Palliative radiation therapy (RT) for prostate cancer patients with bone metastases at diagnosis: A hospital-based analysis of patterns of care, RT fractionation scheme, and overall survival

Benjamin W. Fischer-Valuck, Brian C. Baumann, Anthony Apicelli, Yuan James Rao, Michael Roach, Mackenzie Daly, Maria C. Dans, Patrick White, Jessika Contreras, Lauren Henke, Hiram Gay, Jeff M. Michalski, Christopher Abraham

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Prostate cancer (PCa) is one of the most common malignancies associated with bone metastases, and palliative radiation therapy (RT) is an effective treatment option. A total of 2641 patients were identified with PCa and bone metastases at diagnosis from 2010 to 2014 in the NCDB. Fractionation scheme was designated as short course ([SC-RT]: 8 Gy in 1 fraction and 20 Gy in 5 fractions) vs long course ([LC-RT]: 30 Gy in 10 fractions and 37.5 Gy in 15 fractions). Patient characteristics were correlated with fractionation scheme using logistic regression. Overall survival was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. A total of 2255 (85.4%) patients were included in the LC-RT group and 386 (14.6%) patients in the SC-RT group. SC-RT was more common in patients over 75 years age (odds ratio [OR]: 1.70, 95% confidence interval [CI] 1.32-2.20), treatment at an academic center (OR: 1.76, 1.20-2.57), living greater than 15 miles distance to treatment facility (OR: 1.38, 1.05-1.83), treatment to the rib (OR: 2.99, 1.36-6.60), and in 2014 (OR: 1.73, 1.19-2.51). RT to the spine was more commonly long course (P <.0001). In the propensity-matched cohort, LC-RT was associated with improved OS (P <.0001), but no OS difference was observed between 37.5 Gy and either 8 Gy in one fraction or 20 Gy in 5 fractions (P >.5). LC-RT remains the most common treatment fractionation scheme for palliative bone metastases in PCa patients. Use of palliative SC-RT is increasing, particularly in more recent years, for older patients, treatment at academic centers, and with increasing distance from a treatment center.

Original languageEnglish
Pages (from-to)4240-4250
Number of pages11
JournalCancer medicine
Volume7
Issue number9
DOIs
StatePublished - Sep 2018

Keywords

  • National Cancer Database
  • metastatic prostate cancer
  • palliative radiation

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