期刊
CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY
卷 27, 期 -, 页码 64-69出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ctro.2021.01.004
关键词
Bone metastases; SFRT MFRT Single fraction radiotherapy; Palliation; Patterns of practice; Uncomplicated
This study evaluated the adoption of single-fraction radiotherapy (SFRT) and multiple-fraction radiotherapy (MFRT) for uncomplicated painful bone metastases, showing that adherence to the international guidelines for SFRT was high and increased over time to 95%.
Background: Single-fraction radiotherapy (SFRT) offers equal pain relief for uncomplicated painful bone metastases as compared to multiple-fraction radiotherapy (MFRT). Despite this evidence, the adoption of SFRT has been poor with published rates of SFRT for uncomplicated bone metastases ranging from <10% to 70%. We aimed to evaluate the adoption of SFRT and its evolution over time following the more formal endorsement of the international guidelines in our centre starting from 2013. Materials and methods: We performed a retrospective review of fractionation schedules at our centre for painful uncomplicated bone metastases from January 2013 until December 2017. Only patients treated with 1 x 8 Gy (SFRT-group) or 10 x 3 Gy (MFRT-group) were included. We excluded other fractionation schedules, primary cancer of the bone and post-operative radiotherapy. Uncomplicated was defined as painful but not associated with impending fracture, existing fracture or existing neurological compression. Temporal trends in SFRT/MFRT usage and overall survival were investigated. We performed a lesion-based patterns of care analysis and a patient-based survival analysis. Mann-Whitney U and Chisquare test were used to assess differences between fractionation schedules and temporal trends in prescription, with Kaplan-Meier estimates used for survival analysis (p-value <0.05 considered significant). Results: Overall, 352 patients and 594 uncomplicated bone metastases met inclusion criteria. Patient characteristics were comparable between SFRT and MFRT, except for age. Overall, SFRT was used in 92% of all metastases compared to 8% for MFRT. SFRT rates increased throughout the study period from 85% in 2013 to 95% in 2017 (p = 0.06). Re-irradiation rates were higher in patients treated with SFRT (14%) as compared to MFRT (4%) (p = 0.046). Four-week mortality and median overall survival did not differ significantly between SFRT and MFRT (17% vs 18%, p = 0.8 and 25 weeks vs 38 weeks, p = 0.97, respectively). Conclusions: Adherence to the international guidelines for SFRT for uncomplicated bone metastasis was high and increased over time to 95%, which is the highest reported rate in literature. (C)2021 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.
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