Trends in Radiation Fractionation for Bone Metastases: A Contemporary Nationwide Analysis

Wegner, Rodney E.; Matani, Hirsch; Colonias, Athanasios; Price, F.W; Fuhrer, Russell; Abel, Stephen

doi:10.1016/j.prro.2020.03.009

Cited by 10 publications

(17 citation statements)

References 13 publications

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“…Although differences may be observed with other histologies, such as breast or prostate cancer, lung cancer represents the majority of palliative radiation courses for bone metastases. 3,6,13 Finally, although we observed an increase in rates of compliance with NQF 1822 since its introduction, some of the increase predated adoption of the measure, and it is likely that additional factors have contributed to this trend.…”

Section: Discussionmentioning

confidence: 74%

“…1 There exists wide practice variability in palliative treatment schedules, 2,3 with multiple randomized trials showing similar pain relief between single-and multiple-fraction courses for uncomplicated metastases. 4,5 However, single-fraction treatments are relatively uncommon in the United States, 6 despite proven advantages with regard to patient cost and convenience. 7 The National Quality Forum (NQF) is a not-for-profit healthcare organization that recommends consensus and evidence-based quality measures to state and federal payfor-performance programs.…”

Section: Introductionmentioning

confidence: 99%

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National Quality Measure Compliance for Palliative Bone Radiation Among Patients With Metastatic Non–Small Cell Lung Cancer

Grant

Smith

Colbert

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: There exists wide practice variability in palliative treatment schedules for bone metastases. In an effort to reduce variation and promote high-quality, cost-conscious care, the National Quality Forum (NQF) endorsed measure 1822 in 2012. This measure recommends the use of 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fractions, or 8 Gy in a single fraction for palliative radiation for bone metastases. We report on longitudinal compliance with this measure. Methods: Using the National Cancer Database, patients with metastatic thoracic non–small cell lung cancer diagnosed between 2004 and 2016 who received radiation therapy for bony sites of metastatic disease were identified. Treatment courses fitting 1 of the 4 recommended schedules under NQF 1822 were coded as compliant. Rates of compliance by patient, tumor, and treatment characteristics were analyzed. Results: A total of 42,685 patients met the criteria for inclusion. Among all patients, 60.2% of treatment courses were compliant according to NQF 1822. Compliance increased over time and was highest for treatments to the extremity (69.8%), lowest for treatments to the skull or head (48.8%), and higher for academic practice (67.1%) compared with community (56.0%) or integrated network facilities (61.2%). On multivariable analysis, predictors of NQF 1822 compliance included year of diagnosis after 2011, treatment to an extremity, or treatment at an academic facility. Of noncompliant treatment courses, extended fractionation (≥11 fractions) occurred in 62.6% and was more common before 2012, in community practice, and for treatments of the skull or head. Conclusions: Among patients treated for metastatic non–small cell lung cancer, compliance with NQF 1822 increased over time. Although extended fractionation constituted a majority of noncompliant treatment courses, a substantial proportion also involved shorter courses.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

National Quality Measure Compliance for Palliative Bone Radiation Among Patients With Metastatic Non–Small Cell Lung Cancer

Grant

Smith

Colbert

et al. 2021

Journal of the National Comprehensive Cancer Network

View full text Add to dashboard Cite

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“…The studies were all from Global North countries despite the study team not imposing any restrictions on healthcare system or country in the searches. These included 11 studies from Canada,6 18–27 four studies from the USA,28–32 one from Australia,33 two from Norway34 35 and one from France 17. This represented a mixture of healthcare systems from the free at the point of use systems in Canada, Norway and Australia to a mixture of insurance and non-insurance-based healthcare systems in the USA and France.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of the studies in the review (14 studies) drew their populations from cancer registries and included different primary cancer sites in their analysis. Seven studies focused on specific primary cancers, which were prostate cancer,30 31 36 breast cancer,18 non-small cell lung cancer31 and multiple myeloma 28 32. The majority of studies (19 studies) focused on PRT for bone metastases, with two studies looking specifically at PRT to the whole of the brain 23 24…”

