Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis
Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis
复制标题
DOI：
10.1016/j.ijrobp.2018.02.037
复制
发表时间：
2018-06-01
影响因子：
7
通讯作者：
Jolly, Shruti
中科院分区：
文献类型：
--
作者：
Spratt, Daniel E.;Mancini, Brandon R.;Jolly, Shruti
目的：骨转移的姑息性放射治疗通常被视为一个单一的实体，尽管国家指南主要只为疼痛的无并发症的骨转移提供输入。围绕骨转移治疗的数据通常来自于提供者理论上在实践中会做什么的问卷调查，或者来自于缺乏关键颗粒信息的基于人群的数据。我们调查了真实世界的治疗骨转移与放射therapy.Methods和材料：二十个不同的机构在密歇根州的数据提取的10个最近的情况下，提供放射治疗的骨转移在他们的机构之间的治疗1月和2月2017年。单因素和多因素二元Logistic回归分析用于评估单次分割（8戈伊x 1）放射治疗的使用。确定了28种不同的分馏方案。最常见的方案为3戈伊x 10次（n = 100; 51.0%）、4戈伊x 5次（n = 32; 16.3%）和8戈伊x 1次（n = 15; 7.7%）。使用单次放疗的显著预测因素是寡转移性疾病（P= 0.008），既往重叠放疗（P= 0.050）和学术实践类型（P= 0.039）。29例（14.8%）接受了> 10次（中位数15，范围11-20）。14例（7.1%）采用调强放射治疗，11例（5.6%）采用立体定向体部放射治疗，11例（5.6%）采用锥形束计算机断层扫描图像引导。在单纯疼痛性骨转移瘤病例中（无手术史、脊髓压迫、骨折、软组织侵犯或重叠放疗史; n=70），仅12.9%接受了8戈伊× 1的治疗。结论：骨转移瘤是一种异质性疾病，骨转移瘤的放射治疗同样多样。未来的工作需要了解单一组分使用的障碍，临床试验是必要的，以建立适当的指导方针，这种复杂的疾病的广度。(C)2018爱思唯尔公司All rights reserved.
Purpose: Palliative radiation therapy for bone metastases is often viewed as a single entity, despite national guidelines providing input principally only for painful uncomplicated bone metastases. Data surrounding the treatment of bone metastases are often gleaned from questionnaires of what providers would theoretically do in practice or from population-based data lacking critical granular information. We investigated the real-world treatment of bone metastases with radiation therapy.Methods and Materials: Twenty diverse institutions across the state of Michigan had data extracted for their 10 most recent cases of radiation therapy delivered for the treatment of bone metastases at their institution between January and February 2017. Uni- and multivariable binary logistic regression was used to assess the use of single fraction (8 Gy x 1) radiation therapy.Results: A total of 196 cases were eligible for inclusion. Twenty-eight different fractionation schedules were identified. The most common schedule was 3 Gy x 10 fractions (n = 100; 51.0%), 4 Gy x 5 fractions (n = 32; 16.3%), and 8 Gy x 1 (n = 15; 7.7%). The significant predictors for the use of single fraction radiation therapy were the presence of oligometastatic disease (P=.008), previous overlapping radiation therapy (P=.050), and academic practice type (P=.039). Twenty-nine cases (14.8%) received > 10 fractions (median 15, range 11-20). Intensity modulated radiation therapy was used in 14 cases (7.1%), stereotactic body radiation therapy in 11 (5.6%), and image guidance with cone beam computed tomography in 11 (5.6%). Of the cases of simple painful bone metastases (no previous surgery, spinal cord compression, fracture, soft tissue extension, or overlapping previous radiation therapy; n=70), only 12.9% were treated with 8 Gy x 1.Conclusions: Bone metastases represent a heterogeneous disease, and radiation therapy for bone metastases is similarly diverse. Future work is needed to understand the barriers to single fraction use, and clinical trials are necessary to establish appropriate guidelines for the breadth of this complex disease. (C) 2018 Elsevier Inc. All rights reserved.