Impact of Peer-Review Intervention on Radiotherapy Schedules for Palliative Treatment of Bone Metastases


Key Points

  • Use of 30 Gy in 10 fractions decreased from 55.2% to 47.4% postintervention.
  • Use of ≥ 11 fractions decreased from 16.2% to 5.8%.

In a single-center study reported in the Journal of Oncology Practice, Walker et al found that institution of a peer-review process resulted in shorter fractionation schedules for palliation of bone metastases, consistent with current guidelines.

As stated by the authors, “Shorter fractionation radiation regimens for palliation of bone metastases result in lower financial and social costs for patients and their caregivers and have similar efficacy as longer fractionation schedules, although practice patterns in the United States show poor adoption.”

Study Details

In June 2016, a practice of mandated peer review of total dose and fractionation for all patients receiving palliative treatment during weekly chart rounds was instituted in a single radiation oncology department, with the aim of improving compliance with recommended fractionation regimens. Length of treatment of uncomplicated bone metastases before and after implementation of the practice was compared.

Between July 2015 and December 2016, a total of 242 palliative treatment courses were delivered, including 105 courses before the peer-review intervention and 137 after the intervention. For preintervention vs postintervention, the use of 8 Gy in 1 fraction increased from 2.8% to 13.9% of cases, use of 20 Gy in 5 fractions increased from 25.7% to 32.8% of cases, use of 30 Gy in 10 fractions decreased from 55.2% to 47.4% (P = .002), and use of ≥ 11 fractions decreased from 16.2% to 5.8% (P = .006).

The investigators concluded, “Prospective peer review of palliative regimens for bone metastases can lead to greater adoption of shorter palliative fractionation schedules in daily practice, in accordance with national guidelines. This simple intervention may therefore benefit patients and their caregivers as well as provide value to the health-care system.”

Gary V. Walker, MD, MPH, of the Department of Radiation Oncology, Banner MD Anderson Cancer Center, is the corresponding author for the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.




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