Section: Resultsmentioning

confidence: 99%

“…The review identified differences in the distances that some patients with cancer would have to travel to access a hospital with radiotherapy facilities, ranging from 0 km to >800 km away 35 to <8.5 km versus >8.5 km. 31 Indicating again the inequalities in access to specialist radiotherapy facilities that can provide PRT that some patients living in expansive healthcare geographical catchment areas such as in Canada, USA and Australia face. The meta-analyses focused on comparing across the same travel threshold (<50 km vs ≥50 km).…”

Section: Discussionmentioning

confidence: 99%

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Geographical distance and reduced access to palliative radiotherapy: systematic review and meta-analysis

Chand

Greenley

Macleod

et al. 2022

BMJ Support Palliat Care

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BackgroundPalliative radiotherapy (PRT) is an effective way of reducing symptoms caused by advanced incurable cancer. Several studies have investigated factors that contribute to inequalities in access to PRT; distance to a radiotherapy centre has been identified as one potential barrier.AimTo assess whether there is an association between distance to a radiotherapy centre and utilisation rates of PRT in adults with cancer.MethodsA systematic review and meta-analysis protocol was registered in the PROSPERO database (CRD42020190772). MEDLINE, EMBASE, CINAHL and APA-PsycINFO were searched for relevant papers up to 28 February 2021.ResultsTwenty-one studies were included. Twelve studies focused on whether patients with incurable cancer received PRT, as part of their treatment package. Pooled results reported that living ≥50 km vs <50 km from the radiotherapy centre was associated with a reduced likelihood of receiving PRT (OR 0.84 (95%CI 0.80, 0.88)). Nine focused on distance from the radiotherapy centre and compared single-fraction (SF) versus multiple-fraction PRT, indicating that patients living further away were more likely to receive SF. Pooled results comparing ≥50 km versus <50 km showed increased odds of receiving SF for those living ≥50 km (OR 1.48 (95%CI 1.26,1.75)).ConclusionPatients living further away from radiotherapy centres were less likely to receive PRT and those who received PRT were more likely to receive SF PRT, providing some evidence of inequalities in access to PRT treatment based on proximity to centres providing radiotherapy. Further research is needed to understand whether these inequalities are influenced by clinical referral patterns or by patients unwilling or unable to travel longer distances.PROSPERO registration numberCRD42020190772.

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Factors affecting local control of bone metastases from radioresistant tumors treated with palliative external beam radiotherapy

et al. 2023

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Background This study aimed to evaluate the factors that affect the local control (LC) of bone metastases from radioresistant carcinomas (renal cell carcinoma, hepatocellular carcinoma [HCC], and colorectal carcinoma [CRC]) treated with palliative external-beam radiotherapy (EBRT). Methods and materials Between January 2010 and December 2020, 211 bone metastases in 134 patients were treated with EBRT in two hospitals (a cancer center and university hospital). Based on follow-up CT, these cases were reviewed retrospectively to evaluate LC at the EBRT site. Results The median EBRT dose (BED10) was 39.0 Gy (range, 14.4–66.3 Gy). The median follow-up time of the imaging studies was 6 months (range, 1–107 months). The 0.5-year overall survival and LC rates of the EBRT sites were 73% and 73%, respectively. Multivariate analysis revealed that the primary sites (HCC/CRC), low EBRT dose (BED10) (≤ 39.0 Gy), and non-administration of post-EBRT bone modifying agents (BMAs) and/or antineoplastic agents (ATs) were statistically significant factors that negatively affected the LC of EBRT sites. In the absence of BMAs or ATs, the EBRT dose (BED10) escalation from 39.0 Gy improved the LC of EBRT sites. Based on ATs administration, the LC of EBRT sites was significantly affected by tyrosine kinase inhibitors and/or immune checkpoint inhibitors. Conclusions Dose escalation improves LC in bone metastases from radioresistant carcinomas. Higher EBRT doses are needed to treat patients for whom few effective systemic therapies remain available.

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Trends in Radiation Fractionation for Bone Metastases: A Contemporary Nationwide Analysis

Cited by 10 publications

References 13 publications

National Quality Measure Compliance for Palliative Bone Radiation Among Patients With Metastatic Non–Small Cell Lung Cancer

National Quality Measure Compliance for Palliative Bone Radiation Among Patients With Metastatic Non–Small Cell Lung Cancer

Geographical distance and reduced access to palliative radiotherapy: systematic review and meta-analysis

Factors affecting local control of bone metastases from radioresistant tumors treated with palliative external beam radiotherapy

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