Comparison of patient-reported outcomes with single versus multiple fraction palliative radiotherapy for bone metastasis in a population-based cohort

Conway, Jessica L.; Yurkowski, Emily; Glazier, Justin; Gentles, Quinn; Walter, Allison; Bowering, Gale; Curtis, Susan; Schellenberg, Devin; Halperin, Ross; Lapointe, Vincent; Beckham, Wayne; Olivotto, Ivo A.; Olson, Robert

doi:10.1016/j.radonc.2016.03.025

Cited by 27 publications

(36 citation statements)

References 32 publications

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“…More than 50% of patients with incurable NSCLC received >10 fractions of palliative RT including 42% who received RT associated with a bone metastasis diagnosis code despite national guidelines that suggest shorter courses. 19 This is consistent with findings from other studies 28 , 29 , 30 and suggests that there may be opportunities to streamline or consolidate care by implementing programs to evaluate whether and when shorter courses of radiation are appropriate.…”

Section: Discussionsupporting

confidence: 85%

Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer

Lam

Cronin

et al. 2018

Advances in Radiation Oncology

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PurposePalliative radiation therapy (RT) can improve quality of life but also incurs time and financial costs. The aim of this study was to evaluate factors associated with use and intensity of palliative RT for incurable non-small cell lung cancer (NSCLC).Methods and materialsThis was a retrospective analysis of Medicare's Surveillance, Epidemiology and End Results data. We identified patients who were diagnosed with incurable (American Joint Committee on Cancer 6th edition stage IIIB with malignant effusion or stage IV) NSCLC between 2004 and 2011. Univariable and multivariable logistic regressions were used to identify factors associated with the receipt of palliative RT and the use of >10 fractions during the first course of radiation. Among patients who were treated with radiation, freestanding versus hospital-based center information was collected on the basis of the location of the RT delivery claim.ResultsAmong 55,258 patients with incurable NSCLC, 38% (21,053 patients) received palliative RT during the first year after diagnosis. Among patients who received RT, 56% (11,717 patients) received >10 fractions. On multivariable analysis, factors associated with greater RT use included younger age group (overall P < .01), lower modified Charlson comorbidity score (overall P < .01), female sex (odds ratio [OR]: 1.1; P < .01), marital status (OR: 1.1; P < .01), and chemotherapy use (OR: 3.6; P < .01). Predictors for >10 fractions were chemotherapy use (OR: 1.7; P < .01) and treatment at a freestanding versus hospital-based facility (58% vs 43%; OR: 1.7; P < .01).ConclusionsMore than a third of patients diagnosed with incurable lung cancer receive palliative RT and 56% received >10 fractions. The use of RT varied by region and patient characteristics, and patients treated at freestanding RT centers were more likely to receive >10 fractions. Further research into factors that influence treatment decisions including potential financial incentives may contribute to the high value and strategic utilization of palliative RT.

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Section: Discussionsupporting

confidence: 85%

Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer

Lam

Cronin

et al. 2018

Advances in Radiation Oncology

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“…Two studies had a retrospective design. In 4 studies, the main objective was the comparison of single- versus multiple-fraction RT 17, 19, 21, 25. In the other 5 studies, the response rates were extracted for each single- and multiple-fraction RT 18, 20, 22, 23, 24…”

Section: Resultsmentioning

confidence: 99%

“…A 1 × 8 Gy radiation schedule was frequently used in single-fraction therapy, and schedules of 5 × 4 Gy and 10 × 3 Gy were frequently used in multiple-fraction therapy. In 4 studies, overall response was defined only on the basis of pain intensity 17, 18, 19, 21. In the other 5 studies, overall response was defined on the basis of pain intensity and analgesic use 20, 22, 23, 24, 25.…”

