Study on psychological resilience and associated influencing factors in lung cancer patients with bone metastases

BACKGROUND Evaluating the psychological resilience of lung cancer(LC)patients helps understand their mental state and guides future treatment.However,there is limited research on the psychological resilience of LC patients with bone me-tastases.AIM To explore the psychological resilience of LC patients with bone metastases and identify factors that may influence psychological resilience.METHODS LC patients with bone metastases who met the inclusion criteria were screened from those admitted to the Third Affiliated Hospital of Wenzhou Medical University.The psychological scores of the enrolled patients were collected.They were then grouped based on the mean psychological score:Those with scores lower than the mean value were placed in the low-score group and those with scores equal to or greater than the mean value was placed in the high-score group.The baseline data(age,gender,education level,marital status,residence,monthly income,and religious beliefs),along with self-efficacy and medical coping mode scores,were compared.RESULTS This study included 142 LC patients with bone metastases admitted to our hospital from June 2022 to December 2023,with an average psychological resilience score of 63.24±9.96 points.After grouping,the low-score group consisted of 69 patients,including 42 males and 27 females,with an average age of 67.38±9.55 years.The high-score group consisted of 73 patients,including 49 males and 24 females,with a mean age of 61.97±5.00 years.χ2 analysis revealed significant differences between the two groups in education level(χ2=6.604,P=0.037),residence(χ2=12.950,P=0.002),monthly income(χ2=9.375,P=0.009),and medical coping modes(χ2=19.150,P=0.000).Independent sample t-test showed that the high-score group had significantly higher self-efficacy scores(t=3.383,P=0.001)and lower age than the low-score group(t=4.256,P<0.001).Furthermore,multivariate logistic regression hazard analysis confirmed that self-efficacy is an independent protective factor for psychological resilience[odds ratio(OR)=0.926,P=0.035,95%confidence interval(CI):0.862-0.995],while age(OR=1.099,P=0.003,95%CI:1.034-1.169)and medical coping modes(avoidance vs confrontation:OR=3.767,P=0.012,95%CI:1.342-10.570;resignation vs confrontation:OR=5.687,P=0.001,95%CI:1.974-16.385)were identified as independent risk factors.A predictive model based on self-efficacy,age,and medical coping modes was developed.The receiver operating characteristic analysis showed an area under the curve value of 0.778(95%CI:0.701-0.856,P<0.001),indicating that the model has good predictive performance.CONCLUSION LC patients with bone metastases are less psychologically resilient than the general population.Factors such as self-efficacy,age,and medical coping modes influence their psychological resilience.Patients with low self-efficacy,old age,and avoidance/resignation coping modes should be closely observed.

Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine?

To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.

Impacts of radiation therapy on quality of life and pain relief in patients with bone metastases

Bone metastases(BM)are a common complication in advanced cancer patients,significantly contributing to morbidity and mortality due to their ability to cause pain,fractures,and spinal cord compression.Radiation therapy(RT)is vital in managing these complications by targeting metastatic lesions to ease pain,improve mobility,and reduce the risk of skeletal-related events such as fractures.Evidence supports the effectiveness of RT in pain relief,showing its ability to provide significant palliation and lessen the need for opioid painkillers,thereby enhancing the overall quality of life(QoL)for patients with BM.However,optimizing RT outcomes involves considerations such as the choice of radiation technique,dose fractionation schedules,and the integration of supportive care measures to mitigate treatment-related side effects like fatigue and skin reactions.These factors highlight the importance of personalized treatment planning tailored to individual patient needs and tumor characteristics.This mini-review aims to provide comprehensive insights into the multifaceted impacts of RT on pain management and QoL enhancement in BM patients,with implications for refining clinical practices and advancing patient care through the synthesis of findings from various studies.

Hyoid metastasis an unusual location from lung cancer

Bone metastases from lung cancer account for 8.5%,with those located in the hyoid bone being extremely rare.In this editorial,we made a review about Hsu et al case report highlighted the importance of palliative radiotherapy,even with an unusual but effective scheme in pain control in a patient with non-small cell lung cancer in stage IV.

