Petrushevski A N, Gabriel G S, Hanna T P, Allen S, Allison R W, Barton M B
Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia.
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
Clin Oncol (R Coll Radiol). 2015 Apr;27(4):205-12. doi: 10.1016/j.clon.2014.11.027. Epub 2014 Dec 17.
Palliative radiotherapy for bone metastases remains an important treatment in patients with metastatic malignancy. Previous studies have indicated a reluctance to adopt single-fraction treatment despite considerable evidence. This study aims to describe the factors determining the use of palliative radiotherapy in patients with bone metastases and assess whether fractionation patterns have changed over time with emerging evidence.
A retrospective review of radiotherapy databases at Liverpool/Macarthur Cancer Therapy Centre and the Royal Brisbane and Women's Hospital was conducted for the period 1997-2009. Patients receiving palliative radiotherapy for bony metastases were identified and treatment sites were grouped into 'spine', 'limb', 'multiple' or 'other'. Treatment courses were divided into single- or multiple-fraction treatments. The effects of socioeconomic and geographical factors on radiotherapy utilisation and fractionation were assessed.
In total, 5683 patients were identified in the cohort; they received a total of 8211 bone treatments. The overall proportion of single-fraction radiotherapy was 29%, with significant variation over the study period (P < 0.001). Age under 70 years and spine or multiple treatment sites were all associated with lower usage of single-fraction radiotherapy on multivariate analysis. Prostate and lung primary sites were associated with higher usage of single-fraction treatment. The proportion of single-fraction treatment remained low (35%), even for patients who survived less than 22 days from their last treatment. Socioeconomic and geographical factors had little effect on the number of fractions used.
The rate of single-fraction radiotherapy for bone metastases has remained low in two large Australian institutions, despite considerable evidence that single-fraction treatment provides equivalent pain relief to fractionated therapy. This trend towards fractionated treatment was largely maintained, even in patients with limited life expectancy. Further measures to increase the rate of single-fraction therapy are needed.
姑息性放射治疗骨转移瘤仍是转移性恶性肿瘤患者的重要治疗手段。既往研究表明，尽管有大量证据支持，但仍不愿采用单次分割治疗。本研究旨在描述决定骨转移患者姑息性放射治疗使用情况的因素，并评估随着新证据的出现，分割模式是否随时间发生了变化。
对1997年至2009年期间利物浦/麦卡瑟癌症治疗中心以及皇家布里斯班和妇女医院的放射治疗数据库进行回顾性研究。确定接受骨转移瘤姑息性放射治疗的患者，并将治疗部位分为“脊柱”“四肢”“多发”或“其他”。治疗疗程分为单次或多次分割治疗。评估社会经济和地理因素对放射治疗利用率和分割方式的影响。
队列中总共确定了5683例患者；他们共接受了8211次骨治疗。单次分割放射治疗的总体比例为29%，在研究期间有显著变化（P<0.001）。多因素分析显示，70岁以下以及脊柱或多发治疗部位均与单次分割放射治疗的较低使用率相关。前列腺癌和肺癌原发部位与单次分割治疗的较高使用率相关。即使是从最后一次治疗起存活时间少于22天的患者，单次分割治疗的比例仍然较低（35%）。社会经济和地理因素对分割次数的使用影响不大。
在澳大利亚的两家大型机构中，骨转移瘤的单次分割放射治疗率仍然较低，尽管有大量证据表明单次分割治疗与分割治疗在缓解疼痛方面效果相当。即使在预期寿命有限的患者中，这种分割治疗的趋势也基本保持。需要采取进一步措施来提高单次分割治疗的比例。
