Palliative Appropriateness Criteria: A Pragmatic Method to Evaluate the Suitability of Palliative Radiotherapy Fractionation

Farris, Joshua C.; Johnson, Adam G.; Carriere, Patrick P.; Patel, Zachary; Nagatsuka, Moeko; Farris, Michael; Hughes, Ryan T.

doi:10.1089/jpm.2022.0173

Cited by 3 publications

(12 citation statements)

References 13 publications

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“…Calculation is not very time consuming, and the necessary information is readily available. In the original US study, Farris et al reported a median time on treatment of 12 days and that 92% of courses were completed as planned [12]. Median age was 64 years, lung cancer present in 38% (largest subgroup), 69% were outpatients, 80% irradiated to just one site, and 19% with a single fraction.…”

Section: Discussionmentioning

confidence: 99%

“…This retrospective single-institution study resembled the retrospective single-institution study by Farris et al to ensure comparability of the two cohorts. In the original study (1027 courses in 850 patients), inclusion was limited to 2014-2018 and 1, 2-5, or 10 fractions [12]. In order to ensure sufficient cohort size, our inclusion time period was extended (2014-2019; 1, 2-5, or 10 fractions; no exclusion of patients who failed to complete all prescribed fractions).…”

Section: Methodsmentioning

confidence: 99%

“…The methods were identical to those employed by Farris et al. [ 12 ]. Overall survival (time to death) from the first day of radiotherapy was calculated by employing the Kaplan–Meier method for all 287 courses.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, Farris et al. suggested a pragmatic method to evaluate the suitability of palliative radiotherapy fractionation [ 12 ]. They described a novel metric, the palliative appropriateness criteria (PAC) score, after having analyzed the percent of remaining life (PRL).…”

Section: Introductionmentioning

confidence: 99%

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Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

et al. 2023

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Background Recently, the palliative appropriateness criteria (PAC) score, a novel metric to aid clinical decision-making between different palliative radiotherapy fractionation regimens, has been developed. It includes baseline parameters including but not limited to performance status. The researchers behind the PAC score analyzed the percent of remaining life (PRL) on treatment. The latter was accomplished by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. The purpose of the present study was to validate this novel metric. Patients and methods The retrospective validation study included 219 patients (287 courses of palliative radiotherapy). The methods were identical to those employed in the score development study. The score was calculated by assigning 1 point each to several factors identified in the original study and using the online calculator provided by the PAC developers. Results Median survival was 6 months and death within 30 days from start of radiotherapy was recorded in 13% of courses. PRL on treatment ranged from 1 to 23%, median 8%. Significant associations were confirmed between online-calculated PAC score, observed survival, and risk of death within 30 days from the start of radiotherapy. Patients with score 0 had distinctly better survival than all other groups. The score-predicted median risk of death within 30 days from start of radiotherapy was 22% in our cohort. A statistically significant correlation was found between predicted and observed risk (p < 0.001). The original and present study were not perfectly concordant regarding number and type of baseline parameters that should be included when calculating the PAC score. Conclusion This study supports the dual strategy of PRL and risk of early death calculation, with results stratified for fractionation regimen, in line with the original PAC score study. When considering multifraction regimens, the PAC score identifies patients who may benefit from shorter courses. Additional work is needed to answer open questions surrounding the underlying components of the score, because the original and validation study were only partially aligned.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

et al. 2023

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“…Among other quality of care indicators, percent of remaining life (PRL) has recently received scientific attention [ 8 , 9 ]. PRL evaluation is accomplished by calculating the time between start and finish of PRT (minimum 1 day in case of a single- fraction regimen) and dividing it by overall survival in days from start of PRT.…”

Section: Introductionmentioning

confidence: 99%

Percent of remaining life on palliative radiation treatment: solely a function of fractionation?

Nieder

Mannsåker

Dalhaug

2023

Rep Pract Oncol Radiother.