Bone metastases:When and how lung cancer interacts with bone

Bone metastasis is a common and debilitating consequence of lung cancer:30%-40% of patients with nonsmall cell lung cancer develop bone metastases during the course of their disease. Lung cancer cells find a favorable soil in the bone microenvironment due to factors released by the bone matrix, the immune system cells, and the same cancer cells. Many aspects of the cross-talk among lung tumor cells, the immune system,and bone cells are not clear, but this review aims to summarize the recent findings in this field, with particular attention to studies conducted to identify biomarkers for early detection of lung cancer bone metastases.

Efficacy and safety of radiotherapy combined with zoledronic acid in the treatment of lung cancer with bone metastasis: a meta-analysis

Objective: To evaluate the efficacy and safety of radiotherapy combined with zoledronic acid fOr the treatment of bone metastases. Methods: Use Pubmed, Cochrane Library, Embase, CBM, CNKI, Wanfang, Weipu tools to search-related databases at home and abroad. From 2013.1 to March 2019, radiotherapy combined with zoledronic acid and radiotherapy alone for bone metastasis of lung cancer were collected. Experimental studies;quality evaluation and data extraction for each of the included studies, and Cochrane risk bias assessment tools for quality evaluation of the literature. Data processing was performed using RevMan 5.3 and Stata 15.0 software, including risk ratio (OR), 95% CI, I2, and P values. Line sensitivity test, publication bias evaluation is using Egger's, Bgge's method quantitative calculation using Revman 5.3 and Stata 15.0 software for statistical analysis. Results: The total of 8 articles was included, and the number of cases was 703. The results of the meta-analysis showed that the radiotherapy, combined with the zoledronic acid group was effective in the treatment of lung cancer with bone metastasis. The meta-analysis was Z = 6.31 (P < 0.00001), OR (95% CI = 3.57, (2.41, 5.30)), the difference was statistically significant. The combined effect of bone metastases was better than that of the single-stage group. The meta-analysis results were Z = 3.18 (P = 0.001) and OR (95% CI = 3.21, (1.57, 6.59)), indicating the therapeutic effect of the two groups in the treatment of bone metastases. The difference is statistically significant. Adverse reactions include: (1) bone marrow suppression, blood toxicity;(2) fever and rash;(3) nausea, vomiting, and fatigue;(4) liver damage and loss of appetite, meta-analysis results are: bone marrow suppression, blood toxicity: Z =0.73 ( P = 0.47), OR (95% CI = 0.58 (0.13, 2.54));fever, rash: Z = 0.36 (P = 0.36), OR (95% CI = 1.3 (0.31, 5.38));nausea, vomiting, Weakness: Z = 0.29 (P = 0.77), OR (95% CI = 0.85 (0.27, 2.62));liver function damage and loss of appetite: Z = 0.00 (P = 1.00), OR (95% CI = 1.00 (0.17, 6.00)). The P values of the four meta-analyses were all greater than 0.05, and the difference was not statistically significant, indicating that the addition of zoledronic acid to the bone metastasis of lung cancer did not aggravate the changes of the above four adverse reactions. Conclusion: Radiotherapy combined with the zoledronic acid group is better than the single radiotherapy group in treating pain caused by bone metastasis. It can effectively treat bone metastasis and will not aggravate the occurrence of adverse reactions.

Efficacy and nursing of stereotactic radiotherapy in lung cancer patients with brain metastases

Objective: To observe the efficacy of stereotactic radiotherapy (SRT) in lung cancer patients with brain metas-tases and explore the nursing for those patients. Methods: From June 2002 to December 2006, 43 patients of lung cancer with brain metastases were treated with SRT, 8 of them were treated with the association of whole-brain radiotherapy (WBRT) and 6 of them were treated with combination of chemotherapy. During the period of SRT, the patients were applied with active psychological nursing and diet nursing. We also tried to prevent patients from epicranium injury, and meanwhile, patients were asked to took active convalesce exercise. Results: All patients finished SRT without serious reaction and complication. Local control rate was 81.4%, nervous system symptoms relief rate was 76.7% and KPS score was raised significantly. Survival time ranged from 2 to 34 months, median survival time was 8.5 months, and 6-month, 1-and 2-year survival rates were 58.9%, 26.2%, and 6.0% respectively. Conclusion: SRT was one of the effective palliation treatments for the lung cancer patients with brain metastases, and with the assistance of effective nursing, which would prolong their survival time and improved quality of life.

