Advanced Radiation Therapy Technology Use in the Treatment of Bone Metastases in a Public, Salary-Funded, Non-Incentivized Health Care System

Abstract

PURPOSE: There is limited evidence to support the routine use of conformal radiotherapy (RT) techniques in the treatment of bone metastases. This study evaluated trends in advanced technique use within the province of British Columbia. MATERIALS AND METHODS: Data on patients who received RT for bone metastases between 2009 and 2016 (with the exception of 2012) at 6 regional cancer centers were reviewed. Descriptive statistics summarized radiation technique patterns. Logistic regression assessed the influence of patient, treatment, and provider variables on receipt of RT technique. RESULTS: A total of 24,215 RT courses were identified; 97% were planned by simple RT and 3% by advanced techniques (3-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and stereotactic body radiotherapy). The use of advanced techniques was significantly higher in recent years compared with in 2009 (odds ratios [ORs], 2.2, 4.2, 4.2, and 6.3, respectively, for the years 2013 to 2016; P < .001). Patients with thyroid, sarcoma, and neuroendocrine malignancies (ORs, 10.3, 5.5, and 5.2, respectively; P < .005) were more likely to be treated with advanced techniques, as were skull, sternum, rib, and pelvic metastases (ORs, 8.0, 5.2, 2.2, and 2.2, respectively; P < .001). Advanced techniques were most commonly used in the setting of re-irradiation (38%). They were associated with slightly higher incompletion rates (3.0% v 1.5%, P < .005) and less use within 30 days of death (6% v 15%, P < .001). CONCLUSION: Within our publicly funded, salary-based provincial health care system, we found that the majority of bone metastases are still being treated by simple RT; however, the use of advanced techniques is increasing, and we identified select patterns in which they are being prescribed. Additional study into clinical benefit is required.