Annals of palliative medicine最新文献

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Cancer-related cognitive impairment: updates to treatment, the need for more evidence, and impact on quality of life-a narrative review. 与癌症相关的认知障碍:治疗方法的更新、对更多证据的需求以及对生活质量的影响--叙述性综述。
4区 医学
Annals of palliative medicine Pub Date : 2024-09-01 Epub Date: 2024-09-09 DOI: 10.21037/apm-24-70
Yesol Yang, Diane Von Ah
{"title":"Cancer-related cognitive impairment: updates to treatment, the need for more evidence, and impact on quality of life-a narrative review.","authors":"Yesol Yang, Diane Von Ah","doi":"10.21037/apm-24-70","DOIUrl":"10.21037/apm-24-70","url":null,"abstract":"<p><strong>Background and objective: </strong>Due to advances in early detection and treatment options, non-central nervous system (non-CNS) cancer survivors are living longer, even those with metastatic disease. Many of these survivors will experience enduring symptoms of breast cancer, such as cancer-related cognitive impairment (CRCI). Although CRCI is bothersome and, in some cases, potentially debilitating, little research has been done to address this symptom. Thus, the overarching goal of this narrative review is to provide both an overview of the problem of CRCI and its impact and focus on the latest research aimed at addressing CRCI in non-CNS cancer survivors.</p><p><strong>Methods: </strong>A MEDLINE database (PubMed) search was conducted for terms related to non-CNS cancer, cognition, impacts of CRCI, and interventions. The English-language articles published until April 8th, 2024, were included in the search.</p><p><strong>Key content and findings: </strong>CRCI includes self-reported cognitive complaints and/or impaired performance in multiple cognitive domains, including memory, processing speed, attention, and executive function. CRCI, in turn, can have a significant impact on everyday functioning, work ability, work engagement and productivity, and overall quality of life (QoL) of cancer survivors. While some researchers have examined pharmacological approaches, the vast majority of the interventional studies to date to address CRCI has focused on non-pharmacological approaches. Three of the most common non-pharmacological approaches are physical activity or exercise, mind-body approaches [e.g., mindfulness-based stress reduction (MBSR)], and cognitive rehabilitative approaches [e.g., cognitive training (CT) and cognitive behavioral therapy (CBT)].</p><p><strong>Conclusions: </strong>Addressing the cognitive health of cancer survivors is imperative but has only recently been the focus of interventional research. More research in larger and more diverse samples of non-CNS cancer survivors is needed to identify effective ways to manage CRCI for all cancer survivors. Overall, maintaining cognitive health, especially in cancer survivors who are at increased risk for deficits, is a national health care priority that should not be ignored.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1265-1280"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
African American patient and caregiver attitudes and perceptions of community health workers as lay patient navigators in palliative care. 非裔美国人患者和护理人员对社区医疗工作者作为姑息治疗的非专业患者导航员的态度和看法。
4区 医学
Annals of palliative medicine Pub Date : 2024-09-01 Epub Date: 2024-08-05 DOI: 10.21037/apm-23-602
Olivia Monton, Shannon Fuller, Amn Siddiqi, Alison P Woods, Taleaa Masroor, Robert Joyner, Ronit Elk, Jill Owczarzak, Fabian M Johnston
{"title":"African American patient and caregiver attitudes and perceptions of community health workers as lay patient navigators in palliative care.","authors":"Olivia Monton, Shannon Fuller, Amn Siddiqi, Alison P Woods, Taleaa Masroor, Robert Joyner, Ronit Elk, Jill Owczarzak, Fabian M Johnston","doi":"10.21037/apm-23-602","DOIUrl":"10.21037/apm-23-602","url":null,"abstract":"<p><strong>Background: </strong>Concurrent palliative care for patients with advanced cancer has been shown to reduce physical and psychological symptoms, and improve the quality of life of patients with advanced cancer. Underutilization of palliative care services, especially among African American patients with advanced cancer, remains an important public health problem. To address this gap, we developed a community health worker (CHW) palliative care intervention for African American patients with advanced cancer, which is being formally assessed through an ongoing effectiveness-implementation trial (NCT05407844). As part of the preparatory phase of this study, we conducted qualitative interviews with African American patients with advanced cancer and their caregivers. The objective of this analysis was to explore patient and caregiver attitudes and perceptions of the CHW palliative care intervention to support African American patients with advanced cancer in accessing palliative care.