Palliative radiation for bone metastases from hepatocellular carcinoma: practice patterns and the amount of remaining life spent receiving treatment. Ann Palliat Med 2022 Jun;11(6):1900-1910
Date
02/12/2022Pubmed ID
35144390DOI
10.21037/apm-21-2657Scopus ID
2-s2.0-85133689481 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Palliative radiation therapy (RT) for bone metastases (BMs) is a common practice. Wide variation exists in clinically used dose schema despite numerous studies demonstrating palliative equipoise between single and multifraction courses. We hypothesize that fraction scheme for palliating BMs for hepatocellular carcinoma (HCC) significantly affects how patients spend their remaining time.
METHODS: Patients with osseous HCC metastases who received RT were identified from the National Cancer Database [2004-2013]. The percentage of remaining life spent receiving radiation therapy (PRLSRT) and the number of incomplete RT courses were calculated. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate trends and predictors.
RESULTS: A total of 1,331 patients met the inclusion criteria. Median overall survival (OS) was 3.3 months. Just 49 (3.7%) of patients received single fraction RT and 34% received >10 fractions. The mean and median PRLSRT were as follows: 1 fraction (8.9% and 3.0%), 2-5 fractions (32.9% and 24.3%), 6-10 fractions (27.2% and 15.9%), and >10 fractions (24.1% and 14.4%). Of the patients with PRLSRT >50%, 99.6% received multifraction RT. The proportion of incomplete RT courses increased as fraction size decreased from 17.6% with 4 Gy to 34% with 2 Gy.
CONCLUSIONS: Single fraction palliative RT is vastly underutilized despite no additional palliative benefit with multifraction RT. PRLSRT significantly increased with multifraction RT. In the palliative treatment of painful BMs from HCC, single fraction treatment reduces time spent receiving radiation treatments and maximizes the number of patients who complete the prescribed treatment.
Author List
Schmid RK, Johnstone CA, Robbins JRAuthor
Candice A. Johnstone MD, MPH Professor in the Radiation Oncology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Bone NeoplasmsCarcinoma, Hepatocellular
Humans
Liver Neoplasms
Pain
Palliative Care