Prognostic Factors Influencing Survival and a Treatment Pattern Analysis of Conventional Palliative Radiotherapy for Patients with Bone Metastases.

Patricia Ignat,Radu-Mihai Ignat,Ofelia Șuteu,Nicolae Todor

doi:10.3390/curroncol28050331

Abstract

Background: Treatment indication for bone metastases is influenced by patient prognosis. Single-fraction radiotherapy (SFRT) was proven equally effective as multiple fractionation regimens (MFRT) but continues to be underused. Objective: Primary objectives: (a) to identify prognostic factors for overall survival and (b) to analyze treatment patterns of palliative radiotherapy (proportion of SFRT indication and predictive factors of radiotherapy regimen) for bone metastases. Methods: 582 patients with bone metastases who underwent conventional radiotherapy between January 1st 2014–31 December 2017 were analyzed. The Cox proportional hazard model was used to identify predictors of overall survival. For the treatment pattern analysis, 677 radiotherapy courses were evaluated. The logistic regression model was used to identify potential predictors of radiotherapy regimen. Results: The 3-year overall survival was 15%. Prognostic factors associated with poor overall survival were multiple bone metastases [hazard ratio (HR = 5.4)], poor performance status (HR = 1.5) and brain metastases (HR = 1.37). SFRT prescription increased from 41% in 2017 to 51% in 2017. Predictors of SFRT prescription were a poor performance status [odds ratio (OR = 0.55)], lung (OR = 0.49) and urologic primaries (OR = 0.33) and the half-body lower site of irradiation (OR = 0.59). Spinal metastases were more likely to receive MFRT (OR = 2.09). Conclusions: Based on the prognostic factors we identified, a selection protocol for patients candidates for palliative radiotherapy to bone metastases could be established, in order to further increase SFRT prescription in our institution.

Highlights

After excluding the patients with at least one radiotherapy course for bone metastases prior to 2014 (64 patients), and patients lost to follow-up (49 patients) a total of 582 patients remained in the study—347 patients in the multiple fractionation regimens (MFRT) group and 235 patients in the Single-fraction radiotherapy (SFRT) group (Figure 1)
The study group consisted of 582 patients who underwent 677 palliative radiotherapy courses on 829 bone metastatic sites
The most important factors significantly associated with a low survival risk were the presence of multiple bone metastases (HR = 5.4, 95%confidence intervals (CIs) [2.94–9.91], p < 0.001), a decreased performance status (HR = 1.5, 95%CI [1.38–1.69], p < 0.001) and the presence of brain metastases (HR = 1.37, 95%CI [1.08–1.73], p < 0.001)

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Bone metastases are one of the most frequent complications of advanced cancer. Lung and prostate cancer are responsible for the majority of bone metastases [1]. It is estimated that they appear in two thirds of the patients with these malignancies, affecting either the pelvic bones, the spine, or limbs [2]. Bone metastases can lead to complicationsfractures, hypercalcemia or spinal cord compression, affecting the performance status of patients and their quality of life [3]. Like fractures of spinal cord compression, the surgical approach is chosen for either a palliative or curative purpose

Objectives

Methods

Results

Discussion

Conclusion