Di Lalla Vanessa, Fortin Bernard, Pembroke Catherine, Freeman Carolyn, Yassa Michael, Hijal Tarek
McGill University Health Centre, Montreal, Quebec, Canada.
Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
Tech Innov Patient Support Radiat Oncol. 2019 Jan 17;9:13-17. doi: 10.1016/j.tipsro.2018.12.001. eCollection 2019 Mar.
Best-practice guidelines recommend single-fraction (SFRT) instead of multi-fraction radiation therapy (MFRT) for uncomplicated symptomatic bone metastases. SFRT is comparable to MFRT in relieving pain, convenient for patients, and cost-effective. Patterns of practice in Canada reveal that SFRT is underused, with significant variability across the country. We audited SFRT use and studied factors that may influence treatment decisions at a large academic tertiary care center in Quebec, Canada.
Patients who received radiotherapy for uncomplicated bone metastases between February 2014 and March 2015 were reviewed. Age, gender, primary histology, site of metastases and performance status were identified as potential factors affecting fractionation. These were explored by Fisher's test on univariate analysis and logistic regression for multivariate analysis. Retreatment rates were analyzed with cumulative incidence and compared with Gray's test.
254 radiotherapy courses were administered to 165 patients, 85.4% of which were delivered using a single fraction of 8 Gy. Patients age less than 70 years and those with breast histology were more likely to receive MFRT (p = 0.04; p = 0.0046). Performance status (ECOG) was a significant predictor of fractionation because of high correlations between young age, breast histology, and ECOG status (p = 0.03). Follow-up was too short in 40% of patients to derive definitive conclusions on retreatment.
In accordance with current guidelines, our audit confirms that use of SFRT in patients with uncomplicated bone metastases at our center is high. We identified that patient age, primary histology, and performance status influenced fractionation. Incorporation of this quality indicator into our performance dashboard will allow assessment of retreatment differences and other criteria that may also influence treatment choice.
最佳实践指南推荐对于无并发症的有症状骨转移采用单次分割放疗（SFRT）而非多次分割放疗（MFRT）。SFRT在缓解疼痛方面与MFRT相当，对患者方便且具有成本效益。加拿大的实践模式显示SFRT未得到充分利用，全国存在显著差异。我们在加拿大魁北克的一家大型学术三级医疗中心审核了SFRT的使用情况，并研究了可能影响治疗决策的因素。
回顾了2014年2月至2015年3月期间接受无并发症骨转移放疗的患者。年龄、性别、原发组织学类型、转移部位和体能状态被确定为影响分割方式的潜在因素。通过单因素分析的Fisher检验和多因素分析的逻辑回归对这些因素进行探讨。采用累积发病率分析再治疗率，并与Gray检验进行比较。
对165例患者进行了254个放疗疗程，其中85.4%采用8Gy单次分割。年龄小于70岁的患者和乳腺组织学类型的患者更有可能接受MFRT（p = 0.04；p = 0.0046）。体能状态（ECOG）是分割方式的重要预测因素，因为年轻、乳腺组织学类型与ECOG状态之间存在高度相关性（p = 0.03）。40%的患者随访时间过短，无法得出关于再治疗的确切结论。
根据当前指南，我们的审核证实我们中心无并发症骨转移患者中SFRT的使用率很高。我们发现患者年龄、原发组织学类型和体能状态会影响分割方式。将此质量指标纳入我们的绩效仪表盘将有助于评估再治疗差异以及其他可能影响治疗选择的标准。
