Methods
The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics.
Results
In general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (−0.11 to −0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions.
Conclusion
Although radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.