PV QA 3 - Poster Viewing Q&A 3
TU_30_3038 - Heterogeneity in the treatment of bone metastases: A contemporary statewide practice pattern analysis
Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3
Shruti Jolly, MD
University of Michigan: Associate Professor: Employee, Faculty: Employee
Heterogeneity in the treatment of bone metastases: A contemporary statewide practice pattern analysis
S. Jolly1, B. R. Mancini Jr2, J. A. Hayman3, T. P. Boike4, K. Griffith5, J. M. Moran6, M. M. Dominello7, M. Fireman8, L. J. Pierce3, and D. E. Spratt1; 1Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Department of Radiation Oncology, University of Michigan, Grand Rapids, MI, 3Michigan Medicine, Ann Arbor, MI, 4McLaren Northern Michigan, Petoskey, MI, 5Department of Biostatistics, University of Michigan, Ann Arbor, MI, 6University of Michigan, Ann Arbor, MI, 7Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 8MidMichigan Medical Center, Midland, MI
Purpose/Objective(s): Palliative radiotherapy for bone metastases is often viewed as a single entity, despite national guidelines providing input principally only for painful bone metastases. Data surrounding the treatment of bone metastases is often gleaned from questionnaires of what providers would theoretically do in practice or population-based data lacking critical granular information. Herein, we investigate the "real-world" radiotherapeutic treatment of bone metastases.
Materials/Methods: Twenty diverse institutions from a statewide Radiation Oncology Quality Consortium had data extracted on their 10 most recent cases of radiotherapy delivered for the treatment of bone metastases at their institution between January and February of 2017. Uni- and multivariable binary logistic regression were used to assess use of single fraction (8 Gy x 1) radiotherapy.
Results: A total of 196 cases were eligible for inclusion. Twenty-eight different fractionation schedules were identified. The most common schedule was 3 Gy x 10 fractions (n=100, 51.0%), 4 Gy x 5 fractions (n=32, 16.3%), and 8 Gy x 1 (n=15, 7.7%). Significant predictors for use of single fraction radiotherapy were presence of oligometastatic disease (p=0.008), no prior overlapping radiotherapy (p=0.050), and academic practice type (p=0.039). Twenty-nine cases (14.8%) received >10 fractions (median 15, range 11-20 fractions). Intensity modulated radiotherapy was used in 14 cases (7.1%), stereotactic body radiotherapy in 11 cases (5.6%), and image guidance with cone beam CT in 11 cases (5.6%). Amongst simple painful bone metastases (no prior surgery, cord compression, fracture, soft tissue extension, or overlapping prior radiotherapy; n=70), only 12.9% were treated with 8 Gy x 1.
Conclusion: To our knowledge, this is the most granular assessment of practice patterns for bone metastases performed to date. We demonstrate that bone metastases represent a heterogeneous disease, and the radiotherapeutic treatment of bone metastases is similarly diverse. Future work is needed to understand barrier to single fraction use, and clinical trials are necessary to establish appropriate guidelines for the breadth of this complex disease.
Author Disclosure: S. Jolly: None. B.R. Mancini: None. J.A. Hayman: Research Grant; Blue Cross Blue Shield of Michigan. T.P. Boike: Partner; Petoskey Radiation Oncology. Honoraria; ASTRO APEx Reviewer. Member; NCI Prostate Cancer Task Force. K. Griffith: None. J.M. Moran: Research Grant; Varian Medical Systems, Blue Cross Blue Shield of Michigan, NIH. We have a collaboration regarding the use of gel dosimetry. Modus Medical supplies gels for the research.; Modus Medical Devices. Consultant; Chartrounds, St. Jude Children's Research Hospital, VA National Center for Patient Safety. Travel Expenses; AAPM, St. Jude Children's Research Hospital. Chair; AAPM. M.M. Dominello: None. M. Fireman: None. L.J. Pierce: Royalty; UpToDate.