Effect of high-dose hypofractionated radiotherapy on quality of life of patients with pancreatic cancer
Qin Qing, Ren Gang, Li Jing, Xia Tingyi, Zhang Xiaodan
Air Force Clinical Institute of Anhui Medical University,Beijing 100142,China(Qin Q,Xia TY),Department of Radiation Oncology,Air Force General Hospital,People′s Liberation Army (Ren G,Li J,Xia TY,Zhang XD)
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.
Qin Qing,Ren Gang,Li Jing et al. Effect of high-dose hypofractionated radiotherapy on quality of life of patients with pancreatic cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(7): 656-660.
[1] Siegel RL,Miller KD.Cancer statistics,2018[J].J Clin,2018,68(1):7-30.DOI:10.3322/caac.21442
[2] Ren G,Xia T,Di Y,et al. Hypofractionated and Simultaneous Integrated Boost Radiation Therapy for Locally Advanced Pancreatic Cancer With Helical Tomotherapy[J].Int J Radiat Oncol Biol Phys,2015,93(3):E149-E150.
[3] Wang J,Xia T,Wang Y,et al. Long-term Results of Gamma Ray-based Stereotactic Body Radiation Therapy in Treatment of Medically Unfit or Inoperable Nonmetastatic Pancreatic Adenocarcinoma[J].Int J Radiat Oncol Biol Phys,2012,84(3):S815-S816.
[4] 任刚,王竞,夏廷毅.《胰腺癌综合诊治中国专家共识(2014年版)》放射治疗部分的解读[J].临床肝胆病杂志,2014(12):1249-1252.
Ren G,Wang J,Xia TY.<Chinese expert consensus on integrated diagnosis and treatment of pancreatic cancer (2014 Edition)> interpretation of radiotherapy[J].J Clin Hepatobiliary Dis,2014(12):1249-1252.
[5] 任刚,林凯,邸玉鹏,等.血清铁蛋白与胰腺癌高剂量少分次放疗预后的关系[J].中华实用诊断与治疗杂志,2016,30(2):184-186.
Ren G,Lin K,Di YP,et al. Relationship between serum ferritin and prognosis of high dose and low dose radiotherapy for pancreatic cancer[J].Chin J Pract Diag Ther,2016,30(2):184-186.
[6] 万崇华,陈明清,张灿珍,等.癌症患者生命质量测定量表EORTC QLQ-C30中文版评介[J].实用肿瘤杂志,2005,20(4):353-355.
Wan CH,Chen MQ,Zhang CZ,et al. Evaluation of EORTC QLQ-C30 Chinese version of quality of Life scale for Cancer patients[J].J Appl Oncol,2005,20(4):353-355.
[7] Aaronson N K,Ahmedzai S,Bergman B,et al. The European organization for research and treatment of cancer QLQ-C30:a quality-of-life instrument for use in international clinical trials in oncology.[J].J Nat Cancer Inst,1993,85(5):365-76.
[8] Groenvold M,Klee MC,Sprangers MA,et al. Validation of the EORTC QLQ-C30 quality of life questionnaire through combinedqualitative and quantitative assessment of patient-observer agreement.[J].J Clin Epidemiol,1997,50(4):441-50.
[9] Fitzsimmons D,Johnson CD,George S,et al. Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire,the QLQ-C30 in patients with pancreatic cancer. EORTC study group on quality of life[J].Eur J Cancer,1999,35(6):939-41.
[10] Montazeri A,Harirchi I,Vahdani M,et al. The european organization for research and treatment of cancer quality of life questionnaire (EORTC QLQ-C30):translation and validation study of the Iranian version[J].Support Care Cancer,1999,7(6):400-406.
[11] Fayers PM,Aaronson NK,Bjordal K.The EORTC QLQ-C30 scoring manual[M].2001
[12] Ren G,Xia T,Wang Y.IMRT with capecitabine in advanced pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2014,89(2):431.DOI:10.1016/j.ijrobp.2014.02.004.
[13] Xia T,Chang D,Wang Y,et al. Dose Escalation to Target Volumes of Helical Tomotherapy for pancreatic cancer in the phase 1-2 clinical trial[J].Int J Radiat Oncol Biol Phys,2013,87(2):S303-S303.
[14] Rao A D,Sugar E A,Chang D T,et al. Patient-reported outcomes of a multi-center phase Ⅱ study investigating gemcitabine and stereotactic body radiotherapy in locally advanced pancreatic cancer[J].Pract Radiat Oncol,2016,6(6):417-424.DOI:10.1016/j.prro.2016.05.005.
[15] Polistina F,Costantin GF,Francescon P,et al. Unresectable locally advanced pancreatic cancer:a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration.[J].Ann Surg Oncol,2010,17(8):2092-101.DOI:10.1245/s10434-010-1019-y.
[16] Ueno H,Ioka T,Ikeda M,et al. Randomized phase Ⅲ study of gemcitabine plus S-1,S-1 alone,or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan:GEST study[J].J Clin Oncol,2013,31(13):1640-8. DOI:10.1200/JCO.2012.43.3680.
[17] Yovino S,Poppe M,Jabbour S,et al. Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers[J].Int J Radiat Oncol Biol Phys,2011,79(1):158-62.DOI:10.1016/j.ijrobp.2009.10.043.
2018, Vol. 27 
