Palliative Care

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TU_32_3051 - Prospective Pilot Comparison Of Acute Gastrointestinal Toxicities And Quality Of Life Among Patients With Spinal Metastases Receiving Radiation Therapy Delivered With Three Planning Techniques

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Prospective Pilot Comparison Of Acute Gastrointestinal Toxicities And Quality Of Life Among Patients With Spinal Metastases Receiving Radiation Therapy Delivered With Three Planning Techniques
D. D. Shi1,2, L. M. Hertan3, T. A. Balboni1, R. Shiloh1, L. Warren1, S. Skamene1, K. Roper1, D. Apkon1, Y. H. Chen1, and M. S. Krishnan1; 1Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, 2Harvard Medical School, Boston, MA, 3Beth Israel Deaconess Medical Center, Boston, MA

Purpose/Objective(s): Patients receiving palliative radiation therapy (RT) to the spine often develop acute gastrointestinal (GI) toxicities. Though advances in RT delivery techniques have improved conformality, it is unclear whether different RT techniques correlate with clinically significant reduced toxicity. This study aims to prospectively characterize acute GI toxicities during and following palliative spinal RT delivered by three treatment modalities.

Materials/Methods: This prospective cohort study enrolled spinal metastases patients treated with RT at a single institution from December 2016 through June 2017. RT technique (AP/PA, 3DCRT, or SBRT) was clinically determined prior to enrollment. A modified version of the MD Anderson Symptom Inventory (MDASI, items scored 0-10) was given to patients at RT start, 1 week after RT initiation, the day of RT completion, and 1 and 4 weeks post RT completion. Also assessed were GI-toxicity related interventions during and up to 4 weeks post RT, including initiation of IV fluids and of anti-reflux, anti-emetic, anti-diarrhea, and esophagitis medications (excluding GI prophylaxis medications). The Kruskal-Wallace test assessed differences in maximum GI-toxicity score change across treatment groups; chi-square tests assessed differences in GI-toxicity related interventions during and up to 4 week post RT.

Results: A total of 62 patients were included, 19 AP/PA, 23 3DCRT, and 20 SBRT. There was a trend (p=0.09) toward lesser maximum change in GI toxicities in the SBRT group [mean change=5.1, standard deviation (SD)=3.4], as compared to AP/PA (6.7, SD=2.7) and 3DCRT (7.2, SD=28). Fewer patients in the SBRT group required IV fluids (20%) as compared to the AP/PA (78.9%) or 3DCRT (43.5%) groups (p=0.001); and overall fewer in the SBRT arm (p=0.03) required initiation of GI medications, including anti-reflux, anti-emetic, anti-diarrhea, and esophagitis medications (15.0%, 30%, 15.0%, 5.0%, respectively) than the AP/PA (31.6%, 47.4%, 5.3%, 10.5%, respectively) or 3DCRT (47.8%, 56.5%, 8.7%, 21.7%, respectively) groups.

Conclusion: Patients treated with AP/PA, 3DCRT and SBRT demonstrated a trend, though not significant, toward differing maximum change in GI toxicity scores, with the least change in the SBRT group. There was less frequent initiation of interventions related to GI toxicities (e.g., IV fluids, GI medications) in the SBRT group.

Author Disclosure: D.D. Shi: None. L.M. Hertan: None. T.A. Balboni: Employee; Dana-Farber Cancer Institute. Research Grant; Templeton Foundation. Steering Committee Member; ASCO Palliative Care Steering Committee Member. R. Shiloh: None. S. Skamene: None. Y. Chen: None. M.S. Krishnan: None.

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