Estimating Need for Palliative External Beam Radiotherapy in Adult Cancer Patients

Nieder, Carsten; Pawinski, Adam; Haukland, Ellinor; Dokmo, Raymond; Phillipi, Isabelle; Dalhaug, Astrid

doi:10.1016/j.ijrobp.2009.01.028

Cited by 16 publications

(14 citation statements)

References 9 publications

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“…Cancer 2011;117:2505-12.Worldwide, a considerable number of patients with advanced and/or metastatic solid tumors develop brain metastases. 1,2 The estimated number of patients in the United States was 170,000 per year. 1 Our group has recently analyzed the cost of care, which corresponded to €43,955 per life year for the average patient.…”

mentioning

confidence: 99%

Presentation, patterns of care, and survival in patients with brain metastases

Nieder

Spanne

Mehta

et al. 2010

Cancer

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180

106

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. RESULTS: Patterns of care have changed significantly. Contemporary patients received focal treatments such as stereotactic radiosurgery and surgical resection far more frequently. Furthermore, systemic treatment was used more often in contemporary patients, both before and after diagnosis of brain metastasis. Improved survival was observed in the contemporary cohort (P ¼ .03). The 1-year survival rate increased from 15% (95% confidence interval [CI], 7%-25%) to 34% (95% CI, 25%-44%). However, this improvement was largely driven by patients with favorable prognostic features. More than 40% of the patients still belong to unfavorable prognostic groups with limited median survival and little improvement. CONCLUSIONS: Contemporary patients were managed on a much more individualized basis, requiring multidisciplinary case discussion and thorough assessment of prognostic features. Progress has been made, but the overall outcome needs to be improved further. Avoiding overtreatment in patients with poor prognosis is as important as aggressive treatment in patients who might survive for several years. Cancer 2011;117:2505-12.

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confidence: 99%

Presentation, patterns of care, and survival in patients with brain metastases

Nieder

Spanne

Mehta

et al. 2010

Cancer

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180

106

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“…Finally, it was necessary to estimate the number of potential candidates for palliative RT in each hospital, although our estimation was slightly lower than that reported by Nieder et al [5]. …”

Section: Discussionmentioning

confidence: 70%

“…The use of RT in this setting is supported by considerable and robust evidence. It is considered one of the most effective and cost-effective treatments in patients with bone (BM) or brain (BrM) metastases [4], and palliative RT represents around 10-20% of the total workload in a typical radiotherapy unit [5]. Hypofractionated regimens of short duration are generally prescribed for these patients, although a wide range of regimens and combinations has been applied [6,7].…”

Section: Introductionmentioning

confidence: 99%

Use of palliative radiotherapy in brain and bone metastases (VARA II study)

Expósito

Jaen²,

Alonso

et al. 2012

Radiat Oncol

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IntroductionMetastases are detected in 20% of patients with solid tumours at diagnosis and a further 30% after diagnosis. Radiation therapy (RT) has proven effective in bone (BM) and brain (BrM) metastases. The objective of this study was to analyze the variability of RT utilization rates in clinical practice and the accessibility to medical technology in our region.Patients and methodsWe reviewed the clinical records and RT treatment sheets of all patients undergoing RT for BM and/or BrM during 2007 in the 12 public hospitals in an autonomous region of Spain. Data were gathered on hospital type, patient type and RT treatment characteristics. Calculation of the rate of RT use was based on the cancer incidence and the number of RT treatments for BM, BrM and all cancer sites.ResultsOut of the 9319 patients undergoing RT during 2007 for cancer at any site, 1242 (13.3%; inter-hospital range, 26.3%) received RT for BM (n = 744) or BrM (n = 498). These 1242 patients represented 79% of all RT treatments with palliative intent, and the most frequent primary tumours were in lung, breast, prostate or digestive system. No significant difference between BM and BrM groups were observed in: mean age (62 vs. 59 yrs, respectively); gender (approximately 64% male and 36% female in both); performance status (ECOG 0–1 in 70 vs. 71%); or mean distance from hospital (36 vs. 28.6 km) or time from consultation to RT treatment (13 vs. 14.3 days). RT regimens differed among hospitals and between patient groups: 10 × 300 cGy, 5 × 400 cGy and 1x800cGy were applied in 32, 27 and 25%, respectively, of BM patients, whereas 10 × 300cGy was used in 49% of BrM patients.ConclusionsPalliative RT use in BM and BrM is high and close to the expected rate, unlike the global rate of RT application for all cancers in our setting. Differences in RT schedules among hospitals may reflect variability in clinical practice among the medical teams.

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“…There are three centers that have radiation treatment facilities in the northern and central region of Norway (Bodø, Tromsø and Trondheim), one of which is The Nordland Hospital, which are separated by large distances; therefore, dilution effects, where a patient receives radiotherapy at other centre, does not apply in the collection of reliable data if the study population lives within close proximity to one of the centers. One of these centers is The Nordland Hospital, which forms the basis of the present and previous analyses (7).…”

Section: Methodsmentioning

confidence: 99%

Impact of intense systemic therapy and improved survival on the use of palliative radiotherapy in patients with bone metastases from prostate cancer

Nieder¹,

Haukland²,

Mannsåker³

et al. 2016

Oncology Letters

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Abstract. More effective drugs may reduce the requirement for palliative external beam radiotherapy for bony target volumes; however, living with metastases for prolonged periods of time may result in more frequent episodes of bone pain or serious skeletal-related events. The purpose of the present study was to evaluate how recent advances in systemic therapy impact radiotherapy utilization. A retrospective analysis of a comprehensive regional database was performed. All oncology care in this region was provided by only one center, assuring complete data. Patients that had succumbed between June 1, 2004 and June 1, 2015 were included. For all 236 patients, the median age at diagnosis of bone metastases was 75 years and median overall survival was 20 months. More intense systemic therapy was associated with a significantly longer survival time. Only 69 patients (29%) did not receive palliative radiotherapy for bony target volumes, whilst 1 course was given to 101 patients (43%), 2 courses to 34 patients (14%) and >2 courses to 32 patients (14%). Radiotherapy was used more frequently in younger patients, those with spinal cord compressions or pathological fractures, and those treated with intense and long-standing systemic therapy. Radiotherapy utilization increased with survival time. For 100 poor-prognosis patients that succumbed within 12 months, 57 courses of palliative radiotherapy were administered, whilst 100 patients that survived for 12-24 months were administered 114 courses (24-36 months, 148 courses). In conclusion, the use of palliative radiotherapy did not decrease when more effective systemic therapy was administered. However, provided that only 5% of patients received radionuclide treatment, additional studies in other populations are required.

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Estimating Need for Palliative External Beam Radiotherapy in Adult Cancer Patients

Cited by 16 publications

References 9 publications

Presentation, patterns of care, and survival in patients with brain metastases

Presentation, patterns of care, and survival in patients with brain metastases

Use of palliative radiotherapy in brain and bone metastases (VARA II study)

Impact of intense systemic therapy and improved survival on the use of palliative radiotherapy in patients with bone metastases from prostate cancer

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