The impact of radiation treatment planning technique on unplanned hospital admissions

Abstract

PurposeTreatment burdens and toxicities related to palliative radiation therapy (RT) may lead to unplanned hospital admissions (UHAs). The likelihood for these toxicities may be related to treatment technique. We compared rates of UHA between patients receiving nonconformal (2-dimensional) and conformal (3-dimensional or higher) radiation treatments to bone metastases involving the vertebral column.Methods and materialsWe retrospectively analyzed patients treated with RT for bone metastases at a single tertiary care center between 2010 and 2017. We compared rates of RT-related UHA within 90 days of receiving radiation using Cox competing risk regression models.ResultsWe identified 326 patients with bone metastases involving the vertebral column, 139 of whom received radiation by nonconformal technique and 187 by conformal technique. On multivariable analysis, conformal techniques were associated with a reduced risk of 90-day UHA (hazard ratio [HR]: 0.35; 95% confidence interval [CI], 0.14-0.88). Other significant factors include hematologic cancer (HR: 0.17; 95% CI, 0.03-0.82) and baseline Eastern Cooperative Oncology Group score ≥2 (HR: 3.02; 95% CI, 1.05-8.69).ConclusionsThe utilization of conformal (non-2-dimensional) radiation treatment plans may help reduce treatment-related toxicities and consequently UHAs after palliation of bone metastases.

Dosimetric evaluation of a spinal cord dose‐limiting 3D‐CRT technique for radiotherapy of spinal metastases

“…In a study by Pope et al., a prospective cohort of patients treated with 3D‐CRT plans for bone metastases (50% spine involvement) was compared to a historical cohort treated with 2D plans and no difference in patients‐related outcomes were observed 22 . Two other retrospective series concerning irradiation of bone and spine metastases however revealed a tendency for better clinical outcomes of 3D‐CRT versus 2D planning in terms of pain response and toxicity 23,24 . Unfortunately, further evidence from prospective trials is not available, so a definitive conclusion cannot be drawn yet 25 …”

“…22 Two other retrospective series concerning irradiation of bone and spine metastases however revealed a tendency for better clinical outcomes of 3D-CRT versus 2D planning in terms of pain response and toxicity. 23,24 Unfortunately, further evidence from prospective trials is not available, so a definitive conclusion cannot be drawn yet. 25 When thinking about the appropriate irradiation technique in daily practice, one should also be concerned by the possible need for future re-treatment of the same spinal site.…”

“… 22 Two other retrospective series concerning irradiation of bone and spine metastases however revealed a tendency for better clinical outcomes of 3D‐CRT versus 2D planning in terms of pain response and toxicity. 23 , 24 Unfortunately, further evidence from prospective trials is not available, so a definitive conclusion cannot be drawn yet. 25 …”