Systematic review of patient reported quality of life following stereotactic ablative radiotherapy for primary and metastatic liver cancer.
Systematic review of patient reported quality of life following stereotactic ablative radiotherapy for primary and metastatic liver cancer.
复制标题
DOI：
10.1186/s13014-017-0818-8
复制
发表时间：
2017-06-29
期刊：
影响因子：
--
通讯作者：
Swaminath A
中科院分区：
文献类型：
--
作者：
Mutsaers A;Greenspoon J;Walker-Dilks C;Swaminath A
立体定向消融放射治疗(SABR)对不能接受其他局部治疗的肝癌患者是一种安全有效的治疗方法。然而，SABR不是目前的实践标准，需要进一步验证。患者报告的生活质量(QOL)是这一验证的关键，然而到目前为止还没有系统的评价来分析肝脏SABR后的生活质量。生活质量是治疗评估的关键部分，特别是在预期寿命较短的疾病状态下。本研究的目的是对肝脏SABR的生活质量结果进行系统回顾。查询1996年至2015年10月的Medline和EMBASE数据库，获取分析肝脏SABR后生活质量的英文研究。纳入的研究将患者报告的生活质量描述为主要或次要终点，并分析了随着时间的推移生活质量的变化。对研究进行筛选，提取相关数据并进行分析。在2181项初步筛选的研究中，5项符合所有纳入标准。抽取的研究包括总共392名符合条件的肝细胞癌、肝转移癌和肝内胆管细胞癌患者。有四项研究在设计上是前瞻性的，只有一项研究是会议摘要。提取的研究在使用的剂量处方(11-70Gy3-30次)，以及已报道的QOL指标(EORTC QLQ C-15 PAL，/C-30/LM-21，EuroQol 5D，FACT-HEP，FLIC)和最终终点(6周至12个月)方面是不同的。尽管如此，SABR后的生活质量评分在统计学上几乎没有显著下降。四项研究显示在最初的1-4周内出现一过性疲劳，而两项研究显示在1个月后食欲出现一过性恶化。除一例外(6周时食欲不振)，到最终终点时，水平回到了无显著差异的基线。所有研究都表明，在各自的终点，任何领域的生活质量都没有显著下降。在使用重叠的生活质量工具的研究中，SABR后3个月的全球生活质量的估计是相似的。这项系统性综述的结果表明，肝脏SABR术后生活质量保存良好。这些发现加强了肝脏SABR的论点，并应旨在支持未来与其他局部方法(包括手术、化疗栓塞术和射频消融术)的比较有效性试验，重点关注作为重要终点的生活质量结果。本文的在线版本(doi：10.1186/s13014-0170818-8)包含补充材料，授权用户可以使用。
Stereotactic ablative radiotherapy (SABR) is a safe and effective modality in patients with liver cancer who are ineligible for other local therapies. However SABR is not current standard of practice and requires further validation. Patient reported quality of life (QOL) is key to this validation, yet no systematic reviews to date have been performed to analyse QOL following liver SABR. QOL is a critical part of therapy evaluation, particularly in disease states with short life expectancy. The purpose of this study was to conduct a systematic review of QOL outcomes for liver SABR. MEDLINE and EMBASE databases from 1996 to October 2015 were queried to obtain English language studies analysing QOL following liver SABR. Included studies described patient-reported QOL as either a primary or secondary endpoint, and analysed QOL change over time. Studies were screened, and relevant data were abstracted and analysed. Of 2181 initially screened studies, 5 met all inclusion criteria. Extracted studies included a total of 392 eligible patients with hepatocellular carcinoma, liver metastases and intrahepatic cholangiocarcinoma. Four studies were prospective in design, and only one study was a conference abstract. Extracted studies were heterogeneous in dose prescription used (11–70 Gy in 3–30 fractions), in addition to reported QOL metrics (EORTC QLQ C-15 PAL,/C-30/LM-21, EuroQol 5D, FACT-Hep, FLIC) and final endpoints (range 6 weeks to 12 months). Despite this there were few statistically significant declines in QOL scores following SABR. Four studies demonstrated transient fatigue in the first 1–4 weeks, while 2 studies showed transient worsening of appetite at 1 month. In all but one instance (loss of appetite at 6 weeks), levels returned to insignificant difference baseline by the final endpoints. All studies showed no significant QOL decline in any domain at their respective endpoints. In studies with overlapping QOL tools, estimates of 3-month post SABR global QOL were similar. Results of this systematic review demonstrate well-preserved post liver SABR QOL. These findings strengthen the argument for liver SABR, and should aim to support future comparative effectiveness trials with other local modalities including surgery, chemoembolization and radiofrequency ablation, with a focus on QOL outcomes as an important endpoint. The online version of this article (doi:10.1186/s13014-017-0818-8) contains supplementary material, which is available to authorized users.