Section: Resultsmentioning

confidence: 99%

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Saitô

Yamaguchi

Toya

et al. 2019

Advances in Radiation Oncology

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PurposeSingle-fraction radiation therapy (RT) is a convenient and cost-effective regimen for the palliation of painful bone metastases, but is still underused. Randomized controlled trials comparing single- versus multiple-fraction RT are limited by generalizability. We compared the pain response rates after single- versus multiple-fraction RT in nonrandomized studies.Methods and MaterialsWe searched PubMed and Scopus from the inception of each database through August 2018. We sought to identify nonrandomized studies in which data on pain response rates could be extracted for single- and multiple-fraction RT. Our primary outcomes of interest were the overall and complete pain response rates in evaluable patients. The analysis was performed using a random-effects model with the Mantel-Haenszel method.ResultsOf the 3933 articles identified through our search, 9 met our inclusion criteria. Five of 9 included studies did not exclude patients with features of complicated bone metastases. A 1 × 8 Gy radiation schedule was frequently used in single-fraction therapy, and schedules of 5 × 4 Gy and 10 × 3 Gy were frequently used in multiple-fraction therapy. In the 9 studies, the overall response rate was 67% (884 of 1321 patients) for patients in the single-fraction arm and 70% (953 of 1360 patients) for those in the multiple-fraction arm (pooled odds ratio [OR]: 0.85; 95% confidence interval [CI], 0.66-1.08). In 5 studies, the complete response rate was 26% (195 of 753 patients) for patients in the single-fraction arm and 35% (289 of 821 patients) for those in the multiple-fraction arm (pooled OR: 0.89; 95% CI, 0.70-1.13).ConclusionsThere were no significant differences in the overall and complete response rates between single- and multiple-fraction RT. The effectiveness of single-fraction regimens was shown in nonrandomized settings, which better reflect daily practice than randomized studies. The CIs for the pooled ORs included clinically meaningful differences, and the study results are inconclusive.

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“…In 1 population-based cohort study, no clear differences in overall response rates were observed between patients with complicated and uncomplicated bone metastases (statistical analysis not shown). 26 The effects of the presence of complicated bone metastases on pain response need to be further studied. Finally, the presence of pain other than index pain caused by the irradiated tumors may have contributed to the differences in response rates between RCTs and nonrandomized studies.…”

Section: Discussionmentioning

confidence: 99%

Pain Response Rates After Conventional Radiation Therapy for Bone Metastases in Prospective Nonrandomized Studies: A Systematic Review

Saitô

Toya

Oya

2019

Practical Radiation Oncology

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This study aimed to determine the pain response rates after conventional radiation therapy (RT) for painful bone metastases in prospective nonrandomized studies, which better reflect daily practice than randomized controlled trials. Methods and materials: A literature search was conducted in PubMed and Scopus for articles published between 2002 and 2018. We only included articles in which pain response after RT was assessed using the International Consensus Endpoint initially published in 2002, or the updated version from 2012. In addition, to be included in this review, the study design was required to be prospective or based on prospectively collected data. Our primary outcomes of interest were the overall and complete response rates after conventional RT for bone metastases. Results: Of the 2863 articles identified in our database search, 12 met the inclusion criteria. Six studies excluded patients with features of complicated bone metastases. Only 2 papers reported exclusion criteria regarding analgesic use. Radiation schedules that were frequently used were 1 Â 8 Gy, 5 Â 4 Gy, and 10 Â 3 Gy. The overall response rate in evaluable patients was 55%, and 754 of the 1379 evaluable patients experienced a complete or partial response. The complete response rate was 15% (196 of 1348 evaluable patients). In the intent-to-treat patient group, the overall response rate was 29% (754 of 2559 enrolled patients), and the complete response rate 8% (196 of 2528 enrolled patients). Conclusions: We determined the pain response rates after conventional RT for painful bone metastases in prospective nonrandomized studies. The present review may provide benchmarks for future nonrandomized studies that investigate palliative RT for bone metastases.

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Comparison of patient-reported outcomes with single versus multiple fraction palliative radiotherapy for bone metastasis in a population-based cohort

Cited by 27 publications

References 32 publications

Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer

Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Pain Response Rates After Conventional Radiation Therapy for Bone Metastases in Prospective Nonrandomized Studies: A Systematic Review

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