Haddad P, Wong R K S, Pond G R, Soban F, Williams D, McLean M, Levin W, Bezjak A
Radiation Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Clin Oncol (R Coll Radiol). 2005 Sep;17(6):430-4. doi: 10.1016/j.clon.2005.03.012.
Evidence from a number of randomised trials and meta-analyses supports the use of single-fraction radiotherapy for the palliation of painful bone metastases. This study explores patient and treatment factors that influence the choice of single compared with multiple-fraction radiotherapy for the treatment of bone metastases in clinical practice.
The Princess Margaret Hospital Palliative Radiation Oncology Program Database served as the basis for our report. All courses of treatment delivered for bone metastases were extracted. Courses were classified into single or multiple fractions. Clinical characteristics were compared between the two groups.
Between 1998 and 2002, 882 courses of radiotherapy were delivered for the treatment of bone metastases, of which 283 (32%) were a single fraction. The proportion of single-fraction treatments was 37% in 1998, 30% in 1999 and 43% in 2000, but dropped to 26% and 28% in 2001 and 2002, respectively (P = 0.02). Patients treated with single fractions were significantly older (68 +/- 12 years vs 64 +/- 12 years), and had more weight loss and poor performance status. Single fractions included 20% of treatments in palliative irradiation of the spine, 36% in the pelvis and long bones, and 59% in the chest wall (P < 0.001). There was no significant difference in patients' gender, primary cancers, number of metastatic sites, treating physicians, enrollment in a clinical trial and general radiotherapy waiting time in our department. Multivariate analysis indicated age (P = 0.001), performance status (P < 0.001), anatomical site (P < 0.001) and year of radiotherapy (P = 0.006) as significant.
One-third of palliative radiotherapy courses for bone metastases in our programme were given as single fractions. Performance status, age and anatomical site were significant factors affecting single compared with multiple fractionation. The variation in the use of single fractions over time may reflect the dynamic process of interpretation and application of evidence from clinical trials to practice.
多项随机试验和荟萃分析的证据支持采用单次分割放射治疗来缓解疼痛性骨转移。本研究探讨了在临床实践中，与多次分割放射治疗相比，影响选择单次分割放射治疗骨转移的患者因素和治疗因素。
玛格丽特公主医院姑息性放射肿瘤学项目数据库是我们报告的基础。提取了所有针对骨转移的治疗疗程。疗程分为单次或多次分割。比较了两组之间的临床特征。
1998年至2002年期间，共进行了882个骨转移放射治疗疗程，其中283个（32%）为单次分割。1998年单次分割治疗的比例为37%，1999年为30%，2000年为43%，但在2001年和2002年分别降至26%和28%（P = 0.02）。接受单次分割治疗的患者年龄显著更大（68±12岁对64±12岁），体重减轻更多，身体状况较差。单次分割包括脊柱姑息性照射治疗的20%，骨盆和长骨的36%，以及胸壁的59%（P < 0.001）。患者的性别、原发癌症、转移部位数量、治疗医生、参加临床试验情况以及在我们科室的一般放疗等待时间方面无显著差异。多因素分析表明年龄（P = 0.001）、身体状况（P < 0.001）、解剖部位（P < 0.001）和放疗年份（P = 0.006）具有显著意义。
我们项目中三分之一的骨转移姑息性放射治疗疗程采用单次分割。身体状况、年龄和解剖部位是影响单次分割与多次分割治疗选择的重要因素。单次分割使用情况随时间的变化可能反映了从临床试验证据到实践的解释和应用的动态过程。
