Yoğun bakım yatışı sırasında radyoterapi endikasyonu konulan hastalarda tedavi sonuçlarımız

Abstract

Amaç: Radyasyon onkolojisi kliniğinde yoğun bakım ünitesi (YBÜ) yatışı sırasında radyoterapi endikasyonu konulan hastaların tedavi tamamlama durumunu ve sağkalım sonuçlarını değerlendirmek amaçlanmıştır. Gereç ve Yöntem: Ankara Şehir Hastanesi Radyasyon Onkolojisi Kliniği’nde 01.01.2020-30.06.2022 tarihleri arasında RT uygulanmış hastaların verileri retrospektif olarak değerlendirilmiştir. Bu araştırmanın primer sonlanım noktası hastaların tedaviyi tamamlama durumudur ve sekonder sonlanım noktası genel sağkalımdır (GS). Veriler SPSS ver. 26 (İBM Corporation, Armonk, NY, USA) kullanılarak kaydedilmiştir ve analiz edilmiştir. Bulgular: Araştırmamızda Ankara Şehir Hastanesi Radyasyon Onkolojisi Kliniğinde 20.05.2020 - 30.06.2022 tarihleri arasında radyoterapi alan hastalardan, endikasyonu yoğun bakım yatışı sırasında konulmuş olan 11 hastanın verileri retrospektif incelenmiştir. RT başlangıcından itibaren medyan takip süresi 4.1 (range 1-9.8) aydır. Bu süre içinde 9 (81.8%) hasta ex, 2 (18.2%) hasta hayattadır. Hastaların median yaşı 55 (range 3-70); 4 (36.4%) kadın 7 (63.6%)’sı erkektir. Hastaların 7 (%63.6)’ si planlanan radyoterapi şemasını tamamlanmıştır ve 4 (36.4%)’ü ise tedaviyi tamamlayamamıştır. Tedaviyi tamamlayamama ile primer tanı (p=0.545) arasında anlamlı ilişki tespit edilememiştir. Hastaların median GS değeri 4.1 (range 1-9.8) aydır Ayrıca 1 aylık sağkalım 60.6 % ve 6 aylık sağkalım 20%’dır. GS ile yaş (p=0.401; correlation coefficient -282) ve primer tanı (p=0.638) arasında anlamlı ilişki yoktur. Kadınlarda median GS 5.3 (range 2.7-9.8) aydır; erkeklerde median GS 1 (range 1-5.5) aydır (p=0.059). Tedaviyi tamamlayanların median GS değeri 4.5 (aralık 1-9.8) ay iken; tedaviyi tamamlayamayanlar median GS 1.1 (range 1-4) aydır (p=0.037). Sonuç: YBÜ yatışı olup RT endikasyonu konulan hastaların yaklaşık %60’ı tedaviyi tamamlayabilmiştir. Planlanan RT şemasını tamamlayan hastalarda anlamlı olarak daha yüksek GS elde edilmiştir. Yoğun bakım yatışı olan kanser hastalarının radyoterapi endikasyonlarını belirlerken uygulanacak kriterlerin geliştirilmesi gerekmektedir.

Keywords

• Radyoterapi
• yoğun bakım ünitesi
• palyatif

Treatment results of intensive care patients with cancer undergoing radiotherapy

Abstract

Aim: This paper aims to evaluate the treatment completion status and survival outcomes of patients who were prescribed radiotherapy during intensive care unit (ICU) hospitalization in the radiation oncology clinic. Material and Method: Data on patients who underwent RT between January 1, 2020, and June 30, 2022, in the Radiation Oncology Clinic of Ankara City Hospital were retrospectively evaluated. The primary endpoint of this study is the patient status at the completion of the planned radiotherapy and the secondary endpoint is the overall survival (OS). The data were recorded and analyzed using SPSS version 26 (IBM Corporation, Armonk, NY, USA). Results: The data of 11 patients who were indicated for radiotherapy while hospitalized for intensive care between May 20, 2020, and June 30, 2022, in the Ankara City Hospital Radiation Oncology Clinic were retrospectively analyzed. The median follow-up period from the onset of RT was 4.1 months (range 1–9.8). During this period, nine (81.8%) patients had deceased, and two (18.2%) patients were surviving. The median age of the patients was 55 years (range 3–70); four (36.4%) were female and seven (63.6%) were male. Seven (63.6%) of the patients completed the planned radiotherapy scheme and four (36.4%) did not complete the treatment. There was no significant relationship between the inability to complete the treatment and gender (p=0.194) or primary diagnosis (p=0.545). The median OS value of the patients was 4.1 months (range 1–9.8). In addition, the 1-month survival was 60.6%, and the 6-month survival was 20%. There was no significant relationship between OS and age (p=0.401; correlation coefficient: ‑282) or primary diagnosis (p=0.638). The median OS in women was 5.3 (range 2.7–9.8) months; the median OS in men was 1 month (range 1–5.5; p=0.059). The median OS of those who completed treatment was 4.5 months (range 1–9.8), while that of those who did not complete the treatment was 1.1 months (range 1–4; p=0.037). Conclusion: Approximately 60% of the patients who were hospitalized in the ICU and indicated for RT were able to complete treatment. A significantly higher OS was achieved in patients who completed the RT protocol. Criteria must be developed when determining the indications for radiotherapy of cancer patients hospitalized in intensive care.