Efficacy of Temozolomide Combined with Whole Brain Radiotherapy in the Treatment of Cerebral Metastases from Lung Cancer

[Objectives] To observe the clinical efficacy,adverse reaction and survival time of temozolomide combined with whole brain radiotherapy in the treatment of lung cancer. [Methods] A total of 43 patients with lung cancer and cerebral metastases were reviewed and analyzed. Three-dimensional conformal radiotherapy(3D-CRT) technique was used to perform whole brain radiotherapy,one time a day and5 times a week. At the same time of radiotherapy,temozolomide chemotherapy was performed,150 mg/( m2·d),continuous oral administration of 5 d,every 28 days were a cycle( those patients who continue receiving temozolomide chemotherapy did not receive other related antitumor therapy,such as systemic chemotherapy and molecular targeted therapy,etc.),and drugs were administered for 4-6 cycles according to tolerance of patients. Kaplan-Meier method was used to calculate the survival rate. [Results]The objective response rate of 43 patients was79. 0%(34/43),in which CR was 6/43,PR was 28/43,and 9 cases had PD. By December 31,2016,7 patients in 43 cases died,one patient died of cerebral hernia due to intracranial lesions and 6 patients died of failure of other important organs due to metastasis. The OS and PFS of the whole group of patients in one year were 49. 1% and 56. 9% respectively. The adverse reactions were mild and the patients could tolerate such treatment. [Conclusions] Temozolomide combined with whole brain radiotherapy in the treatment of lung cancer with cerebral metastases has excellent clinical efficacy,while patients can tolerate such treatment.

Advance of prophylactic cranial irradiation in lung cancer

Brain metastases in patients with lung cancer are a devastating problem with profound impact on survival. Prophylactic cranial irradiation has been discussed as an option to reduce the risk of brain metastases. This report provides an extensive review of the current evidence from non-randomized and randomized trials regarding the use of prophylactic cranial irradiation in lung cancer.

肺癌骨转移治疗中纳米材料应用的研究进展

根据世界卫生组织国际癌症研究机构(IARC)发布的“2020年全球新发癌症病例”报道,全球肺癌新发病例约220万例,死亡约180万例,肺癌是癌症死亡的主要原因。肺癌骨转移发生率为30%~40%,46%的肺癌骨转移患者并发疼痛、高钙血症、病理性骨折等骨相关事件(SRE)^([1,2])。

肺癌骨转移机制相关血清学标志物的研究进展

肺癌是人类常见的恶性肿瘤之一,约30%~40%的肺癌患者最终会发展为骨转移。骨转移引起的骨相关事件以及其临床上难以治愈的特性,严重影响了患者的生存质量和生存期。目前,肺癌骨转移的临床诊断主要依赖于影像学方法,但由于其敏感性不足和潜在的辐射风险等限制,约半数患者在明确诊断时已发生了骨相关事件。该文简要概述了肺癌骨转移的分子机制,包括肿瘤细胞预转移、定植、休眠、再激活以及增殖过程,并进一步详述了血清学标志物在肺癌骨转移诊断中的独立或联合应用的潜在价值。

联合免疫检查点抑制剂治疗驱动基因阴性非小细胞肺癌脑转移的研究进展

非小细胞肺癌(non-small cell lung cancer,NSCLC)是肺癌中最常见的组织学类型,约66%的患者在确诊时就被发现伴有远处转移。脑转移是最常见的转移部位之一,约13%的患者在初诊时即发现颅内受累,严重影响生活质量,预后不佳。驱动基因阳性的NSCLC脑转移患者靶向治疗可以达到较好的颅内控制率,但驱动基因阴性的患者治疗手段较为局限。近年来,随着免疫治疗的兴起,免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)被广泛运用于临床,ICIs联合放疗的治疗模式为驱动基因阴性NSCLC脑转移患者的治疗带来了新希望。本文就放疗联合免疫治疗在敏感驱动基因阴性NSCLC脑转移患者中的临床研究进展进行综述,以期为临床治疗方案的选择提供参考。

