Radiation Oncology, CancerCare Manitoba, Winnipeg.
Rady Faculty of Health Sciences, University of Manitoba, Winnipeg.
Curr Oncol. 2020 Aug;27(4):190-197. doi: 10.3747/co.27.6193. Epub 2020 Aug 1.
Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (sfrt) and multiple-fraction radiotherapy (mfrt) for the palliation of painful bone metastases, sfrt remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (cwc) that recommend sfrt. We assessed whether dissemination of the guidelines influenced sfrt use in Manitoba in 2016, and we identified factors associated with mfrt.
All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with mfrt.
In 2016, 807 patients (mean age: 70 years; range: 35-96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, mfrt was used-a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (or): 5.3] or lung primary (or: 3.3), complicated bone metastasis (or: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of mfrt use.
Dissemination of cwc recommendations alone did not increase sfrt use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of sfrt in Manitoba.
尽管有 1 级证据表明单次分割放疗（sfrt）和多次分割放疗（mfrt）在缓解疼痛性骨转移方面等效，但 sfrt 的应用仍然不足。2015 年，为了鼓励在姑息性放射肿瘤学资源方面的可持续利用，马尼托巴癌症护理中心向马尼托巴的每位放射肿瘤学家分发了来自明智选择加拿大（cwc）的指南，该指南建议使用 sfrt。我们评估了 2016 年指南的传播是否影响了马尼托巴的 sfrt 应用，并确定了与 mfrt 相关的因素。
从省级放射治疗数据库中确定了 2016 年 1 月 1 日至 12 月 31 日期间因骨转移接受姑息性放射治疗的所有马尼托巴患者。从电子病历中提取患者、治疗和疾病特征，并按分割方案进行列表。进行单变量和多变量逻辑回归分析，以确定与 mfrt 相关的危险因素。
2016 年，807 名（平均年龄：70 岁；范围：35-96 岁）患者因骨转移接受姑息性放射治疗，其中 69%的患者有单纯性骨转移。最常见的原发恶性肿瘤是前列腺癌（27.1%）、肺癌（20.6%）和乳腺癌（15.9%）。在 62%的病例中，使用了 mfrt-与 2015 年相比没有变化。多变量分析显示，胃肠道[比值比（or）：5.3]或肺部原发肿瘤（or：3.3）、复杂的骨转移（or：4.3）和在分支机构站点进行治疗（or：4.4）增加了使用 mfrt 的可能性。
2016 年，cwc 建议的传播并没有增加放射肿瘤学家使用 sfrt 的比例。因此，需要进行更全面的知识转化工作，目前正在进行中，以鼓励在马尼托巴增加 sfrt 的应用。
