Effectiveness of palliative hemostatic radiotherapy for hemoptysis: a prospective single-arm observation study.

4区 医学 Q2 Nursing Annals of palliative medicine Pub Date : 2024-11-01 DOI:10.21037/apm-24-45
Saif Aljabab, Ionut Busca, Yasir Alayed, Kristopher Dennis, Robert MacRae
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Abstract

Background: Palliative radiotherapy (RT) is commonly used for malignancy-associated hemoptysis. This study aims to determine RT control probability, durability, and influencing factors.

Methods: This single-institution prospective observational study included patients ≥18 years old with any lung malignancy and active hemoptysis. Hemoptysis severity was captured and monitored via Common Terminology Criteria for Adverse Events (CTCAE) and an in-house developed Patient-Reported Outcome Measure (PROM) tool. Patients were interviewed at enrollment, 2 weeks, 3 months, and 6 months post-treatment. Descriptive statistics, the Kaplan-Meier (KM) method, the Wilcoxon signed-rank test, and Cox regression models were used.

Results: From April 2016 to November 2018, 41 patients were enrolled. One patient withdrew consent and was excluded. The median age was 68 years. Most patients were male (67%) with stage 4 (87.5%), lung primary (85%) disease, and Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (55%). The most common fractionation scheme (72.5%) was 2,000 cGy in 5 fractions. Eight patients (20%) passed away before 2-week assessment. Median follow-up was 6.1 months (range, 0.9-6.2 months). The 6-month overall survival (OS) rate was 26% [95% confidence interval (CI): 13-41%]. The 6-month bleeding-related survival (BRS) was 95% (95% CI: 80-99%), and the 6-month freedom from hemoptysis rate was 37% (95% CI: 18-57%). No patient received re-irradiation for their hemoptysis. On univariate analysis, ECOG status (P=0.01) and prior radiation (P=0.006) were strongly associated with freedom from hemoptysis survival.

Conclusions: Hemostatic RT remains an effective modality for controlling hemoptysis. The short interval high mortality rate post-RT challenges whether fractionated palliative RT should be used for this patient population. Conducting a large clinical trial with a hemoptysis PROM tool is necessary to identify hemostatic durability and influencing factors properly.

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姑息性止血放疗治疗咯血的有效性:一项前瞻性单臂观察研究。
背景:姑息性放射治疗(RT)常用于恶性相关性咯血。本研究旨在确定RT控制概率、持续时间及影响因素。方法:这项单机构前瞻性观察性研究纳入了年龄≥18岁的任何肺部恶性肿瘤和活动性咯血患者。通过不良事件通用术语标准(CTCAE)和内部开发的患者报告结果测量(PROM)工具捕获和监测咯血严重程度。患者在入组时、治疗后2周、3个月和6个月接受访谈。采用描述性统计、Kaplan-Meier (KM)法、Wilcoxon sign -rank检验和Cox回归模型。结果:2016年4月至2018年11月,共纳入41例患者。一名患者撤回同意并被排除在外。中位年龄为68岁。大多数患者为男性(67%),4期(87.5%),肺原发(85%)疾病,东部肿瘤合作组(ECOG)表现状态≥2(55%)。最常见的分馏方案(72.5%)为5份2000 cGy。8例患者(20%)在2周评估前死亡。中位随访时间为6.1个月(范围0.9-6.2个月)。6个月总生存率(OS)为26%[95%可信区间(CI): 13-41%]。6个月出血相关生存率(BRS)为95% (95% CI: 80-99%), 6个月无咯血率为37% (95% CI: 18-57%)。没有患者因咯血而再次接受放射治疗。单因素分析显示,ECOG状态(P=0.01)和既往放疗(P=0.006)与无咯血生存密切相关。结论:止血RT仍是控制咯血的有效方式。放疗后的短间隔高死亡率挑战了是否应该在这一患者群体中使用分级姑息性放疗。使用咯血PROM工具进行大型临床试验是必要的,以正确确定止血耐久性和影响因素。
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来源期刊
Annals of palliative medicine
Annals of palliative medicine Medicine-Anesthesiology and Pain Medicine
自引率
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发文量
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期刊介绍: Annals of Palliative Medicine (Ann Palliat Med; Print ISSN 2224-5820; Online ISSN 2224-5839) is an open access, international, peer-reviewed journal published quarterly with both online and printed copies since 2012. The aim of the journal is to provide up-to-date and cutting-edge information and professional support for health care providers in palliative medicine disciplines to improve the quality of life for patients and their families and caregivers.
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