Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: A meta-analysis

Kutzko, Justin Henry; Dadwal, Parvati; Holt, Tanya; Rahman, Muhammed A.; Zahir, Syeda Farah; Hickey, Brigid E

doi:10.1016/j.radonc.2022.01.030

Cited by 15 publications

(29 citation statements)

References 121 publications

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“…Modest increase of the cut-off, from 30 to 40 days from start of radiotherapy, increased the rate from 13 to 18%. In a recent large meta-analysis [ 7 ], 16% of patients with advanced cancer who had received palliative radiotherapy died within 30 days of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Weight loss and other parameters available in the present study were not included. The large meta-analysis by Kutzko et al identified multiple treatment sites, hepatobiliary primary, inpatient status, and ECOG PS 3–4 as predictors of 30-day mortality [ 7 ]. In contrast to these results, Wu et al performed a multivariate analysis suggesting that breast or prostate primary tumor, ECOG PS, body mass index, liver metastases, more than 5 active metastases (dichotomized, radiographically identified), albumin level, and hospitalization within 3 months of radiotherapy consult were associated with 30-day survival [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…3 Gy × 10 [ 6 ]. As suggested by a recent large meta-analysis [ 7 ], there is room for improvement of physicians’ prescription habits or ability to decipher prognosis, because the authors found that 16% of patients with advanced cancer receiving palliative radiotherapy died within 30 days of treatment. In other words, the remaining life time with, e.g.…”

Section: Introductionmentioning

confidence: 99%

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Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

et al. 2023

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Background This study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated. Methods Different baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed. Results Of 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60–70, 80–100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0–75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality. Conclusion Early death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

et al. 2023

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“…As a result, there has been an increasing interest in identifying patients near the end of life and reducing the use of RT in the last few weeks of life (4). The expected 30-day mortality rate has been examined in 42 studies in relation to the use of palliative RT (5). Several groups have proposed using this metric to determine which patients should not receive RT.…”

Section: Background and Objectivementioning

confidence: 99%

Appropriateness of the 30-day expected mortality metric in palliative radiation treatment: a narrative review

Navarro-Domenech¹,

Behroozian²,

Hoskin³

et al. 2023

Ann Palliat Med

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Background and Objective: The 30-day expected mortality rate is frequently used as a metric to determine which patients benefit from palliative radiation treatment (RT). We conducted a narrative review to examine whether its use as a metric might be appropriate for patient selection.Methods: A literature review was conducted to identify relevant studies that highlight the benefits of palliative RT in timely symptom management among patients with a poor performance status, the accuracy of predicting survival near the end of life and ways to speed up the process of RT administration through rapid response clinics.Key Content and Findings: Several trials have demonstrated substantial response rates for pain and/or bleeding by four weeks and sometimes within the first two weeks after RT. Models of patient survival have limited accuracy, particularly for predicting whether patients will die within the next 30 days. Dedicated Rapid Access Palliative RT (RAPRT) clinics, in which patients are assessed, simulated and treated on the same day, reduce the number of patient visits to the radiation oncology department and hence the burden on the patient as well as costs.^ ORCID: 0000-0001-7347-2461.Conclusions: Single-fraction palliative RT should be offered to eligible patients if they are able to attend treatment and could potentially benefit from symptom palliation, irrespective of predicted life expectancy.We discourage the routine use of the 30-day mortality as the only metric to decide whether to offer RT.More common implementation of RAPRT clinics could result in a significant benefit for patients of all life expectancies, but particularly those having short ones.

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“…The overall 30-day mortality rate after palliative RT was found to be 16%. Patients in PS 3–4 were more likely to die within 30 days after RT ( 30 ). In order to minimize 30-day mortality after RT, an accurate estimation of disease related survival is imperative to know.…”

Section: Palliative Rt For Nsclc: the State Of The Art Before An Era ...mentioning

confidence: 99%

Palliative extracranial radiotherapy in patients receiving immunotherapy for non-small cell lung cancer: a narrative review

Kępka¹

2023

Transl Cancer Res

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Background and Objective: Role of radiotherapy (RT) in the era of immuno-oncology (IO) in advanced non-small cell lung cancer (NSCLC) is rapidly changing. RT is not only intended for addressing palliation symptoms but also is considered as a potential tool potentializing an immunogenic effect of given drugs.However, the best timing, techniques, doses, volumes, and its use for asymptomatic patients is a subject of research. We performed a review on the role of palliative RT schedules in combination with IO for advanced NSCLC. Indications in symptomatic and asymptomatic patients, outcomes, toxicity, and possible developments are discussed.Methods: A literature search was conducted in MEDLINE and PubMed databases and clinicaltrials.gov using the keywords 'lung cancer' AND "immunotherapy" AND 'radiotherapy' OR "palliative radiotherapy".

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Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: A meta-analysis

Cited by 15 publications

References 121 publications

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

Appropriateness of the 30-day expected mortality metric in palliative radiation treatment: a narrative review

Palliative extracranial radiotherapy in patients receiving immunotherapy for non-small cell lung cancer: a narrative review

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