Keywords:
Outcomes, Image guided radiotherapy, Radiation therapy / Oncology, CT, Oncology, Management, Radiotherapy techniques
Authors:
R. Bamford1, T. Smith2, S. Needleman2; 1Stevenage/UK, 2London/UK
DOI:
10.26044/ecr2019/C-0438
Conclusion
In accordance with the Royal College of Radiology guidelines,
a single 8Gy fraction was the most commonly used treatment for painful bony metastases at the Royal Free NHS Foundation Trust.
However, a significant number of patients were treated with multi-fractionation,
particularly 20Gy in 5 fractions.
Whilst it could be argued that radiotherapy should be delivered on an individual basis and there are many reasons for multi-fractionation,
it should be noted that the high mortality of the cohort supports a single fraction to reduce the burden of treatment for patients with poor prognosis.
Not only is reducing the amount of time spent in hospital beneficial to patients with poor prognosis,
but as the response to radiotherapy can take up to 4-6 weeks [3],
there should be careful consideration over which patients are recommended palliative radiotherapy,
especially as it can worsen pain for a period before improving it.
Whilst the majority of our patients continue to be treated using simpler techniques,
more complex technique’s including CT-planned VMAT treatments are being used for select patients. In our study,
these patients were younger (mean age 58.8 vs.
69.3) and,
notably,
both patients with cancer of unknown primary (CUP) were treated with VMAT.
33% of these select patients died within 30 days of radiotherapy,
as opposed to 17.1% of the cohort.
There is no doubt that more complex techniques are important in palliative radiotherapy,
especially with improving survival of oncology patients,
but it is also essential to select these patients carefully.
VMAT is costly but,
more importantly,
time consuming compared to 2D techniques.