Institute of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway.
Radiat Oncol. 2024 Nov 1;19(1):151. doi: 10.1186/s13014-024-02547-x.
Complex high-precision radiotherapy, such as stereotactic body radiotherapy (SBRT), should only be offered to patients with sufficiently long survival. In the context of bone metastases radiotherapy, low rates of treatment close to the end of life, e.g. last 30 days (RT30), may serve as a quality of care indicator. While traditional, pain-relieving short-course regimens have been studied comprehensively, real-world SBRT results are still limited.
Retrospective analysis (2010-2023, n = 1117 episodes) of patients with bone metastases treated with traditional single-fraction (8 Gy × 1) or multi-fraction regimens (often 4 Gy × 5 or 3 Gy × 10) compared to stereotactic single-fraction (12-16 Gy × 1) or multi-fraction regimens.
Except for gender, almost all baseline variables were uneven distributed. Failure to complete fractionated radiotherapy was uncommon in the stereotactic (4%) and non-stereotactic group (3%), p = 1.0. With regard to RT30, relevant differences emerged (19% for 8-Gy single-fraction versus 0% for stereotactic single-fraction, p = 0.01). The corresponding figures were 11% for multi-fraction non-stereotactic and 2% for multi-fraction stereotactic, p = 0.08. Median overall survival was shortest after 8-Gy single-fraction irradiation (4.2 months) and longest after stereotactic multi-fraction treatment (13.9 months). Neither stereotactic radiotherapy nor multi-fraction treatment improved survival in multivariate Cox regression analysis. Factors significantly associated with longer survival included better performance status, lower LabBM score (5 standard blood test results), stable disease outside of irradiated area(s), metachronous distant metastases, longer time interval from metastatic disease to bone irradiation, and outpatient status.
The implementation of SBRT for selected patients has resulted in low rates of non-completion and RT30. Optimal selection criteria remain to be determined, but in current clinical practice we exclude patients with poor performance status, unfavorable blood test results (high LabBM score) and progressive disease sites not amenable to SBRT. Established, guideline-endorsed short-course regimens, especially 8-Gy single-fraction treatment, continue to represent an important palliative approach.
复杂的高精度放疗，如立体定向体部放疗（SBRT），仅应提供给具有足够长生存时间的患者。在骨转移放疗的背景下，接近生命末期（例如最后 30 天）的治疗低比例，例如 RT30，可能作为护理质量的指标。虽然已经全面研究了传统的、缓解疼痛的短程方案，但现实世界的 SBRT 结果仍然有限。
回顾性分析（2010-2023 年，n=1117 例）了接受传统单次分割（8Gy×1）或多分割方案（通常为 4Gy×5 或 3Gy×10）或立体定向单次分割（12-16Gy×1）或多分割方案治疗的骨转移患者。
除了性别，几乎所有的基线变量分布都不均匀。在立体定向（4%）和非立体定向组（3%）中，未能完成分割放疗并不常见，p=1.0。关于 RT30，出现了相关差异（8Gy 单次分割为 19%，立体定向单次分割为 0%，p=0.01）。相应的数字为非立体定向多分割的 11%和立体定向多分割的 2%，p=0.08。8Gy 单次分割照射后的中位总生存期最短（4.2 个月），立体定向多分割治疗后的最长（13.9 个月）。多变量 Cox 回归分析显示，立体定向放疗和多分割治疗均未改善生存。与生存时间延长显著相关的因素包括更好的表现状态、较低的 LabBM 评分（5 项常规血液检查结果）、照射区外的稳定疾病、远处转移的同时发生、从转移性疾病到骨照射的时间间隔较长、以及门诊状态。
为选定的患者实施 SBRT 导致非完成率和 RT30 率较低。最佳选择标准仍有待确定，但在当前的临床实践中，我们排除了表现状态不佳、血液检查结果不利（高 LabBM 评分）和不适合 SBRT 的进展性疾病部位的患者。既定的、指南认可的短程方案，特别是 8Gy 单次分割治疗，仍然是一种重要的姑息治疗方法。
