高剂量少分次放疗模式治疗胰腺癌对患者生活质量的影响

Effect of high-dose hypofractionated radiotherapy on quality of life of patients with pancreatic cancer

目的 评估高剂量少分次放疗对胰腺癌患者生活质量的影响。方法 前瞻性研究2016年-2017年间50例胰腺癌患者,均采用螺旋断层调强放疗技术,PTV、CTV、GTV的处方剂量分别为50、60、70 Gy分15-20次,5 次/周,共分别于放疗前、放疗结束时、放疗后1个月及放疗后3个月采用QLQ-C30和QLQ-PAN26评估患者生活质量,比较放疗前后和随访过程中患者的生活质量变化。结果 共纳入50例胰腺癌患者,放疗结束时QLQ-C30问卷总体健康评分与放疗前相近（P=0.330）,放疗后1个月较放疗前升高（P=0.000）,放疗后3个月与放疗后1个月持平（P=0.665）。放疗后3个月,社会功能评分降低（P=0.047）,其余功能评分与放疗后1个月持平。放疗结束时QLQ-C30问卷中疲倦症状较放疗前有所改善,放疗后1个月进一步好转,放疗后3个月趋于平稳。疼痛、失眠、食欲下降及腹泻在放疗结束时无明显变化,放疗后1个月有所改善。恶心呕吐在放疗结束时加重（P=0.000）,放疗后1个月恢复至放疗前水平,放疗后3个月与放疗后1个月相近。经济困难在放疗结束时加重（P=0.046）,放疗后1个月尚可,放疗后3个月再次加重。QLQ-PAN26问卷中胰腺特殊疼痛（后背痛、夜间痛）放疗结束时症状好转（P=0.009、P=0.000）,放疗后1个月时进一步改善,放疗后3个月与放疗后1个月持平。体重减轻在放疗结束时较放疗前有所改善（P=0.000）,放疗后1个月进一步好转（P=0.024）,放疗后3个月与放疗后1个月相近（P=0.226）。结论 高剂量少分次放疗可使胰腺癌患者生活质量在治疗后1-3个月获得显著改善。本研究在以往研究表明高剂量少分次模式放疗显著改善胰腺癌局控率和生存率基础上,进一步证明了该方案在改善生活质量方面的临床价值。

Objective To evaluate the effect of high-dose hypofractionated radiotherapy upon the quality of life （QOL） of patients diagnosed with pancreatic cancer. Methods In this prospective study, 50 patients with pancreatic cancer admitted to our hospital between 2016 and 2017 were recruited. All patients underwent high-dose hypofractionated helical tomotherapy. The prescription doses for PTV, CTV, and GTV were 50, 60, and 70 Gy in 15-20 fractions, 5 times per week. The QOL was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire （QLQ-C30） and pancreatic cancer-specific （European Organization for Research and Treatment of Cancer QLQ-PAN26） questionnaires before, after, 1-month and 3-month after the radiotherapy to statistically compare the QOL changes before and after radiotherapy and subsequent follow-up. Results A total of 50 patients with pancreatic cancer were included. At the end of radiotherapy, the overall QLQ-C30 score did not differ from that before radiotherapy （P=0.330）. At 1 month after radiotherapy, the overall QLQ-C30 score was significantly higher than that before radiotherapy （P=0.000）. The overall QLQ-C30 scores did not significantly differ at 1-and 3-month after radiotherapy （P=0.665）. At 3 months after radiotherapy, social function score was considerably decreased （P=0.047）, and the remaining function scores were equal to those at 1 month post-radiotherapy. The symptoms of fatigue in the QLQ-C30 questionnaire were slightly improved at the end of radiotherapy, which were mitigated at 1-month after radiotherapy and became stable at 3-month following radiotherapy. Pain, insomnia, loss of appetite and diarrhea did not significantly change at the end of radiotherapy, whereas were improved at 1 month after radiotherapy. Nausea and vomiting were aggravated at the end of radiotherapy （both P=0.000）, restored to the level before radiotherapy at 1 month after radiotherapy, and the symptoms were similar at 1-and 3-month after radiotherapy. Financial difficulty was worsened at the end of radiotherapy （P=0.046）, acceptable at 1 month after radiotherapy and worsened at 3 months following radiotherapy. In the QLQ-PAN26 questionnaire, the symptoms of pancreatic pain （backache, nocturnal pain） were mitigated at the end of radiotherapy （P=0.009, P=0.000）, and further alleviated at 1 month after radiotherapy. No significant difference was noted at 1-and 3-month after radiotherapy. The body weight loss was slightly mitigated compared with that before radiotherapy （P=0.000）, and further improved at 1 month after radiotherapy （P=0.024）. No significant difference was noted at 1-and 3-month after radiotherapy （P=0.226）. Conclusion High-dose hypofractionated radiotherapy can significantly enhance quality of life of pancreatic cancer patients at 1- and 3- month following radiotherapy.This study further demonstrated the clinical value of high-dose hypofractionated radiotherapy in improving the quality of life on the basis of previous studies showing that high-dose hypofractionated radiotherapy can significantly improve the local control rate and survival rate of pancreatic cancer.