Contemporary statewide practice pattern assessment of the palliative treatment of bone metastasis

Publication date: Available online 6 March 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Daniel E. Spratt, Brandon Mancini, James A. Hayman, Thomas Boike, Lori Pierce, Jean M. Moran, Michael M. Dominello, Mark Fireman, Kent Griffith, Shruti Jolly
PurposePalliative radiotherapy 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 is often gleaned from questionnaires of what providers would theoretically do in practice or population-based data lacking critical granular information. Herein, we investigate the real-world treatment of bone metastases with radiotherapy.Methods and MaterialsTwenty diverse institutions across the state of XXXXX had data extracted on their 10 most recent cases of radiotherapy delivered for the treatment of bone metastases at their institution between January and February of 2017. Uni- and multivariable binary logistic regression was used to assess use of single fraction (8 Gy x 1) radiotherapy.ResultsA 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%). Significant predictors for use of single fraction radiotherapy were presence of oligometastatic disease (p=0.008), prior overlapping radiotherapy (p=0.050), and academic practice type (p=0.039). Twenty-nine cases (14.8%) received >10 fractions (median 15, range 11-20 fractions). Intensity modulated radiotherapy was used in 14 cases (7.1%), stereotactic body radiotherapy in 11 cases (5.6%), and image guidance with cone beam CT in 11 cases (5.6%). Amongst simple painful bone metastases (no prior surgery, cord compression, fracture, soft tissue extension, or overlapping prior radiotherapy; n=70), only 12.9% were treated with 8 Gy x 1.ConclusionsBone metastases represent a heterogeneous disease, and the radiotherapeutic treatment of bone metastases is similarly diverse. Future work is needed to understand barrier to single fraction use, and clinical trials are necessary to establish appropriate guidelines for the breadth of this complex disease.



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