Skamene Sonia, Agarwal Isha, Makar Maggie, Krishnan Monica, Spektor Alex, Hertan Lauren, Mouw Kent W, Taylor Allison, Noveroske Philbrick Sarah, Balboni Tracy
Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Ann Palliat Med. 2018 Apr;7(2):186-191. doi: 10.21037/apm.2017.11.02. Epub 2017 Nov 30.
Radiation therapy (RT) is frequently used to palliate symptomatic bone metastases. While high quality literature has shown that for uncomplicated bone metastases, shorter radiotherapy courses are just as effective as longer courses for the treatment of pain, shorter courses remain under-utilized. We aimed to assess the impact of a dedicated palliative radiation oncology service on the frequency of single fraction RT (SF-RT) and hypofractionated radiation (hypo-RT) (≤5 fractions) among patients with bone metastases.
We identified 2,086 instances of palliative radiation (RT) for complicated and uncomplicated bone metastases between April 10, 2008 and September 17, 2014. We used multivariable logistic regression analysis (MVA) to estimate the association of the Supportive and Palliative Radiation Oncology (SPRO) service with the likelihood of receiving SF-RT or hypo-RT after controlling for age, sex, tumor type, and treatment site.
Prior to SPRO's implementation on July 1, 2011, the proportion of SF-RT and hypo-RT for bone metastases was 6.4% and 27.6% respectively. After SPRO's implementation, the proportion of SF-RT and hypo-RT increased to 22.3% (P<0.001) and 53.5% (P<0.001) respectively. In MVA, patients were more likely to receive SF-RT [odds ratio (OR) =3.3, 95% confidence interval (CI) =2.4-4.7, P<0.001], and hypo-RT (OR =2.5, 95% CI =2.0-3.1, P<0.001) after SPRO's implementation. Compared to sites without a dedicated palliative service, patients receiving care at the SPRO affiliated department were more likely to receive SF-RT (OR =1.9, 95% CI =1.1-3.2, P=0.02) and hypo-RT (OR =1.5, 95% CI =1.1-2.0, P=0.004) for bone metastases. After SPRO's implementation, the average number of RT courses delivered for bone metastases increased from 17.4 to 25.6 per month, (+8.3, 95% CI =4.99-11.55, P<0.001). Despite greater SF-RT and hypo-RT, the average total fractions per month of palliative RT for bone metastases increased from 163.5 pre-SPRO to 166.8 post-SPRO, though not significantly (+3.22, P=NS).
Implementation of a dedicated palliative radiation oncology service was associated with increased use of SF and hypo-RT and with greater courses of RT delivered for bone metastases.
放射治疗（RT）常用于缓解有症状的骨转移。虽然高质量文献表明，对于无并发症的骨转移，较短疗程的放射治疗在缓解疼痛方面与较长疗程同样有效，但较短疗程的放射治疗仍未得到充分利用。我们旨在评估专门的姑息性放射肿瘤学服务对骨转移患者单次分割放疗（SF-RT）和短程分割放疗（hypo-RT）（≤5次分割）频率的影响。
我们确定了2008年4月10日至2014年9月17日期间2086例针对复杂和无并发症骨转移的姑息性放疗（RT）病例。我们使用多变量逻辑回归分析（MVA）来估计在控制年龄、性别、肿瘤类型和治疗部位后，支持性和姑息性放射肿瘤学（SPRO）服务与接受SF-RT或hypo-RT可能性之间的关联。
在2011年7月1日SPRO实施之前，骨转移的SF-RT和hypo-RT比例分别为6.4%和27.6%。SPRO实施后，SF-RT和hypo-RT的比例分别增至22.3%（P<0.001）和53.5%（P<0.001）。在MVA中，SPRO实施后患者更有可能接受SF-RT [优势比（OR）=3.3，95%置信区间（CI）=2.4 - 4.7，P<0.001]和hypo-RT（OR =2.5，95% CI =2.0 - 3.1，P<0.001）。与没有专门姑息服务的科室相比，在SPRO附属科室接受治疗的患者更有可能接受针对骨转移的SF-RT（OR =1.9，95% CI =1.1 - 3.2，P=0.02）和hypo-RT（OR =1.5，95% CI =1.1 - 2.0，P=0.004）。SPRO实施后，每月针对骨转移的RT疗程平均数量从17.4增加到25.6，（+8.3，95% CI =4.99 - 11.55，P<0.001）。尽管SF-RT和hypo-RT增加，但骨转移姑息性RT每月平均总分割次数从SPRO实施前的163.5增加到实施后的166.8，不过增幅不显著（+3.22，P=无统计学意义）。
专门的姑息性放射肿瘤学服务的实施与SF和hypo-RT使用增加以及针对骨转移的RT疗程增多有关。