Keywords

• Radiotherapy
• intensive care unit
• palliative

References

1. Martins F, Sofiya L, Sykiotis GP, et al. Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance. Nat Rev Clin Oncol 2019; 16: 563–80.
2. Debela DT, Muzazu SG, Heraro KD, et al. New approaches and procedures for cancer treatment: Current perspectives. SAGE Open Med 2021; 9: 20503121211034366.
3. Vigneron C, Charpentier J, Valade S, et al. Patterns of ICU admissions and outcomes in patients with solid malignancies over the revolution of cancer treatment. Ann Intensive Care 2021; 11: 182.
4. Kress JP, Christenson J, Pohlman AS, et al. Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999; 160: 1957-61.
5. Yıldız M, Çelik D, Çakır M, Savaşır T. Yoğun bakım ünitesi ve palyatif bakım servisinde çalışan hekim ve hemşirelerinin iyi ölüme ve saygın ölüm ilkelerine ilişkin tutumları . Journal of Medicine and Palliative Care 2021; 2: 77-85 .
6. Aslan Y. Palyatif bakımda psikososyal yaklaşım ve değerlendirme. J Med Palliat Care 2020; 1: 41-5.
7. Baskar R, Lee KA, Yeo R, et al. Cancer and radiation therapy: current advances and future directions. Int J Med Sci 2012; 9: 193-9.
8. Sampath S. Treatment: Radiation Therapy. Cancer Treat Res 2016; 170: 105-18.

9. Voigt LP, Pastores SM, Raoof ND, et al. Review of a large clinical series: intrahospital transport of critically ill patients: outcomes,timing, and patterns. J Intensive Care Med 2009; 24: 108–15.
10. Hong Y, Hong JY, Park J. Differences in ICU outcomes according to the type of anticancer drug in lung cancer patients. Front Med (Lausanne) 2022; 9: 824266.
11. Lecuyer L, Chevret S, Thierry G, et al. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 2007; 35: 808-14.
12. Assi HI, Halim NA, Alameh I, et al. Outcomes of patients with malignancy admitted to the intensive care units: a prospective study. Crit Care Res Pract 2021; 2021: 4792309.
13. Mittmann N, Liu N, Cheng SY,et al. Health system costs for cancer medications and radiation treatment in Ontario for the 4 most common cancers: a retrospective cohort study. CMAJ Open 2020; 8: 191-8.
14. Van Dyk J, Zubizarreta E, Lievens Y. Cost evaluation to optimise radiation therapy implementation in different income settings: A time-driven activity-based analysis. Radiother Oncol 2017; 125: 178-85.
15. Rodrigues G, Videtic GM, Sur R, et al. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation oncology evidence-based clinical practice guideline. Pract Radiat Oncol 2011; 1: 60-71.
16. Louie AV, Lane S, Palma DA, Warner A, Cao JQ, Rodrigues GB. Radiotherapy for intubated patients with malignant airway obstruction: futile or facilitating extubation? J Thorac Oncol 2013; 8: 1365-70.
17. Louie AV, Li L, Jenkyn KB, et al. A population-based analysis of outcomes after radiotherapy in intensive care unit patients with lung cancer. J Thorac Dis 2018; 10: 1440-8.
18. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Characteristics and outcomes of cancer patients in European ICUs. Crit Care 2009; 13: 15.
19. Schellongowski P, Sperr WR, Wohlfarth P, et al. Critically ill patients with cancer: chances and limitations of intensive care medicine-a narrative review. ESMO Open 2016; 1: e000018.
20. Spencer K, Parrish R, Barton R, et al. Palliative radiotherapy. BMJ 2018; 360: 821.
21. Arscott WT, Emmett J, Ghiam AF, et al. Palliative radiotherapy: inpatients, outpatients, and the changing role of supportive care in radiation oncology. Hematol Oncol Clin North Am 2020; 34: 253-77.