Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Department of Radiation Oncology, West Michigan Cancer Center, Kalamazoo, Michigan.
Pract Radiat Oncol. 2019 Nov;9(6):e541-e548. doi: 10.1016/j.prro.2019.07.005. Epub 2019 Jul 19.
Single-fraction (SF) radiation therapy is effective and convenient for patients with painful noncomplex bone metastases. Prior survey results reported a low recommendation of SF radiation therapy in the US. We sought to assess contemporary treatment recommendations for the management of bone metastases among diverse physicians participating in a statewide quality consortium.
Members of the Michigan Radiation Oncology Quality Consortium were surveyed between April and May 2017. Physicians rated the importance of 31 variables on their choice of dose fractionation. The survey also covered 7 patient scenarios.
Fifty-six physicians responded who were practicing at 18 of 20 centers surveyed. Respondents recommended 23 dose-fractionation schedules across the 7 scenarios. Highest-rated factors considered when choosing a dose fractionation regimen were performance status, prognosis, spinal cord compression, and prior radiation therapy. Recommendations for SF overall were uncommon (16.1%). On multivariable analysis, factors associated with SF use included academic employment (odds ratio [OR] 2.04; 95% CI, 1.02-4.08; P = .044) and higher palliative case volume (OR 2.59; 95% CI, 1.45-4.63; P = .001). Stereotactic body radiation therapy (SBRT) was recommended in 16.4% of scenarios overall, and on multivariable analysis, significant predictors for SBRT use were academic employment (OR 2.99; 95% CI, 1.39-6.44; P = .005), more recent residency completion (OR 4.37; 95% CI, 1.26-15.17; P = .02), spine location (OR 12.54; 95% CI, 3.96-39.68; P < .001), and prior radiation therapy (OR 26.67; 95% CI, 7.86-90.57; P < .001). SF rates were higher than in a survey reported in 2009 (16.1% vs 9.4%, P = .0004).
SF radiation therapy remains uncommonly recommended, although it may be recommended more now than it was 10 years ago despite the increased utilization of SBRT. We identify multiple key drivers in physician decision making affecting SF recommendations that have not been addressed by prior level one evidence. Further research with evidence-based recommendations to clarify the role of SF and SBRT in management of patients with bony metastases are needed.
单次分割（SF）放射治疗对患有疼痛性非复杂性骨转移的患者有效且方便。先前的调查结果报告称，在美国 SF 放射治疗的推荐率较低。我们旨在评估参与全州质量联盟的不同医生在管理骨转移方面的当代治疗建议。
密歇根州放射肿瘤学质量联盟的成员于 2017 年 4 月至 5 月间接受了调查。医生根据其对剂量分割的选择对 31 个变量的重要性进行了评分。该调查还涵盖了 7 个患者场景。
56 名医生做出了回应，他们在接受调查的 20 个中心中的 18 个中心工作。受访者在 7 个场景中推荐了 23 种剂量分割方案。在选择剂量分割方案时，考虑的最高因素是一般健康状况、预后、脊髓压迫和先前的放射治疗。SF 整体的推荐率并不高（16.1%）。多变量分析显示，与 SF 使用相关的因素包括学术就业（比值比[OR]2.04；95%置信区间[CI]1.02-4.08；P=.044）和较高的姑息性病例量（OR 2.59；95%CI 1.45-4.63；P=.001）。SBRT 总体上在 16.4%的场景中被推荐，多变量分析显示，SBRT 使用的显著预测因子是学术就业（OR 2.99；95%CI 1.39-6.44；P=.005）、最近的住院医师培训完成情况（OR 4.37；95%CI 1.26-15.17；P=.02）、脊柱位置（OR 12.54；95%CI 3.96-39.68；P<.001）和先前的放射治疗（OR 26.67；95%CI 7.86-90.57；P<.001）。SF 率高于 2009 年的一项调查（16.1%对 9.4%，P=.0004）。
尽管 SBRT 的使用增加，但 SF 放射治疗的推荐仍然不常见，尽管与 10 年前相比，现在可能更推荐 SF 放射治疗。我们确定了影响 SF 推荐的医生决策中的多个关键驱动因素，这些因素在之前的一级证据中没有得到解决。需要进一步进行基于证据的研究，以澄清 SF 和 SBRT 在管理骨转移患者中的作用。
