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Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis.

ABSTRACT: PURPOSE:Palliative radiation therapy for bone metastases is often viewed as a single entity, despite national guidelines providing input principally only for painful uncomplicated bone metastases. Data surrounding the treatment of bone metastases are often gleaned from questionnaires of what providers would theoretically do in practice or from population-based data lacking critical granular information. We investigated the real-world treatment of bone metastases with radiation therapy. METHODS AND MATERIALS:Twenty diverse institutions across the state of Michigan had data extracted for their 10 most recent cases of radiation therapy delivered for the treatment of bone metastases at their institution between January and February 2017. Uni- and multivariable binary logistic regression was used to assess the use of single fraction (8 Gy × 1) radiation therapy. RESULTS:A total of 196 cases were eligible for inclusion. Twenty-eight different fractionation schedules were identified. The most common schedule was 3 Gy × 10 fractions (n = 100; 51.0%), 4 Gy × 5 fractions (n = 32; 16.3%), and 8 Gy × 1 (n = 15; 7.7%). The significant predictors for the use of single fraction radiation therapy were the presence of oligometastatic disease (P = .008), previous overlapping radiation therapy (P = .050), and academic practice type (P = .039). Twenty-nine cases (14.8%) received >10 fractions (median 15, range 11-20). Intensity modulated radiation therapy was used in 14 cases (7.1%), stereotactic body radiation therapy in 11 (5.6%), and image guidance with cone beam computed tomography in 11 (5.6%). Of the cases of simple painful bone metastases (no previous surgery, spinal cord compression, fracture, soft tissue extension, or overlapping previous radiation therapy; n = 70), only 12.9% were treated with 8 Gy × 1. CONCLUSIONS:Bone metastases represent a heterogeneous disease, and radiation therapy for bone metastases is similarly diverse. Future work is needed to understand the barriers to single fraction use, and clinical trials are necessary to establish appropriate guidelines for the breadth of this complex disease.

SUBMITTER: Spratt DE

PROVIDER: S-EPMC6844366 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis.

Spratt Daniel E DE Mancini Brandon R BR Hayman James A JA Boike Thomas T Pierce Lori J LJ Moran Jean M JM Dominello Michael M MM Fireman Mark M Griffith Kent K Jolly Shruti S

International journal of radiation oncology, biology, physics 20180306 2

<h4>Purpose</h4>Palliative radiation therapy for bone metastases is often viewed as a single entity, despite national guidelines providing input principally only for painful uncomplicated bone metastases. Data surrounding the treatment of bone metastases are often gleaned from questionnaires of what providers would theoretically do in practice or from population-based data lacking critical granular information. We investigated the real-world treatment of bone metastases with radiation therapy.<h ...[more]

PMID: 29726364

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Project description:BackgroundElucidation of mechanisms regulating bone metastasis has progressed significantly in recent years and this has translated to many new therapeutic options for patients with bone metastatic cancers. However, the rapid rate of progress in both the basic science literature and therapies undergoing clinical trials makes staying abreast with current developments challenging. This review seeks to provide an update on the current state of the science in bone metastasis research and give a snap shot of therapies in clinical trials for bone metastatic cancer.Main bodyBone metastasis represents a difficult to treat clinical scenario due to pain, increased fracture risk, decreased quality of life and diminished overall survival outcomes. Multiple types of cancer have the specific ability to home to the bone microenvironment and cause metastatic lesions. This osteotropism was first described by Stephen Paget nearly 100 years ago as the 'seed and soil' hypothesis. Once cancer cells arrive at the bone they encounter a variety of cells native to the bone microenvironment which contribute to the establishment of bone metastatic lesions. In the first part of this review, the 'seed and soil' hypothesis is revisited while emphasizing recent developments in understanding the impact of native bone microenvironment cells on the metastatic process. Next, approved therapies for treating bone metastasis at the systemic level as well as those that target the bone microenvironment are discussed and current National Comprehensive Cancer Network (NCCN) guidelines relating to treatment of bone metastases are summarized. Finally, all open interventional clinical trials for therapies relating to treatment of bone metastasis have been complied and categorized.ConclusionUnderstanding the recent advancements in bone metastasis research is important for continued development of novel bone targeted therapies. The plethora of ongoing clinical trials will hopefully translate into improved treatments options for patients suffering from bone metastatic cancers.

