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Int J Radiat Oncol Biol Phys. 2015 Mar 1;91(3):548-55. doi: 10.1016/j.ijrobp.2014.10.045. Epub 2014 Dec 24.

Assessment of national practice for palliative radiation therapy for bone metastases suggests marked underutilization of single-fraction regimens in the United States.

Author information

1
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut. Electronic address: charles.rutter@yale.edu.
2
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.

Abstract

PURPOSE:

To characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions.

PATIENTS AND METHODS:

The National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details.

RESULTS:

We included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05).

CONCLUSIONS:

Single-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such that evidence-based and cost-conscious care becomes more commonplace.

PMID:
25542310
DOI:
10.1016/j.ijrobp.2014.10.045
[Indexed for MEDLINE]

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