Chang Sanders, Ru Meng, Moshier Erin L, Mazumdar Madhu, Ricks Doran, Goldstein Nathan E, Wisnivesky Juan P, Dharmarajan Kavita V
Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science & Policy, Mount Sinai Health System, New York, New York.
Adv Radiat Oncol. 2018 Jul 12;3(4):647-654. doi: 10.1016/j.adro.2018.06.006. eCollection 2018 Oct-Dec.
Treatment burdens and toxicities related to palliative radiation therapy (RT) may lead to unplanned hospital admissions (UHAs). The likelihood for these toxicities may be related to treatment technique. We compared rates of UHA between patients receiving nonconformal (2-dimensional) and conformal (3-dimensional or higher) radiation treatments to bone metastases involving the vertebral column.
We retrospectively analyzed patients treated with RT for bone metastases at a single tertiary care center between 2010 and 2017. We compared rates of RT-related UHA within 90 days of receiving radiation using Cox competing risk regression models.
We identified 326 patients with bone metastases involving the vertebral column, 139 of whom received radiation by nonconformal technique and 187 by conformal technique. On multivariable analysis, conformal techniques were associated with a reduced risk of 90-day UHA (hazard ratio [HR]: 0.35; 95% confidence interval [CI], 0.14-0.88). Other significant factors include hematologic cancer (HR: 0.17; 95% CI, 0.03-0.82) and baseline Eastern Cooperative Oncology Group score ≥2 (HR: 3.02; 95% CI, 1.05-8.69).
The utilization of conformal (non-2-dimensional) radiation treatment plans may help reduce treatment-related toxicities and consequently UHAs after palliation of bone metastases.
姑息性放射治疗（RT）相关的治疗负担和毒性可能导致非计划住院（UHA）。这些毒性的可能性可能与治疗技术有关。我们比较了接受非适形（二维）和适形（三维或更高维度）放射治疗脊柱骨转移患者的UHA发生率。
我们回顾性分析了2010年至2017年在单一三级医疗中心接受RT治疗骨转移的患者。我们使用Cox竞争风险回归模型比较了接受放疗后90天内与RT相关的UHA发生率。
我们确定了326例脊柱骨转移患者，其中139例接受了非适形技术放疗和187例接受了适形技术放疗。多变量分析显示，适形技术与90天UHA风险降低相关（风险比[HR]: 0.35；95%置信区间[CI]，0.14 - 0.88）。其他显著因素包括血液系统癌症（HR: 0.17；95% CI, 0.03 - 0.82）和东部肿瘤协作组基线评分≥2（HR: 3.02；95% CI, 1.05 - 8.69）。
采用适形（非二维）放射治疗方案可能有助于降低治疗相关毒性，从而减少骨转移姑息治疗后的UHA。
