Aims

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.

Materials and methods

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.

Results

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.

Conclusion

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.

中文翻译：

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澳大利亚肺癌骨转移姑息性放疗实践模式的演变

宗旨

放射治疗是治疗骨转移的有效方法。单次适形放疗 (SF-CRT) 与多次放疗在治疗无并发症的骨转移方面同样有效。放射肿瘤学中的先进放射治疗技术 (ART) 得到了快速发展。我们评估了 SF-CRT 和 ART 用于管理肺癌骨转移的变化模式。

材料和方法

这是来自澳大利亚维多利亚州的全州肺癌患者队列，他们在 2012 年至 2017 年期间接受了骨转移放射治疗。主要结果是使用以下放射治疗课程的比例：SF-CRT 和 ART。我们确定了一个亚组，其中在生命末期 (EOL)，即在死亡 30 天内进行放射治疗。Cochran-Armitage 趋势检验用于评估 SF-CRT 和 ART 使用模式随时间的变化。多变量分析用于确定与主要结果相关的因素。

结果

在肺癌骨转移的 4335 个放射治疗疗程中，20% 是 SF- CRT——从 2012 年的 19% 增加到 2017 年的 26%（P趋势 = 0.004）。在多变量分析中，肋骨、肩部、髋部或四肢的治疗以及公共机构的治疗与 SF-CRT 的使用独立相关，但放射治疗年份的影响不再显着。5% 的放射治疗是使用 ART 进行的，从 2016 年起显着增加（P-趋势 < 0.001）。在多变量分析中，私立机构的治疗和最近几年的治疗与 ART 的使用独立相关。在 EOL 进行了 587 个放射治疗疗程，SF-CRT 在接近死亡时更常用——53%、29% 和 25% 在死亡后 7 天、8-14 天和 15-30 天内进行放射治疗，分别。

结论

在澳大利亚，SF-CRT 继续用于肺癌骨转移，包括 EOL。我们观察到自 2016 年以来骨转移的 ART 使用有所增加，这与政府资金的变化同时发生。