</p><p><strong>Methods: </strong>We used purposive sampling to identify African American patients with advanced cancer and their informal caregivers from clinic lists and through referring oncologists. We conducted six individual and group semi-structured interviews with patients and caregivers between November 2022 and April 2023 at three enrollment sites: Johns Hopkins Hospital, TidalHealth Peninsula Regional, and University of Alabama at Birmingham Hospital. The interview guide was informed by the Consolidated Framework for Implementation Research, with a focus on the Innovation and Inner Setting domains. We used the framework method for thematic analysis.</p><p><strong>Results: </strong>Overall, there was a lack of awareness and understanding of palliative care, due primarily to limited experiences with palliative care services among study participants. Despite this lack of familiarity, participants recognized the potential benefits of palliative care for patients with advanced cancer. All study participants were enthusiastic about the concept of patient navigation and the CHW palliative care intervention, with CHWs as lay patient navigators in palliative care. When reflecting on their own experiences, patients and their caregivers identified several areas where CHWs may have supported their cancer care, such as care coordination. Study participants viewed the CHW palliative care intervention as fulfilling a need within the African American community. Participants also made intervention delivery recommendations related to CHW characteristics, training and integration, and communication.</p><p><strong>Conclusions: </strong>This study provides evidence for the acceptability of a CHW palliative care intervention for African American patients with advanced cancer and their caregivers. The findings of this study have led to intervention refinement, which will enhance implementation, delivery, and sustainability of the intervention.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1189-1201"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist. 老年人慢性疼痛和姑息治疗阿片类药物管理中的风险缓解策略综述:与药剂师的跨专业合作。
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 Epub Date: 2024-05-09 DOI: 10.21037/apm-23-488
Insaf Mohammad, Candice L Garwood, Lisa Binns-Emerick
{"title":"A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist.","authors":"Insaf Mohammad, Candice L Garwood, Lisa Binns-Emerick","doi":"10.21037/apm-23-488","DOIUrl":"10.21037/apm-23-488","url":null,"abstract":"<p><strong>Background and objective: </strong>The prevalence of chronic non-cancer pain (CNCP) in older adults is high. Opioids carry significant risk for harm in older adults. Yet, many older adults are established on long-term opioid therapy for the treatment of CNCP despite limited documented efficacy. Many of the non-opioid options to treat pain present challenges in this population. Since challenges with tapering patients off of opioids exist, older adults may remain established on long-term opioid therapy for CNCP. While opioid use is less scrutinized for older adults receiving palliative care, significant safety concerns exist. Therefore, efforts to mitigate risks for older adults receiving long-term opioids for CNCP and for palliative care are essential. Pharmacists as members of the interprofessional team are equipped to improve safety among older adults on chronic opioid therapy. Among patients receiving palliative care, collaboration with palliative care specialists is also key. The purpose of this narrative review is to describe risk mitigation strategies for opioid use among older adults with CNCP and those receiving palliative care.</p><p><strong>Methods: </strong>Data were identified by searching PubMed (January 1, 1990 to February 21, 2024) using the following search terms: older adults, opioids, chronic pain, palliative care, and pharmacist. The search was repeated using terms geriatric, elderly, opiates, narcotics, and controlled substances. Non-English articles and observational studies with fewer than 100 patients were excluded. Major North American and European guidelines were reviewed. Additional literature was obtained through review of relevant references of identified articles.</p><p><strong>Key content and findings: </strong>A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists.</p><p><strong>Conclusions: </strong>There are many opioid risk mitigation strategies for older adults. Collaboration with pharmacists and palliative care specialists can be an effective means for implementing strategies to optimize opioid safety for older adults with CNCP and those receiving palliative care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"901-913"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140910948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Palliative care interventional research in general practice: a narrative review of factors affecting research conduct. 全科医学中的姑息关怀干预研究:对影响研究开展的因素的叙述性回顾。
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 Epub Date: 2024-05-10 DOI: 10.21037/apm-23-587
