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Title: Evolving Practice Pattern of Palliative Radiation Therapy for Bone Metastases from Lung Cancer in Australia.
Austin Authors: Ong, Wee Loon ;Ball, D L;Milne, R L;Foroudi, Farshad ;Millar, J L
Affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Central Clinical School, Monash University, Melbourne, Victoria, Australia
School of Clinical Medicine, University of Cambridge, Cambridge, UK
Radiation Oncology
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
Olivia Newton-John Cancer Wellness and Research Centre
Issue Date: Dec-2021
Date: 2021-08-05
Publication information: Clinical Oncology 2021; 33(12): e530-e539
Abstract: Radiation therapy is an effective treatment for bone metastases. Single-fraction conformal radiation therapy (SF-CRT) is equally effective as multifraction radiation therapy for the management of uncomplicated bone metastases. There has been a rapid development of advanced radiation therapy techniques (ART) in radiation oncology. We evaluated the changing pattern of SF-CRT and ART use for the management of bone metastases in lung cancer. This was a state-wide population-based cohort of lung cancer patients from Victoria, Australia, who received radiation therapy for bone metastases between 2012 and 2017. The primary outcomes were proportion of radiation therapy courses using: SF-CRT and ART. We identified a subcohort in which radiation therapy was delivered at the end of life (EOL), i.e. within 30 days of death. The Cochran-Armitage test for trend was used to evaluate the change in pattern of SF-CRT and ART use over time. Multivariable analyses were used to identify factors associated with the primary outcomes. Of the 4335 courses of radiation therapy for bone metastases in lung cancer, 20% were SF-CRT - increasing from 19% in 2012 to 26% in 2017 (P-trend = 0.004). In multivariate analyses, treatment to the rib, shoulder, hip or extremities, and treatment in public institutions were independently associated with SF-CRT use, but the effect of year of radiation therapy was no longer significant. Five per cent of radiation therapy was delivered using ART, increasing markedly from 2016 onwards (P-trend < 0.001). In multivariate analyses, treatment in private institutions and more recent years of treatment were independently associated with the use of ART. There were 587 courses of radiation therapy delivered at the EOL, with SF-CRT more commonly used closer to death - 53%, 29% and 25% of radiation therapy within 7 days, 8-14 days and 15-30 days of death, respectively. SF-CRT continued to be underutilised for bone metastases in lung cancer in Australia, including at the EOL. We observed an increase in ART use for bone metastases from 2016, which occurred contemporaneously with changes in government funding.
DOI: 10.1016/j.clon.2021.07.013
Journal: Clinical Oncology
PubMed URL: 34366206
Type: Journal Article
Subjects: Bone metastases
radiation therapy
Appears in Collections:Journal articles

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