Cellini Francesco, Di Rito Alessia, Siepe Giambattista, Pastore Francesco, Lattanzi Elisabetta, Meaglia Ilaria, Tozzi Angelo, Manfrida Stefania, Longo Silvia, Saldi Simonetta, Cassese Raffaele, Arcidiacono Fabio, Fiore Michele, Masiello Valeria, Mazzarella Ciro, Diroma Antonio, Miccichè Francesco, Maurizi Francesca, Dominici Luca, Scorsetti Marta, Santarelli Mario, Fusco Vincenzo, Aristei Cynthia, Deodato Francesco, Gambacorta Maria A, Maranzano Ernesto, Muto Paolo, Valentini Vincenzo, Morganti Alessio G, Marino Lorenza, Donati Costanza M, Di Franco Rossella
Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Adv Radiat Oncol. 2022 Nov 28;8(2):101134. doi: 10.1016/j.adro.2022.101134. eCollection 2023 Mar-Apr.
Bone metastases frequently occur during malignant disease. Palliative radiation therapy (PRT) is a crucial part of palliative care because it can relieve pain and improve patients' quality of life. Often, a clinician's survival estimation is too optimistic. Prognostic scores (PSs) can help clinicians tailor PRT indications to avoid over- or undertreatment. Although the PS is supposed to aid radiation oncologists (ROs) in palliative-care scenarios, it is unclear what type of support, and to what extent, could impact daily clinical practice.
A national-based investigation of the prescriptive decisions on simulated clinical cases was performed in Italy. Nine clinical cases from real-world clinical practice were selected for this study. Each case description contained complete information regarding the parameters defining the prognosis class according to the PS (in particular, the Mizumoto Prognostic Score, a validated PS available in literature and already applied in some clinical trials). Each case description contained complete information regarding the parameters defining the prognosis class according to the PS. ROs were interviewed through questionnaires, each comprising the same 3 questions per clinical case, asking (1) the prescription after detailing the clinical case features but not the PS prognostic class definition; (2) whether the RO wanted to change the prescription once the PS prognostic class definition was revealed; and (3) in case of a change of the prescription, a new prescriptive option. Three RO categories were defined: dedicated to PRT (RO-d), nondedicated to PRT (RO-nd), and resident in training (IT). Interviewed ROs were distributed among different regions of the country.
Conversion rates, agreements, and prescription trends were investigated. The PS determined a statistically significant 11.12% of prescription conversion among ROs. The conversion was higher for the residents and significantly higher for worse prognostic scenario subgroups, respectively. The PS improved prescriptive agreement among ROs (particularly for worse-prognostic-scenario subgroups). Moreover, PS significantly increased standard prescriptive approaches (particularly for worse-clinical-case presentations).
To the best of our knowledge, the PROPHET study is the first to directly evaluate the potential clinical consequences of the regular application of any PS. According to the Prophet study, a prognostic score should be integrated into the clinical practice of palliative radiation therapy for bone metastasis and training programs in radiation oncology.
骨转移在恶性疾病过程中经常发生。姑息性放射治疗（PRT）是姑息治疗的关键部分，因为它可以缓解疼痛并提高患者的生活质量。通常，临床医生对生存期的估计过于乐观。预后评分（PS）可以帮助临床医生调整PRT的适应症，以避免过度治疗或治疗不足。尽管PS旨在在姑息治疗场景中帮助放射肿瘤学家（RO），但尚不清楚何种类型的支持以及在何种程度上会影响日常临床实践。
在意大利对模拟临床病例的处方决策进行了全国性调查。本研究从实际临床实践中选取了9个临床病例。每个病例描述都包含了根据PS定义预后类别的参数的完整信息（特别是水本预后评分，这是一种文献中已验证且已应用于一些临床试验的PS）。每个病例描述都包含了根据PS定义预后类别的参数的完整信息。通过问卷调查对RO进行访谈，每个问卷针对每个临床病例包含相同的3个问题，询问（1）在详细描述临床病例特征但不提及PS预后类别定义后的处方；（2）一旦揭示PS预后类别定义，RO是否想更改处方；（3）在处方更改的情况下，新的处方选项。定义了三类RO：专门从事PRT的（RO-d）、不专门从事PRT的（RO-nd）和培训中的住院医师（IT）。接受访谈的RO分布在该国的不同地区。
研究了转化率、一致性和处方趋势。PS在RO中确定了具有统计学意义的11.12%的处方转换率。住院医师的转换率更高，预后较差的亚组的转换率则显著更高。PS提高了RO之间的处方一致性（特别是对于预后较差的亚组）。此外，PS显著增加了标准处方方法（特别是对于临床病例表现较差的情况）。
据我们所知，PROPHET研究是首次直接评估常规应用任何PS的潜在临床后果的研究。根据PROPHET研究，预后评分应纳入骨转移姑息性放射治疗的临床实践以及放射肿瘤学培训计划中。
