Palliative Care

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

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.

Shruti Jolly, MD

Disclosure:
Employment
University of Michigan: Associate Professor: Employee, Faculty: Employee

Biography:
Shruti Jolly MD is an Associate Professor and Associate Chair of Community Practices in the Department of Radiation Oncology at the University of Michigan. She received her undergraduate and medical degrees at Wayne State University as a Presidential Scholar. In 2007, she completed her medical training at William Beaumont Hospital in Royal Oak, Michigan where she served as chief resident and received the RSNA Roentgen Resident Research Award. Dr. Jolly then joined the faculty at the University of Michigan Department of Radiation Oncology. Dr. Jolly directs the treatment of thoracic, gynecologic and endocrine malignancies. She also serves as the director of Brachytherapy, specializing in High Dose Rate (HDR) brachytherapy procedures. Additionally, she is the principal investigator of numerous clinical protocols designed to individualize the radiation therapy of lung and gynecologic cancer patients. Dr. Jolly has authored numerous publications in peer-reviewed journals. As Associate chair of Community Practices, she oversees the standardization and quality of care of patients receiving radiation therapy at the numerous UM Radiation Oncology community practices across the state of Michigan. In addition, she serves as a consultant for the Michigan Radiation Oncology Quality Consortium (MROQC) focused on quality improvement in patients undergoing radiation therapy for breast cancer, lung cancer and bone metastases.

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