Project description:BackgroundWe introduced a new surgical method of percutaneous hollow perforated screw (HPS) fixation with concomitant bone-cement injection for the treatment of femoral neck metastasis and evaluated its efficacy for the palliative treatment of patients with advanced cancer.MethodsThe study included 87 patients (39 men and 48 women; mean age [and standard deviation], 64.2 ± 10.2 years; mean body mass index, 24.3 ± 3.2 kg/m2) who underwent percutaneous HPS fixation and cementoplasty (mean cement amount, 19.8 ± 8.3 mL) for the treatment of unilateral or bilateral femoral neck metastasis (total, 95 sites). Anesthesia type, operative time, operative blood loss, pain score changes (according to a visual analog scale [VAS]), walking status, and complications were assessed. The mean duration of follow-up was 10.1 ± 10.8 months (range, 2 to 43 months).ResultsThe majority of procedures were performed with local (3 patients) or spinal (72 patients) anesthesia (total, 75 patients; 86.2%). The mean operative time was 35.9 minutes, and the mean operative blood loss was 97.0 mL. The VAS score for pain improved significantly, from 6.8 ± 2.8 preoperatively to 2.8 ± 2.3 and 2.9 ± 2.8 at 1 and 6 weeks postoperatively (p < 0.001). At 6 weeks postoperatively, 63 (80.8%) of 78 patients were able to walk (with either normal or limping gait, a cane or crutch, or a walker). The prevalence of major local complications (cement leakage into the hip joint, fixation failure) was 10.5% (10 of 95), but major systemic complications (distant cement embolism) were not found.ConclusionsPercutaneous HPS fixation and cementoplasty for the treatment of femoral neck metastasis is a minimally invasive technique that provides effective pain relief and early stabilization. This technique seems to be useful for patients with advanced cancer for whom open surgery would be hazardous.Level of evidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Project description:The goal of this study was to assess the frequency and predictors of vascular closure device (VCD) deployment failure, and its association with vascular complications of 3 commonly used VCDs.VCDs are commonly used following percutaneous coronary intervention on the basis of studies demonstrating reduced time to ambulation, increased patient comfort, and possible reduction in vascular complications as compared with manual compression. However, limited data are available on the frequency and predictors of VCD failure, and the association of deployment failure with vascular complications.From a de-identified dataset provided by Massachusetts Department of Health, 23,813 consecutive interventional coronary procedures that used either a collagen plug-based (n = 18,533), a nitinol clip-based (n = 2,284), or a suture-based (n = 2,996) VCD between June 2005 and December 2007 were identified. The authors defined VCD failure as unsuccessful deployment or failure to achieve immediate access site hemostasis.Among 23,813 procedures, the VCD failed in 781 (3.3%) procedures (2.1% of collagen plug-based, 6.1% of suture-based, 9.5% of nitinol clip-based VCDs). Patients with VCD failure had an excess risk of "any" (7.7% vs. 2.8%; p < 0.001), major (3.3% vs. 0.8%; p < 0.001), or minor (5.8% vs. 2.1%; p < 0.001) vascular complications compared with successful VCD deployment. In a propensity score-adjusted analysis, when compared with collagen plug-based VCD (reference odds ratio [OR] = 1.0), nitinol clip-based VCD had 2-fold increased risk (OR: 2.0, 95% confidence interval [CI]: 1.8 to 2.3, p < 0.001) and suture-based VCD had 1.25-fold increased risk (OR: 1.25, 95% CI: 1.2 to 1.3, p < 0.001) for VCD failure. VCD failure was a significant predictor of subsequent vascular complications for both collagen plug-based VCD and nitinol clip-based VCD, but not for suture-based VCD.VCD failure rates vary depending upon the type of VCD used and are associated with significantly higher vascular complications as compared with deployment successes.

Dataset Information

Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis.

Publications

Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis.

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