Matthew Grant, Maike van der Waal, Tania Pastrana, Joel Rhee, Saskia Teunissen
{"title":"Palliative care interventional research in general practice: a narrative review of factors affecting research conduct.","authors":"Matthew Grant, Maike van der Waal, Tania Pastrana, Joel Rhee, Saskia Teunissen","doi":"10.21037/apm-23-587","DOIUrl":"10.21037/apm-23-587","url":null,"abstract":"<p><strong>Background and objective: </strong>The majority of palliative care provision occurs in general practice, yet only 9% of palliative care clinical trials were conducted in this setting. Evidence from hospital and specialist settings is not readily transferable to general practice, as the population, context and care processes are vastly different. Conducting interventional palliative care research in general practice settings is subject to many challenges and barriers. This narrative review aims to describe the factors influencing the conduct of interventional research in general practice settings for patients with palliative care needs.</p><p><strong>Methods: </strong>A narrative review was performed to identify factors affecting the conduct of palliative care interventional studies in general practice. A literature search of MEDLINE was conducted on 26 September 2023, and data were synthesised utilising a narrative approach.</p><p><strong>Key content and findings: </strong>Sixteen articles were identified. Five thematic groupings were identified from the literature that affected the interventions: factors related to health care professionals (HCPs), patients and carers, general practices, health systems, and research design. HCPs and practices were focused on providing clinical care and struggled to incorporate research into their workload. Staff and patients often had negative perceptions in palliative care combined with limited research experience, often resulting in unwillingness to engage in interventions and gatekeeping. Engaging with general practice staff to design, participate and champion research were key facilitators of successful interventions.</p><p><strong>Conclusions: </strong>Palliative care interventions in general practice are invariably complex and challenging, yet acutely needed to address the care needs of patients in the community setting. Working together with patients, carers and clinicians to design and implement interventions appropriate for general practice settings is fundamental to their success.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"869-879"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Re-irradiation practice and ESTRO/EORTC consensus recommendations: 2023 ASTRO education panel. 再照射实践和 ESTRO/EORTC 共识建议:2023 ASTRO 教育小组。
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 Epub Date: 2024-05-28 DOI: 10.21037/apm-24-4
Shing Fung Lee, Peter J Hoskin
{"title":"Re-irradiation practice and ESTRO/EORTC consensus recommendations: 2023 ASTRO education panel.","authors":"Shing Fung Lee, Peter J Hoskin","doi":"10.21037/apm-24-4","DOIUrl":"10.21037/apm-24-4","url":null,"abstract":"<p><p>Indications for re-irradiation are increasing both for palliation and potentially curative attempts to achieve durable local control. This has been in part driven by the technological advances in the last decade including image-guided brachytherapy, volumetric-modulated arc therapy and stereotactic body radiotherapy. These enable high dose focal irradiation to be delivered to a limited target volume with minimal normal tissue re-irradiation. The European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC) have collaboratively developed a comprehensive consensus on re-irradiation practices, aiming to standardise definitions, reporting, and clinical decision-making processes. The document introduces a universally applicable definition for re-irradiation, categorised into two primary types based on the presence of geometric overlap of irradiated volumes and concerns for cumulative dose toxicity. It also identifies \"repeat organ irradiation\" and \"repeat irradiation\" for cases without such overlap, emphasising the need to consider toxicity risks associated with cumulative doses. Additionally, the document presents detailed reporting guidelines for re-irradiation studies, specifying essential patient and tumour characteristics, treatment planning and delivery details, and follow-up protocols. These guidelines are designed to improve the quality and reproducibility of clinical research, thus fostering a more robust evidence base for future re-irradiation practices. The consensus underscores the necessity of interdisciplinary collaboration and shared decision-making, highlighting performance status, patient survival estimates, and response to initial radiotherapy as critical factors in determining eligibility for re-irradiation. It advocates for a patient-centric approach, with transparent communication about treatment intent and potential risks. Radiobiological considerations, including the application of the linear-quadratic model, are recommended for assessing cumulative doses and guiding re-irradiation strategies. By providing these comprehensive recommendations, the ESTRO-EORTC consensus aims to enhance the safety, efficacy, and quality of life for patients undergoing re-irradiation, while paving the way for future research and refinement of treatment protocols in the field of oncology.