Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Int J Radiat Oncol Biol Phys. 2014 Aug 1;89(5):1100-1105. doi: 10.1016/j.ijrobp.2014.04.028. Epub 2014 Jul 8.
This study evaluates outcomes and patterns of care among patients receiving radiation therapy (RT) for bone metastases at a high-volume academic institution.
Records of all patients whose final RT course was for bone metastases from April 2007 to July 2012 were identified from electronic medical records. Chart review yielded demographic and clinical data. Rates of complicated versus uncomplicated bone metastases were not analyzed.
We identified 339 patients whose final RT course was for bone metastases. Of these, 52.2% were male; median age was 65 years old. The most common primary was non-small-cell lung cancer (29%). Most patients (83%) were prescribed ≤10 fractions; 8% received single-fraction RT. Most patients (52%) had a documented goals of care (GOC) discussion with their radiation oncologist; hospice referral rates were higher when patients had such discussions (66% with vs 50% without GOC discussion, P=.004). Median life expectancy after RT was 96 days. Median survival after RT was shorter based on inpatient as opposed to outpatient status at the time of consultation (35 vs 136 days, respectively, P<.001). Hospice referrals occurred for 56% of patients, with a median interval between completion of RT and hospice referral of 29 days and a median hospice stay of 22 days.
These data document excellent adherence to American Society for Radiation Oncolology Choosing Wisely recommendation to avoid routinely using >10 fractions of palliative RT for bone metastasis. Nonetheless, single-fraction RT remains relatively uncommon. Participating in GOC discussions with a radiation oncologist is associated with higher rates of hospice referral. Inpatient status at consultation is associated with short survival.
本研究评估了在一家高容量学术机构接受骨转移放射治疗（RT）的患者的治疗结果和护理模式。
从电子病历中确定了 2007 年 4 月至 2012 年 7 月期间最后一次 RT 治疗为骨转移的所有患者的记录。通过图表审查获得了人口统计学和临床数据。未分析复杂与非复杂骨转移的发生率。
我们共确定了 339 例最后一次 RT 治疗为骨转移的患者。其中，52.2%为男性；中位年龄为 65 岁。最常见的原发疾病是非小细胞肺癌（29%）。大多数患者（83%）接受的 RT 分割剂量不超过 10 次；8%接受单次 RT。大多数患者（52%）与放射肿瘤医生进行了记录在案的治疗目标（GOC）讨论；当患者进行此类讨论时，转介至临终关怀机构的比例更高（有 GOC 讨论的患者中为 66%，无 GOC 讨论的患者中为 50%，P=.004）。RT 后中位预期寿命为 96 天。与 RT 时的门诊状态相比，住院状态下的中位生存时间更短（分别为 35 天和 136 天，P<.001）。56%的患者接受了临终关怀转介，从 RT 完成到转介至临终关怀机构的中位间隔为 29 天，中位临终关怀时间为 22 天。
这些数据记录了对美国放射肿瘤学会明智选择建议的出色遵循，避免常规使用>10 次姑息性 RT 治疗骨转移。尽管如此，单次 RT 仍相对少见。与放射肿瘤医生进行 GOC 讨论与更高的临终关怀转介率相关。咨询时的住院状态与较短的生存时间相关。