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Background This study analyzed the percent of remaining life (PRL) on treatment in patients irradiated for bone metastases. Bone metastases were treated together with other target volumes, if indicated, e.g. a 10-fraction treatment course that included brain and bone metastases. PRL was determined by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. Materials and methods Different baseline parameters were assessed for association with dichotomized PRL (< 5% vs . ≥ 5%). The retrospective study included 219 patients (287 courses of palliative radiotherapy). After univariate analyses, multi-nominal logistic regression was employed. Results PRL on treatment ranged from 1–23%. Single-fraction radiotherapy resulted in < 5% PRL on treatment in all cases. All courses with 10 fractions resulted in at least 5% PRL on treatment. Significant associations were found between various baseline parameters and PRL category. With fractionation included in the regression model, 3 parameters retained significant p-values: Karnofsky performance status (KPS), none-bone target volume and fractionation (all with p < 0.001). If analyzed without fractionation, none-bone target volume (p < 0.001), hemoglobin (p < 0.001), KPS (p = 0.01), lack of additional systemic treatment (p = 0.01), and hypercalcemia (p = 0.04) were significant. Conclusions Fractionation is an easily modifiable factor with high impact on PRL. Patients with KPS < 70 and those treated for additional target types during the same course are at high risk of spending a larger proportion of their remaining life on treatment.

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Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma

Kaufmann,

Täubl,

Nikolaidou

et al. 2024

Strahlenther Onkol

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Purpose Multiple myeloma is associated with osteolytic bone lesions, often requiring surgery of the spine and postoperative radiotherapy (RT). Although common, data for clinical and informed decision-making are sparse. In this monocentric retrospective study, we aim to report the outcome of patients who underwent spinal surgery and postoperative RT due to multiple myeloma. Methods A total of 54 patients with multiple myeloma who underwent prior spinal surgery and postoperative RT at our institution between 2009 and 2020 were analyzed. Spinal instability neoplastic score (SINS) and Bilsky score, posttherapeutic adverse events, clinical data, and outcomes were collected and analyzed. The primary endpoint of this study was overall survival (OS), secondary endpoints were progression-free survival (PFS), pain response, local control, and skeletal-related events (SRE). Results The 3‑ and 5‑year overall survival (OS) was 74.9% (95% confidence interval [CI]: 63.5–88.4%) and 58% (95% CI: 44.5–75.6%), respectively. Median survival was not reached and 75% survival was 34.3 months (95% CI: 28.7–95.4 months). Median follow-up was 63 months (95% CI: 49–94 months). The number of patients with good to adequate performance status (Karnofsky performance score [KPS] ≥ 70) significantly increased after surgery (p < 0.01). We observed no grade 3/4 toxicity and only 13 (24%) grade 1/2 adverse events. Two patients (4%) experienced SRE. Overall, 92% of patients reported reduced pain after radiotherapy, with 66% reporting complete pain response. There was no difference in pain response between patients with different Bilsky scores. Bisphosphonate therapy and lower Bilsky score at the start of RT were associated with improved OS in univariate analysis (all p < 0.05). Multivariate Cox regression confirmed a Bilsky score of 2 or 3 as an independent negative prognostic factor (HR 3.89; 95 CI 1.4–10.7; p < 0.01). We observed no in-field recurrences. Conclusion In this study, we were able to show that the current standard of RT after spinal surgery of osteolytic lesions is safe. In addition, we observed a very low rate of SRE (4%) and no in-field recurrences, demonstrating the local efficacy of RT in multiple myeloma patients. Higher Bilsky scores were associated with worse OS in multivariate analysis, but had no effect on pain response.

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Palliative Appropriateness Criteria: A Pragmatic Method to Evaluate the Suitability of Palliative Radiotherapy Fractionation

Cited by 3 publications

References 13 publications

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

Percent of remaining life on palliative radiation treatment: solely a function of fractionation?

Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma

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