Purpose

Radiation therapy effectively palliates bone metastases, although variability exists in practice patterns. National recommendations advocate against using extended fractionation (EF) with courses greater than 10 fractions. We previously reported EF use of 14.8%. We analyzed practice patterns within a statewide quality consortium to assess EF use in a larger patient population after implementation of a quality measure focused on reducing EF.

Methods and Materials

Patients treated for bone metastases within a statewide radiation oncology quality consortium were prospectively enrolled from March 2018 through October 2020. The EF quality metric was implemented March 1, 2018. Data on patient, physician, and facility characteristics; fractionation schedules; and treatment planning and delivery techniques were collected. Multivariable binary logistic regression was used to assess EF.

Results

Twenty-eight facilities enrolled 1445 consecutive patients treated with 1934 plans. The median number of treatment plans per facility was 52 (range, 7-307). Sixty different fractionation schedules were used. EF was delivered in 3.4% of plans. Initially, EF use was lower than expected and remained low over time. Significant predictors for EF use included complicated metastasis (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.04-4.02; P = .04), lack of associated central nervous system or visceral disease (OR, 2.27; 95% CI, 1.2-4.2; P = .01), nonteaching versus teaching facilities (OR, 8.97; 95% CI, 2.1-38.5; P < .01), and treating physicians with more years in practice (OR, 12.82; 95% CI, 3.9-42.4; P < .01).

Conclusions

Within a large, prospective population-based data set, fractionation schedules for palliative radiation therapy of bone metastases remain highly variable. Resource-intensive treatments including EF persist, although EF use was low after implementation of a quality measure. Complicated metastases, lack of central nervous system or visceral disease, and treatment at nonteaching facilities or by physicians with more years in practice significantly predict use of EF. These results support ongoing efforts to more clearly understand and address barriers to high-value radiation approaches in the palliative setting.

中文翻译：

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骨转移姑息性放射治疗的当代实践模式：质量改进项目对扩大分割的影响

目的

放射治疗有效地减轻了骨转移，尽管实践模式存在差异。国家建议反对使用超过 10 个分数的课程的扩展分数 (EF)。我们之前报告的 EF 使用率为 14.8%。我们分析了全州质量联盟内的实践模式，以评估在实施以降低 EF 为重点的质量措施后，在更大的患者群体中使用 EF。

方法和材料

从 2018 年 3 月到 2020 年 10 月，前瞻性地在全州放射肿瘤学质量联盟中接受骨转移治疗的患者入组。EF 质量指标于 2018 年 3 月 1 日实施。有关患者、医生和设施特征的数据；分馏时间表；收集了治疗计划和实施技术。多变量二元逻辑回归用于评估 EF。

结果

28 个设施连续招募了 1445 名接受 1934 个计划治疗的患者。每个设施的治疗计划中位数为 52（范围，7-307）。使用了六十种不同的分馏方案。EF 在 3.4% 的计划中交付。最初，EF 的使用低于预期，并且随着时间的推移保持在低水平。使用 EF 的重要预测因素包括复杂转移（优势比 [OR]，2.04；95% 置信区间 [CI]，1.04-4.02；P  = .04），缺乏相关的中枢神经系统或内脏疾病（OR，2.27；95 % CI, 1.2-4.2; P  = .01)，非教学设施与教学设施 (OR, 8.97; 95% CI, 2.1-38.5; P < .01)，以及执业医师年限更长 (OR, 12.82; 95 % CI，3.9-42.4；P < .01)。

结论

在一个庞大的、基于人群的前瞻性数据集中，骨转移姑息性放射治疗的分割方案仍然高度可变。包括 EF 在内的资源密集型治疗仍然存在，尽管在实施质量措施后 EF 的使用率很低。复杂的转移灶、缺乏中枢神经系统或内脏疾病，以及在非教学机构或有多年实践经验的医生进行的治疗显着预测 EF 的使用。这些结果支持正在进行的努力，以更清楚地理解和解决姑息治疗中高价值放射方法的障碍。