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1150-1153"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141299793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Key factors for establishing and sustaining a successful palliative radiation oncology program: a survey of the Society for Palliative Radiation Oncology. 建立和维持成功的姑息放射肿瘤学项目的关键因素:姑息放射肿瘤学学会调查。
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 Epub Date: 2024-05-21 DOI: 10.21037/apm-23-499
Deborah C Marshall, Kavita Dharmarajan, Randy Wei, Yolanda D Tseng, Jessica Schuster, Joshua A Jones, Candice Johnstone, Tracy Balboni, Simon S Lo, Jared R Robbins
{"title":"Key factors for establishing and sustaining a successful palliative radiation oncology program: a survey of the Society for Palliative Radiation Oncology.","authors":"Deborah C Marshall, Kavita Dharmarajan, Randy Wei, Yolanda D Tseng, Jessica Schuster, Joshua A Jones, Candice Johnstone, Tracy Balboni, Simon S Lo, Jared R Robbins","doi":"10.21037/apm-23-499","DOIUrl":"10.21037/apm-23-499","url":null,"abstract":"<p><strong>Background: </strong>Dedicated palliative radiation oncology programs (PROPs) within radiation oncology (RO) practices have been shown to improve quality and decrease costs of radiation therapy (RT) in advanced cancer patients. Despite this, relatively few PROPs currently exist, highlighting an unmet need to understand characteristics of the few existing PROPs and the potential barriers and facilitators that exist in starting and maintaining a successful PROP. We sought to assess the attributes of existing PROPs, the facilitators and barriers to establishing these programs, and the resources needed to create and maintain a successful program.</p><p><strong>Methods: </strong>A 15-item online survey was sent to 157 members of the Society of Palliative Radiation Oncology (SPRO) in July 2019.</p><p><strong>Results: </strong>Of the 157 members, 48 (31%) responded. Most practiced in an academic center (71% at main center and 15% at satellite) and 75% were from a larger group practice (≥6 physicians). Most (89%) believed the development and growth of a dedicated PROPs was either important (50%) or most important (39%) to the field of RO. Only 36% of respondents had a PROP, 38% wanted to establish one, and 13% were currently developing one. Of those with PROPs (N=16), 75% perceived an increase in the number of referrals for palliative RT since starting the program. A majority had an ability to refer to an outside palliative care specialist (64%), an outpatient RO service (53%), and specialized clinical processes for managing palliative radiotherapy patients (53%), with 41% having an inpatient RO consult service. Resources considered most essential were access to specialist-level palliative care, advanced practice provider support, a radiation oncologist with an interest in palliative care, having an outpatient palliative RO clinic, an emphasis on administering short radiation courses, and opportunities for educational development. Of those with a PROP or those who have tried to start one, the greatest perceived barriers to initiating a PROP were committed resources (83%), blocked out clinical time (61%), challenges coordinating management of patients (61%), and support from leaders/colleagues (61%). Perceived barriers to sustaining a PROP were similar. For those without a PROP, the perceived most important resources for starting one included access to palliative care specialist by referral (83%), published guidelines with best practices (80%), educational materials for referring physicians and patients (80%), educational sessions for clinical staff (83%), and standardized clinical pathways (80%).</p><p><strong>Conclusions: </strong>PROPs are not widespread, exist mainly within academic centers, are outpatient, have access to palliative care specialists by referral, and have specialized clinical processes for palliative radiation patients. Lack of committed resources was the single most important perceived barrier for initiating or maintaining ","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"754-765"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141299851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Special considerations in managing pain and psychosocial distress in patients with opioid use disorder and cancer: the role of the supportive care and psycho-oncology interdisciplinary team 管理阿片类药物使用障碍和癌症患者的疼痛和社会心理困扰的特殊考虑因素:支持性护理和肿瘤心理治疗跨学科团队的作用
