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Single-fraction radiation retreatment for bone metastases: role of a rapid access clinic
  1. Minsoo Kim1,
  2. Jose Alberto Maldonado1,2,
  3. Prasamsa Pandey1,
  4. Molly B El Alam1,
  5. Ramez Kouzy1,
  6. Kaitlin Christopherson1,
  7. Bruce D Minsky1,
  8. Quynh-Nhu Nugyen1,
  9. David Grosshans1,
  10. Lilie L Lin1,
  11. Melissa P Mitchell1,
  12. Ann H Klopp1,
  13. Percy P Lee1,
  14. Justin Bird3,
  15. Robert Satcher3,
  16. Valerae O Lewis3,
  17. Patrick P Lin3,
  18. Chad Tang1,
  19. Albert C Koong1,
  20. Bryan Moon3 and
  21. Lauren E Colbert1
  1. 1 Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  3. 3 Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Lauren E Colbert; LColbert{at}mdanderson.org

Abstract

Objectives This study investigates retreatment rates in single-fraction radiation therapy (SFRT) for painful bone metastasis in patients with limited life expectancy. We compared retreatment-free survival (RFS) in patients from a rapid access bone metastases clinic (RABC) and non-RABC patients, identifying factors associated with retreatment.

Methods In this observational study, we analysed RABC patients who received SFRT between April 2018 and November 2019, using non-RABC SFRT patients as a comparison group. Patients with prior or perioperative radiation therapy (RT) were excluded. The primary endpoint was same-site and any-site retreatment with RT or surgery. Patient characteristics were compared using χ2 and Student’s t-tests, with RFS estimates based on a multistate model considering death as a competing risk using Aalen-Johansen estimates.

Results We identified 151 patients (79 RABC, 72 non-RABC) with 225 treatments (102 RABC, 123 non-RABC) meeting eligibility criteria. Of the 22 (10.8%) same-site retreatments, 5 (22.7%) received surgery, 14 (63.6%) received RT and 3 (13.6%) received both RT and surgery. We found no significant differences in any-site RFS (p=0.97) or same-site RFS (p=0.11).

Conclusions RFS is high and similar comparable in the RABC and non-RABC cohorts. Retreatment rates are low, even in patients with low Eastern Cooperative Oncology Group scores.

  • Palliative Care
  • Cancer
  • Bone
  • Pain
  • Supportive care

Data availability statement

Data are available upon reasonable request. Data is available upon reasonable request and with appropriate protocols.

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Data availability statement

Data are available upon reasonable request. Data is available upon reasonable request and with appropriate protocols.

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Footnotes

  • MK and JM contributed equally.

  • BM and LEC contributed equally.

  • Contributors MK and JAM contributed equally as first authors. BM and LEC contributed equally as senior authors. LEC is the corresponding author. LEC is the guarantor.

  • Funding This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award NRSA (TL1) Training Core (TL1TR001440) from the National Center for Advancing Translational Sciences, National Institutes of Health.

  • Competing interests PPLee reports personal fees and non-financial support from Viewray, Inc., grants, personal fees and non-financial support from AstraZeneca, Inc., personal fees and non-financial support from Varian, Inc, outside the submitted work. PPLin reports book royalties from Springer Nature, outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.