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Patterns of Care and Course of Symptoms in Palliative Radiotherapy

A Multicenter Pilot Study Analysis

Alltagspraxis und Symptomverlauf bei palliativer Strahlentherapie – Ergebnisse der Pilotphase einer Multicenterstudie

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Abstract

Background and Purpose:

To evaluate patterns of care as well as effectiveness and side effects of palliative treatment in four German radiation oncology departments.

Patients and Methods:

All referrals in four German radiation oncology departments (two university hospitals, one academic hospital, one private practice) were prospective documented for 1 month in 2008 (2 months at one of the university hospitals). In palliatively irradiated patients, treatment aims and indications as well as treated sites and fractionation schedules were recorded. In addition, symptoms and side effects were analyzed with standardized questionnaires before and at the end of radiotherapy.

Results:

During the observation period, 603 patients underwent radiation therapy in the four centers and 153 (24%, study popu-lation) were treated with palliative intent. Within the study, patients were most frequently treated for bone (34%) or brain (27%) metastases. 62 patients reported severe or very severe pain, 12 patients reported severe or very severe dyspnea, 27 patients reported neurological deficits or signs of cranial pressure, and 43 patients reported a poor or very poor sense of well-being. The most frequent goals were symptom relief (53%) or prevention of symptoms (46%). Life prolongation was intended in 37% of cases. A wide range of fractionation schedules was applied with total doses ranging from 3–61.2 Gy. Of the patients, 73% received a slightly hypofractionated treatment schedule with doses of > 2.0 Gy to ≤ 3.0 Gy per fraction and 12% received moderate to highly hypofractionated therapy with doses of > 3.0 Gy to 8.0 Gy. Radiation therapy led to a significant improvement of well-being (35% of patients) and reduction of symptoms, especially with regard to pain (66%), dyspnea (61%), and neurological deficits (60%). Therapy was very well tolerated with only 4.5% grade I or II acute toxicities being observed. Unscheduled termination was observed in 19 patients (12%).

Conclusions:

Palliative radiation therapy is effective in reducing symptoms, increases subjective well-being, and has minimal side effects. More studies are necessary for subgroup analyses and for clarifying the different goals in palliative radiotherapy.

Zusammenfassung

Ziel:

Evaluation der Alltagspraxis, des Symptomverlaufs und akuter Nebenwirkungen bei palliativer Strahlentherapie in vier strahlentherapeutischen Einrichtungen.

Patienten und Methode:

Alle Erstvorstellungen in den vier Einrichtungen (zwei Universitätskliniken, ein Lehrkrankenhaus und eine private Praxis) wurden einen Monat lang im Jahr 2008 prospektiv dokumentiert und ausgewertet (über 2 Monate in einer der Universitätskliniken). Bei den palliativ bestrahlten Patienten wurden die Indikationen, Behandlungsziele, die bestrahlten Regionen, die Therapiekonzepte und der Behandlungsverlauf dokumentiert. Klinische Symptome und akute Nebenwirkungen wurden zu Beginn und bei Abschluss der Strahlentherapie standardisiert erfasst.

Ergebnisse:

Im Beobachtungszeitraum erhielten 603 Patienten eine Strahlentherapie. 153 Patienten (24%) wurden unter palliativer Zielsetzung bestrahlt, zumeist wegen Knochenmetastasen (34%) oder Hirnmetastasen (27%). Die häufigsten Behandlungsziele waren Symptomlinderung (53%) oder die Prävention klinischer Beschwerden (46%). 66 Patienten berichteten über mittlere oder starke Schmerzen zu Beginn, 12 Patienten berichteten über mittlere oder starke Dyspnoe, 27 Patienten über mittlere oder starke neurologische Ausfälle bzw. Hirndrucksymptomatik, und 43 Patienten berichteten über weniger gutes oder schlechtes Wohlbefinden. In 37% zielte die Strahlentherapie auch auf Lebensverlängerung. Die applizierte Gesamtdosis betrug 3–61,2 Gy. 73% der Patienten wurden mäßig hypofraktioniert bestrahlt (Einzeldosen > 2,0 Gy bis ≤ 3,0 Gy), und 12% der Strahlentherapien wurden mit Einzeldosen > 3,0 Gy–8,0 Gy durchgeführt. Das Allgemeinbefinden war bei 34% der Patienten bei Abschluss der Strahlentherapie signifikant gebessert. 66% der Patienten berichteten eine signifikante Schmerzlinderung, bei 61% konnte Dys-pnoe signifikant gelindert werden, und bei 60% besserten sich neurologische Defizite oder Hirndrucksymptomatik. Die Behand-lung wurde mit 4,5% Grd-I- bis -II-Toxizitäten gut vertragen. 19 Behandlungen wurden vorzeitig abgebrochen (12%).

Schlussfolgerungen:

Die Alltagspraxis und der Symptomverlauf wurden erfolgreich in der Routine dokumentiert. Die palliative Strahlentherapie war gut verträglich, nebenwirkungsarm und wirksam in Bezug auf das Allgemeinbefinden und die Symptomlinderung. Für Subgruppenanalysen und zur Abgrenzung der verschiedenen Endpunkte palliativer Strahlentherapie sind weitere Untersuchungen mit größeren Fallzahlen erforderlich.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Würzburg, Würzburg, Germany

    Birgitt van Oorschot

  2. Institute of Psychotherapy and Medical Psychology, University of Würzburg, Würzburg, Germany

    Michael Schuler

  3. Department of Radiation Oncology, HELIOS Klinikum Erfurt, Erfurt, Germany

    Anke Simon

  4. Center for Radiotherapy, Düren, Germany

    Ursula Schleicher

  5. Department of Radiotherapy and Radiooncology, Technische Universität München, Munich, Germany

    Hans Geinitz

  6. Josef-Schneider-Str. 2, 97080, Würzburg, Germany

    Birgitt van Oorschot

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  2. Michael Schuler
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  4. Ursula Schleicher
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Correspondence to Birgitt van Oorschot.

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van Oorschot, B., Schuler, M., Simon, A. et al. Patterns of Care and Course of Symptoms in Palliative Radiotherapy. Strahlenther Onkol 187, 461–466 (2011). https://doi.org/10.1007/s00066-011-2231-9

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  • DOI: https://doi.org/10.1007/s00066-011-2231-9

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