Patient reported upper gastro-intestinal symptoms associated with fractionated image-guided conformal radiotherapy for metastatic spinal cord compression

Abstract

Background and purpose: Palliative radiotherapy is given to sustain or improve quality of life for patients with advanced cancer. Radiotherapy may however result in symptomatic side effects, which may affect the patient negatively. This prospective longitudinal study of 30 patients aimed at investigating the incidence and severity of early toxicity, particularly focusing on dysphagia, esophagitis and mucositis, following fractionated radiotherapy for cervical and thoracic metastatic spinal cord compression (MSCC), as well as determining the relationship between esophageal dose and early upper gastro-intestinal symptoms. Materials and methods: Thirty patients receiving radiotherapy of 3Gyx10 for MSCC were included in the study. Patients were assessed for a total of 7 weeks from onset of radiotherapy using the Edmonton Symptom Assessment System (ESAS) questionnaire. Upper gastro-intestinal symptoms and severity were assessed from the tenth and eleventh question section of the ESAS questionnaire of ''other problems" and how much this affected them. The relationships between the mean and maximum esophageal doses and incidence of dysphagia, esophagitis or mucositis were estimated and dose response curves determined. Results: Eleven patients reported esophageal symptoms (average duration eleven days, range 1-18 days). Incidence of esophageal toxicity in patients treated at Th8 or above was 79 percent, while no patients treated below Th8 reported any symptoms (p < 0.001). Furthermore, 2 out of 3 patients irradiated at the cervical region reported substantial changes in taste sensation. Risk of symptoms correlated with both mean and maximum esophageal dose and may be a useful tool in planning radiotherapy for MSCC, potentially reducing early upper gastro-intestinal toxicity.

Reduction of oesophageal toxicity with VMAT dose-sparing radiotherapy in thoracic metastatic spinal cord compression: A feasibility study

“…This study reported that for patients irradiated at the level of the oesophagus, the incidence of patient experienced toxicity was 79%, which patients also reported impacted on their well-being [13]. The study also demonstrated a correlation between the mean and maximum oesophageal dose metrics and the risk of developing toxicity; [13]. The average mean and maximum oesophageal dose for patients reporting toxicity was 7.7 Gy and 30.4 Gy respectively, in comparison this was 0.2 Gy and 0.5 Gy for patients without self-reported toxicity [13].…”

“…The cervical and thoracic part of the spinal column is situated posteriorly to the oesophageal tract, which is considered an OAR in thoracic radiotherapy [12] . Although there is a paucity of research on patient reported acute toxicity <grade 3 from palliative RT, one study by Gram et al included all grades of patient self-reported outcomes [13] . This study reported that for patients irradiated at the level of the oesophagus, the incidence of patient experienced toxicity was 79%, which patients also reported impacted on their well-being [13] .…”

“…Although there is a paucity of research on patient reported acute toxicity <grade 3 from palliative RT, one study by Gram et al included all grades of patient self-reported outcomes [13] . This study reported that for patients irradiated at the level of the oesophagus, the incidence of patient experienced toxicity was 79%, which patients also reported impacted on their well-being [13] . The study also demonstrated a correlation between the mean and maximum oesophageal dose metrics and the risk of developing toxicity; [13] .…”

Advancing Roles of Healthcare Professionals in Palliative Radiotherapy

“…The goal of the first research project was to identify the onset of the effect of radiotherapy treatment given for MSCC, as well as the possible side-effects of this treatment (using patient-reported outcomes) [10]. The responsibilities of the RR included patient recruitment, and interviews through questionnaires, data collection and analysis.…”

“…This research led to the finding that toxicity related to the radiotherapy treatment to the upper spine in MSCC has previously been underreported [10]. Further RR-led research is currently ongoing to investigate the possibility of reducing toxicity to patients undergoing radiotherapy for MSCC through advanced treatment options, such as arc therapy and organ at risk delineation.…”