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 DOI: 10.21037/apm-22-1409
M. C. Trimbur, Bridget Sumser, Chelsea Brown, Timothy Steinhoff, Khaldoun Almhanna, Dana Guyer
{"title":"Special considerations in managing pain and psychosocial distress in patients with opioid use disorder and cancer: the role of the supportive care and psycho-oncology interdisciplinary team","authors":"M. C. Trimbur, Bridget Sumser, Chelsea Brown, Timothy Steinhoff, Khaldoun Almhanna, Dana Guyer","doi":"10.21037/apm-22-1409","DOIUrl":"https://doi.org/10.21037/apm-22-1409","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"75 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical, emotional, and practical symptom burden in patients with terminal illnesses 绝症患者的身体、情感和实际症状负担
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 DOI: 10.21037/apm-24-103
C. B. Simone II
{"title":"Physical, emotional, and practical symptom burden in patients with terminal illnesses","authors":"C. B. Simone II","doi":"10.21037/apm-24-103","DOIUrl":"https://doi.org/10.21037/apm-24-103","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comprehensive care for patients with hepatocellular carcinoma: insights from the 2022 San Antonio Liver Cancer Symposium. 肝细胞癌患者的综合护理:2022 年圣安东尼奥肝癌研讨会的启示。
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 Epub Date: 2024-05-09 DOI: 10.21037/apm-24-36
Sukeshi Patel Arora, Sherri Rauenzahn Cervantez
{"title":"Comprehensive care for patients with hepatocellular carcinoma: insights from the 2022 San Antonio Liver Cancer Symposium.","authors":"Sukeshi Patel Arora, Sherri Rauenzahn Cervantez","doi":"10.21037/apm-24-36","DOIUrl":"10.21037/apm-24-36","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"747-748"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reirradiation of metastases of the central nervous system: part 2-metastatic epidural spinal cord compression. 中枢神经系统转移瘤的再放射:第二部分--转移性硬膜外脊髓压迫。
4区 医学
Annals of palliative medicine Pub Date : 2024-07-01 Epub Date: 2024-03-21 DOI: 10.21037/apm-23-594
Dirk Rades, Charles B Simone, Henry C Y Wong, Edward Chow, Shing Fung Lee, Peter A S Johnstone
{"title":"Reirradiation of metastases of the central nervous system: part 2-metastatic epidural spinal cord compression.","authors":"Dirk Rades, Charles B Simone, Henry C Y Wong, Edward Chow, Shing Fung Lee, Peter A S Johnstone","doi":"10.21037/apm-23-594","DOIUrl":"10.21037/apm-23-594","url":null,"abstract":"<p><p>An increasing number of patients irradiated for metastatic epidural spinal cord compression (MESCC) experience an in-field recurrence and require a second course of radiotherapy. Reirradiation can be performed with conventional radiotherapy or highly-conformal techniques such as intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT). When using conventional radiotherapy, a cumulative biologically effective dose (BED) ≤120 calculated with an α/β value of 2 Gy (Gy2) was not associated with radiation myelopathy in a retrospective study of 124 patients and is considered safe. In that study, conventional reirradiation led to improvements of motor deficits in 36% of patients and stopped further symptomatic progression in another 50% (overall response 86%). In four other studies, overall response rates were 82-89%. In addition to the cumulative BED or equivalent dose in 2 Gy fractions (EQD2), the interval between both radiotherapy courses <6 months and a BED per course ≥102 Gy2 (corresponding to an EQD2 ≥51 Gy2) were identified as risk factors for radiation myelopathy. Without these risk factors, a BED >120 Gy2 may be possible. Scoring tools have been developed that can assist physicians in estimating the risk of radiation myelopathy and selecting the appropriate dose-fractionation regimen of re-treatment. Reirradiation of MESCC may also be performed with highly-conformal radiotherapy. With IMRT or VMAT, rates of pain relief and improvement of neurologic symptoms of 60-93.5% and 42-73%, respectively, were achieved. One-year local control rates ranged between 55% and 88%. Rates of myelopathy or radiculopathy and vertebral compression fractures were 0% and 0-9.3%, respectively. With SBRT, rates of pain relief were 65-86%. Two studies reported improvements in neurologic symptoms of 0% and 82%, respectively. One-year local control rates were 74-83%. Rates of myelopathy or radiculopathy and vertebral compression fractures were 0-4.5% and 4.5-13.8%, respectively. For SBRT, a cumulative maximum EQD2 to thecal sac ≤70 Gy2, a maximum EQD2 of SBRT ≤25 Gy2, a ratio ≤0.5 of thecal sac maximum EQD2 of SBRT to maximum cumulative EQD2, and an interval between both courses ≥5 months were associated with a lower risk of myelopathy. Additional prospective trials are required to better define the options of reirradiation of MESCC.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1141-1149"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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