[DG News] ASTRO - 뼈전이 방사선치료에 대한 표준치료 스케쥴 업데이트 (2017)

이번에 ASTRO에서 뼈 전이에 대한 방사선치료의 표준 스케쥴을 업데이트 하였다.

외래로 치료를 받으러 다니는 환자들의 특성 상 8 Gy / 1회 치료는 꽤 괜찮은 선택이다. 하지만, 그에 따라 SBRT에 준하는 IGRT는 꼭 필요하리라 본다.

아래 내용은 DG News의 요약이며, 전체 내용은 아래 링크에서 볼 수 있다.

※ 참조: DG News

※ 관련문서 전문 : Practical Radiation Oncology

Radiotherapy Continues to Be Gold Standard for Palliative Care of Painful Bone Metastases

February 15, 2017

ARLINGTON, Va -- February 15, 2017 -- The American Society for Radiation Oncology (ASTRO) has published an updated clinical guideline that underscores the safety and effectiveness of palliative radiation therapy (RT) for treating painful bone metastases.

Based on recent clinical trial data, the guideline recommends optimal RT dosing schedules for pain relief, including options for re-treatment.

The guideline is available as a free access article in Practical Radiation Oncology.

The updated guideline maintains the 4 previously recommended dosing schedules for external RT to treat previously unirradiated tumours: a single 8 Gray (Gy) fraction of RT; 20 Gy administered in 5 fractions; 24 Gy in 6 fractions; or 30 Gy in 10 fractions.

Research indicates that patients experience similar pain relief and toxicity rates with each of the fractionation options.

Although clinical trials have cited higher retreatment rates for patients who received single-fraction RT, the convenience of this option may make it the optimal choice for patients with limited life expectancy.

A recent analysis of clinical trial data published in JAMA Oncology recommended that a single 8-Gy radiotherapy dose for bone metastases should be offered to all patients, even those with poor survival.

Greater adoption of the single-fraction approach -- which requires only one visit -- also may reduce the disparity between the number of patients who would benefit from this therapy and the markedly small number who actually receive it.

Surveys of palliative care professionals indicate that the vast majority consider RT an important and effective component of hospice care but do not actually refer many of their patients for the therapy. In one study, for example, 88% of hospice professionals said that painful bone metastases merited referral for palliative RT, but only 3% of hospice patients nationwide actually received the treatment. Barriers including cost, transportation, and length of treatment were cited as key reasons for underutilisation.

“Decades of research and many clinical trials have established that radiation therapy provides safe, effective, and quick pain relief for patients suffering from bone metastases,” said Stephen Lutz, MD, Blanchard Valley Regional Health Center, Findlay, Ohio. “Moreover, this relief can be achieved in as little as a single fraction, which alleviates the additional burdens of time, travel and cost for the patient.”

In addition to primary treatment, the guideline also addresses retreatment of bone metastases. It recommends that reirradiation should be considered if patients experience recurrent or persistent pain more than a month following external-beam radiation therapy (EBRT) to treat peripheral bone metastases or spine lesions. Research demonstrates moderate effectiveness for reirradiation (a 2014 systematic review and meta-analysis found an overall pain response rate of 58%).

The guideline also considers the role of advanced RT techniques, such as stereotactic body radiation therapy (SBRT), in primary treatment and retreatment of painful bone metastases. This precise targeting is particularly important for tumour sites near multiple surrounding organs, such as the lung or prostate, or complex sites, such as the neural system.

While emerging evidence points to the potential of SBRT to treat spinal metastases, research in this area is limited compared with the data supporting EBRT. Accordingly, the guideline recommends that the use of advanced RT techniques for primary treatment or retreatment of spinal lesions should be considered only in clinical trial or registry settings. It also recommends that physicians consult the current ASTRO white paper on SBRT to inform their treatment decisions.

The guideline was based on a systematic literature review of studies published from December 2009, the last date that was searched for the original 2011 guideline, through January 2015. A total of 414 abstracts were retrieved from PubMed, and the 56 articles that met inclusion criteria (including 20 randomised controlled trials, 32 nonrandomised prospective studies, and 4 meta-analyses or pooled analyses) were abstracted into evidence tables and evaluated by an 8-member expert panel of radiation oncologists and topic experts in metastatic disease.

SOURCE: American Society for Radiation Oncology