放疗联合重组人血管内皮抑素治疗肺癌脑转移瘤合并脑水肿的疗效评估

目的探讨放疗联合重组人血管内皮抑素(rh-Endostatin)治疗肺癌脑转移瘤合并脑水肿的疗效。方法选取2020-05—2023-03阜阳市肿瘤医院收治的肺癌脑转移瘤合并脑水肿患者74例为研究对象,按随机数排序法分为研究组37例与对照组37例,对照组予以放疗联合传统治疗(激素、甘露醇),研究组予以放疗联合rh-Endostatin治疗,均治疗2周,比较2组患者疗效、水肿程度、癌胚抗原(CEA)水平与不良反应。结果2组患者总有效率比较差异无统计学意义(χ^(2)=1.770,P>0.05),2组患者治疗2周后脑水肿程度均较治疗前改善(Z=17.704、6.211,P<0.05),且研究组优于对照组(Z=5.681,P<0.05)。重复测量方差分析结果显示,2组患者治疗后CEA水平与治疗前相比均降低,且治疗2周后CEA水平低于治疗1周后(P<0.05),研究组治疗1周后、治疗2周后CEA水平均低于对照组(6.12±2.01比7.45±2.03,4.31±1.14比5.52±1.77,P<0.05)。2组患者均未发生贫血、出血倾向、心功能不良反应,心律失常不良反应分级、血小板减少不良反应分级、粒细胞减少不良反应分级比较差异无统计学意义(P>0.05)。结论放疗联合rh-Endostatin治疗肺癌脑转移瘤合并脑水肿具有较好疗效,可有效改善脑水肿指数,降低CEA水平,且无明显不良反应,安全性较好。

经皮骨强化术治疗非小细胞肺癌溶骨性胸骨转移瘤

目的 探讨经皮骨强化术(PBA)治疗非小细胞肺癌溶骨性胸骨转移瘤的疗效。方法 选取10例经病理证实的非小细胞肺癌溶骨性胸骨转移瘤行PBA的资料,回顾性分析手术治疗方法,采用术前、术后视觉模拟评分(VAS)、KPS评分评估临床疗效。采用SPSS 19.0统计学软件单因素方差分析,对所得数据进行统计学分析,以P<0.05为差异有统计学意义。结果 10例患者均顺利完成手术,术后1周,VAS评分由术前8.60±0.97降至术后2.70±0.67;KPS评分由术前31.00±9.94升至术后77.00±10.59,治疗前后两者差异均有统计学意义(P<0.05)。结论 PBA治疗非小细胞肺癌溶骨性胸骨转移瘤创伤小且安全,可获得良好的止痛效果,有效提高患者的生活质量。

