Replacing 30 Gy in 10 fractions with stereotactic body radiation therapy for bone metastases: A large multi-site single institution experience 2016–2018

Clinical and Translational Radiation Oncology

Kaitlyn Lapen¹  Diana G. Wang²  C. Jillian Tsai³  Josh Yamada⁴  Divya Yerramilli⁴  Adam M. Schmitt⁴  Marisa A. Kollmeier⁴  Max Vaynrub⁴  Daniel S. Higginson⁴  N. Wijetunga⁴  Gerri L. Pastrana⁴  Oren Cahlon⁴  Ernesto Santos Martin⁴  Erin F. Gillespie⁴  T. Jonathan Yang⁴  Amy J. Xu⁵ 

[1]Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA

[2]Corresponding author at: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 22, New York, NY 10065, USA.

[3]Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

[4]Department of Radiation Oncology, Precision Radiation for Oligometastatic and Metastatic Disease (PROMISE) Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA

[5]Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

关键词: Bone metastases;    Radiation therapy;    Stereotactic body radiation therapy;    End-of-life;    Palliative care;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Bone metastases cause significant morbidity in patients with cancer, and radiation therapy (RT) is an effective treatment approach. Indications for more complex ablative techniques are emerging. We sought to evaluate RT trends at a large multi-site tertiary cancer center. Methods: Patients who received RT for bone metastases at a single institution (including regional outpatient clinics) from 2016 to 2018 were identified. Patients were grouped by RT regimen: single-fraction conventional RT (8 Gy × 1), 30 Gy in 10 fractions, SBRT, and “other”. Multinomial logistic regression was performed to assess trends in regimens over time. Binary logistic regression was performed to evaluate factors associated with receipt of SBRT. Results: Between 2016 and 2018, 5,952 RT episodes were received by 2,969 patients with bone metastases. Overall, 76% of episodes were ≤ 5 fractions. The median number of fractions planned for SBRT and non-SBRT episodes was 3 (IQR 3–3) and 5 (IQR 5–10), respectively. Use of SBRT increased from 2016 to 2018 (39% to 53%, p < 0.01) while use of 30 Gy in 10 fractions decreased (26% to 12%, p < 0.01), and 8 Gy × 1 was stable (5.3% to 6.9%, p = 0.28). SBRT was associated with higher performance status (p < 0.01) and non-radiosensitive histology (p < 0.01). Use of SBRT increased in the regional network (19% to 48%, p < 0.01) and at the main center (52% to 59%, p = 0.02), but did not increase within 30 days of death. More patients treated with 8 Gy × 1 than SBRT died within 30 days of treatment (24% vs 3.8%, respectively, p < 0.01). Conclusions: SBRT is replacing 30 Gy in 10 fractions for bone metastases, especially among patients with high performance status and non-radiosensitive histologies. Better prognostic algorithms could further improve patient-centered treatment selection at the end of life.

【 授权许可】

Unknown