Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania.
Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania.
Pract Radiat Oncol. 2020 Nov-Dec;10(6):402-408. doi: 10.1016/j.prro.2020.03.009. Epub 2020 Apr 11.
Radiation therapy remains an important palliative tool for patients with bone metastases. The guidelines from the American Society for Therapeutic Radiation Oncology recommend the use of fewer fractions based on randomized data. We used the National Cancer Database to examine trends in radiation fractionation for patients with bone metastases.
We queried breast, prostate, and non-small cell lung cancer in the National Cancer Database from 2010 to 2015 for patients with bone metastases at the time of diagnosis who received bone-directed radiation therapy of 8 Gy in 1 fraction, 20 Gy to 24 Gy in 5 to 6 fractions, 30 Gy in 10 fractions, or >30 Gy in 10 fractions. We tabulated the baseline characteristics, and a multivariable logistic regression analysis was used to identify predictors of single-fraction treatment.
We identified 17,859 patients who met the study criteria. The median patient age was 67 years, and the majority of patients (67%) had primary prostate cancer. Most patients (62%) received spine treatment. Single-fraction treatment increased over time from 3% in 2010 to 7% by 2015. Use of more protracted courses (>30 Gy in 10 fractions) decreased from 34% to 15% over the same interval. The most commonly used regimen (50%-60% of cases) remained 30 Gy in 10 fractions. Predictors of single-fraction treatment included increased age, no systemic therapy, increasing distance from facility, treatment at an academic center, nonspine/nonskull metastasis, and more recent treatment year.
Use of single-fraction radiation for bone metastases has increased steadily but still accounts for <10% of palliative courses. The use of more protracted regimens has decreased significantly, although 30 Gy in 10 fractions remains the most widely used regiment.
放射治疗仍然是治疗骨转移患者的重要姑息治疗手段。美国放射治疗肿瘤学会的指南建议根据随机数据减少分割次数。我们使用国家癌症数据库来研究骨转移患者放射分割的趋势。
我们在国家癌症数据库中查询了 2010 年至 2015 年的乳腺癌、前列腺癌和非小细胞肺癌患者，这些患者在诊断时患有骨转移，接受了 8Gy 单次分割、20Gy 至 24Gy 5 至 6 次分割、30Gy 10 次分割或 >30Gy 10 次分割的骨定向放射治疗。我们列出了基线特征，并使用多变量逻辑回归分析来确定单次分割治疗的预测因素。
我们确定了 17859 名符合研究标准的患者。患者的中位年龄为 67 岁，大多数患者（67%）患有原发性前列腺癌。大多数患者（62%）接受了脊柱治疗。单次分割治疗的比例随着时间的推移而增加，从 2010 年的 3%增加到 2015 年的 7%。在同一时期，采用更长疗程（>30Gy 10 次分割）的比例从 34%下降到 15%。最常用的方案（50%-60%的病例）仍然是 30Gy 10 次分割。单次分割治疗的预测因素包括年龄增加、无全身治疗、距离治疗机构越来越远、在学术中心治疗、非脊柱/非颅骨转移和最近的治疗年份。
单次分割放射治疗骨转移的应用稳步增加，但仍不到姑息治疗疗程的 10%。虽然 30Gy 10 次分割仍然是最广泛使用的方案，但更长疗程的应用显著减少。
