Abstract
Background and purpose
Palliative radiotherapy (RT) is routinely used in end of life care of patients with advanced malignancies; however, unnecessarily burdensome treatment shortly before death should be avoided. There is little knowledge on incidence and causes of intercurrent deaths during palliative RT.
Patients and methods
In this study death events among inpatients receiving palliative RT between January 2009 and December 2011 at this department were retrospectively analyzed. Among epidemiological factors, treatment schedule and chronology, latency and duration of treatment in relation to the actual survival were identified.
Results
In this study 52 patients died during or shortly after palliative RT. Symptomatic bone metastases and brain metastases represented the most common RT indications. The general health status was poor with a median Karnofsky performance score of 50 %, RT was realized with a median single dose of 2.5 Gy to a median total dose of 30.5 Gy and was stopped prematurely in 73 % of patients. On average 53 % of the remaining lifetime was occupied by latency to starting RT. Once RT was begun the treatment duration required a median 64 % of the still remaining lifetime.
Conclusion
The majority of patients who died had explicitly adverse pre-existing factors and rarely completed RT as scheduled. Latency to RT and RT duration occupied more than half of the remaining lifetime.
Zusammenfassung
Hintergrund
Die palliative Radiotherapie (RT) hat einen hohen Stellenwert in der Symptomenkontrolle terminal erkrankter Tumorpatienten. Unnötig belastende Therapien kurz vor Lebensende sollten jedoch vermieden werden. Bislang gibt es kaum strukturierte Daten über Sterbefälle unter palliativer RT.
Patienten und Methode
Im Rahmen der vorgestellten Studie wurden die Sterbefälle unter stationär palliativ bestrahlten Patienten der eigenen Abteilung zwischen Januar 2009 und Dezember 2011 analysiert. Ausgewertet wurden epidemiologische Faktoren, Behandlungskonzept und -verlauf. Zeit bis zum RT-Beginn und RT-Dauer wurden ins Verhältnis zur tatsächlichen Überlebenszeit gebracht.
Ergebnisse
Während oder kurz nach palliativer RT starben 52 Patienten. Symptomatische Knochen- und Hirnfiliae waren die häufigsten Behandlungsindikationen. Der durchschnittliche Allgemeinzustand der Patienten war reduziert (Karnofsky-Index 50 %). Die RT wurde mit einer medianen Einzeldosis von 2,5 Gy bis zu einer medianen Gesamtdosis von 30,5 Gy durchgeführt und in 73 % der Fälle vorzeitig abgebrochen. Die Latenz bis zum RT-Beginn nahm median 53 % der faktisch verbleibenden Lebenszeit ein; nach RT-Start beanspruchte die Therapie median 64 % der noch verbleibenden Lebensstrecke.
Schlussfolgerung
Die Mehrheit der verstorbenen Patienten hatte eindeutig negative Ausgangsfaktoren und bewältigte selten die RT wie geplant. Wartezeit bis zum RT-Start und RT-Dauer nahmen mehr als die Hälfte der verbleibenden Lebenszeit ein.
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Conflict of interest. B. Berger, H. Ankele, M. Bamberg and D. Zips state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.
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Berger, B., Ankele, H., Bamberg, M. et al. Patients who die during palliative radiotherapy. Strahlenther Onkol 190, 217–220 (2014). https://doi.org/10.1007/s00066-013-0471-6
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DOI: https://doi.org/10.1007/s00066-013-0471-6