Impact of Facility Case Volume on Radiation Schema and Outcomes in Palliative Radiation of Osseous Metastases

Abstract

<h3>Purpose/Objective(s)</h3> To compare how facility volume impacts palliative RT practices in patients with osseous metastases, radiation schema used, and outcomes of the applied therapies by analyzing the percentage of remaining life spent receiving RT (PRLSRT) and RT completion rates. <h3>Materials/Methods</h3> A retrospective analysis was conducted using the National Cancer Database (2010-2016). Facilities were grouped and analyzed according to case volume of patients treated with palliative RT for bone mets. Facilities were grouped by case volume (<10, 10-24, 25-49, 50-74, 75-99, 100-149, ≥150). Patterns of palliative RT schemes (extended fractionation (>10 fx), hypofractionation (5 or fewer), and single fraction (8 Gy)) and outcomes were evaluated for facilities based on case volume. PRLSRT and course completion rates were calculated. <h3>Results</h3> 52,864 patient cases from 1,312 facilities were included. Higher facility case volume was associated with facility type (Academic > Comprehensive Community > Integrated Network > Community Cancer Program), higher population areas, higher distance traveled for treatment, lower comorbidity, younger age, and private insurance. Higher volume facilities were associated with the use of higher dose per fraction, resulting in increased use of single fraction, hypofractionation, and less use of extended fractionation regimens (see Table 1). The use of shorter courses at high volume centers resulted in increased radiation completion rates, and remaining life spent receiving radiation. <h3>Conclusion</h3> For palliative treatment of osseous metastases, facilities with higher case volumes favor shorter courses of RT and have better outcomes measured by PRLSRT and higher rates of treatment completion. It should be considered whether facility volume and experience influence the adoption of hypofractionation for palliative treatment of bone mets and how to improve adoption of shorter courses among all volume facilities.