Madeline Grade1, Julie Koenig1, Yushen Qian2, Navjot Sandhu2, Yufei Liu3, Brandon Turner1, Rie von Eyben2, Susan Knox2, Sara Dudley4. 1. Stanford University School of Medicine, Stanford, California. 2. Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California. 3. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. 4. Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: smadani1@jhmi.edu.
Abstract
PURPOSE: Emergent palliative radiation therapy (PRT) of symptomatic metastases can significantly increase the quality of life of patients with cancer. In some contexts, this treatment may be underused, but in others PRT may represent an excessively aggressive intervention. The characterization of the current use of emergent PRT is warranted for optimized value and patient-centered care. METHODS AND MATERIALS: This study is a cross-sectional retrospective analysis of all emergent PRT courses at a single academic tertiary institution across 1 year. RESULTS: A total of 214 patients received a total of 238 treatment courses. The most common indications were bone (39%) and brain (14%) metastases. Compared with outpatients, inpatients had lower mean survival rates (2 months vs 6 months; P < .001), higher rates of stopping treatment early (19.1% vs 9.0%; P = .034), and greater involvement of palliative care (44.8% vs 24.1%; P < .001), but the same mean planned fractions (9.10 vs 9.40 fractions; P = .669). In a multiple predictor survival analysis, palliative care involvement (P = .025), male sex (P = .001), ending treatment early (P = .011), and having 1 of 3 serious indications (airway compromise, leptomeningeal disease, and superior/inferior vena cava involvement; P = .007) were significantly associated with worse overall survival. CONCLUSIONS: Survival is particularly poor in patients who receive emergent PRT, and patient characteristics such as functional status and indication should be considered when determining fractionation schedule and dosing. A multi-institutional study of practice patterns and outcomes is warranted.
PURPOSE: Emergent palliative radiation therapy (PRT) of symptomatic metastases can significantly increase the quality of life of patients with cancer. In some contexts, this treatment may be underused, but in others PRT may represent an excessively aggressive intervention. The characterization of the current use of emergent PRT is warranted for optimized value and patient-centered care. METHODS AND MATERIALS: This study is a cross-sectional retrospective analysis of all emergent PRT courses at a single academic tertiary institution across 1 year. RESULTS: A total of 214 patients received a total of 238 treatment courses. The most common indications were bone (39%) and brain (14%) metastases. Compared with outpatients, inpatients had lower mean survival rates (2 months vs 6 months; P < .001), higher rates of stopping treatment early (19.1% vs 9.0%; P = .034), and greater involvement of palliative care (44.8% vs 24.1%; P < .001), but the same mean planned fractions (9.10 vs 9.40 fractions; P = .669). In a multiple predictor survival analysis, palliative care involvement (P = .025), male sex (P = .001), ending treatment early (P = .011), and having 1 of 3 serious indications (airway compromise, leptomeningeal disease, and superior/inferior vena cava involvement; P = .007) were significantly associated with worse overall survival. CONCLUSIONS: Survival is particularly poor in patients who receive emergent PRT, and patient characteristics such as functional status and indication should be considered when determining fractionation schedule and dosing. A multi-institutional study of practice patterns and outcomes is warranted.
Authors: Sebastian M Christ; Markus Schettle; Jonas Willmann; Maiwand Ahmadsei; Annina Seiler; David Blum; Matthias Guckenberger; Nicolaus Andratschke; Caroline Hertler Journal: Clin Transl Radiat Oncol Date: 2022-04-12
Authors: Sebastian M Christ; Markus Schettle; Annina Seiler; Matthias Guckenberger; David Blum; Nicolaus Andratschke; Caroline Hertler Journal: Clin Transl Radiat Oncol Date: 2021-07-04