溶骨性骨代谢标志物血Ⅰ型CTP、miR-107及TRACP-5b检测在肺癌骨转移中的诊断价值

目的 分析血Ⅰ型胶原交联羧基末端肽(ⅠCTP)、微小RNA-107(miR-107)、血抗酒石酸酸性磷酸酶5b(TRACP-5b)检测在肺癌骨转移中的诊断效果。方法 选取2020年10月至2022年12月于河南省人民医院医治的中晚期肺癌患者122例,根据是否发生骨转移分为骨转移组58例、非骨转移组64例。比较骨转移组、非骨转移组ⅠCTP、miR-107、TRACP-5b水平。比较骨转移组病灶不同分级ⅠCTP、miR-107、TRACP-5b水平。比较骨转移组不同骨转移累及数目ⅠCTP、miR-107、TRACP-5b水平。分析ⅠCTP、miR-107、TRACP-5b对肺癌骨转移的诊断效能。结果 骨转移组ⅠCTP、miR-107、TRACP-5b水平均高于非骨转移组,差异具有统计学意义(P<0.05)。ⅠCTP、miR-107、TRACP-5b水平:Ⅲ~Ⅳ级>Ⅰ~Ⅱ级>0级,差异具有统计学意义(P<0.05)。≥3处以上转移组ⅠCTP、miR-107、TRACP-5b水平高于≤2处转移组,差异具有统计学意义(P<0.05)。ⅠCTP、miR-107、TRACP-5b联合诊断肺癌骨转移灵敏度为96.42%,特异度为93.93%,准确度为95.08%,均高于上述指标单一检查(P<0.05)。结论 ⅠCTP、miR-107、TRACP-5b水平与肺癌骨转移发生具有紧密关联,其中TRACP-5b检测肺癌骨转移灵敏度、特异度及准确度最高,三者联合检测可有效提高肺癌骨转移诊断价值。

王邦才治疗肺癌骨转移经验介绍

介绍王邦才教授治疗肺癌骨转移的临床经验。王邦才教授指出肺肾虚损、骨髓亏虚是肺癌骨转移的核心病机,痰瘀癌毒、胶结蚀骨是形成骨转移和引起骨痛的病理关键。故有补益肺肾、壮骨填髓治其本,祛痰化瘀、清毒止痛治其标的治疗原则;同时,重视对放化疗不良反应的调护,且不忘身心同调、语言疏导以怡情,运用综合疗法提高患者生活质量。

肺癌脊柱转移瘤治疗模式及治疗方式的临床研究进展

脊柱是肺癌远处转移的常见部位,严重影响患者的生活质量。随着医疗水平的提高,肺癌脊柱转移瘤的发病率逐年增加。在多学科治疗模式的推进下,针对肺癌脊柱转移瘤的放疗、化疗、手术治疗等方式取得新的研究进展,同时其治疗模式和决策模式也不断发生新的变化,取得了较为满意的临床效果。目前,多学科模式下根据新型决策模式制订最合适的综合治疗方案,使患者获得更高的生活质量和更长的生存期是治疗的大趋势。现本文对肺癌脊柱转移瘤治疗模式及治疗方式的研究进展进行综述总结,为临床治疗脊柱转移瘤提供参考。

Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis

To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.METHODSSEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved.RESULTSA total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSIONPancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.

Radiotherapy of brain metastases from non-small cell lung cancer

Brain metastases risk at the time of diagnosis or during the course of disease is high in non-small cell lung cancer (NSCLC). Even the incidence of brain metastases has increased in recent years, due to detection of smaller asymptomatic lesions with MRI screening as well as improved survival as a consequence of developments in systemic therapies. In the last decade, there have been many trials in the management of NSCLC patients with brain metastases, questioning the role of adjuvant whole brain radiotherapy (WBRT) after surgery or stereotactic radiosurgery (SRS), WBRT, compared to best supportive care in patients not amenable to surgery, aggressive local therapies in solitary brain metastases, postsurgical cavity SRS, SRS in non-oligometastatic patients, cranial radiotherapy in patients with driver mutations, thyrosine kinase inhibitors, immune check point inhibitors and the impact of therapies on neurocognitive functions and quality of life. The main objective of this review is to provide an update on current trends in radiotherapy in the management of newly diagnosed brain metastases from NSCLC.

Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor:A new paradigm?

Stereotactic ablative body radiotherapy(SABR)is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer(NSCLC)and pulmonary metastasis.Several fractionation schemes have proven to be safe and effective,including the single fraction(SF)scheme.SF is an option costeffectiveness,more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments.The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm,recommending this option to minimize patients’visits to hospital.SF SABR already has a long experience,strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases,making it a valid treatment option;although its use in central locations,synchronous and recurrencies tumors requires more prospective safety and efficacy studies.The SABR radiobiology study,together with the combination with systemic therapies,(targeted therapies and immunotherapy)is a direction of research in both advanced disease and early stages whose future includes SF.