Radiotherapy in oncological emergencies--final results of a patterns of care study in Germany, Austria and Switzerland

Abstract

Radiotherapy (RT) is an important treatment option for emergencies in oncology. A multicenter patterns of care study (PCS) was conducted in all RT institutions in Germany, Austria and Switzerland. In 2003 a standardized structured questionnaire was sent to all RT institutions. Number and type of staff involved, number of patients, over time distribution and expense, treatment indications and concepts of emergency RT were assessed. In addition, treatment outcome for the different indications was evaluated. The PCS was structured and analyzed according to the model for quality assessment set up by Donabedian in three major components: structure, process and outcome. One hundred and forty institutions (70%) answered the questionnaire. For the baseline of 2003 a total of 3244 emergency radiotherapy indications with a mean of 28 per institution were reported. Forty percent of all institutions provide a special 24 h service at night or weekends. Seventy percent of the emergency indications were irradiated between Monday and Thursday, 30% between Friday and Sunday. Ninety percent of all emergencies were referred to RT between 8 a.m. and 6 p.m., 10% between 6 p.m. and 8 a.m. The applied doses for emergency RT ranged between 2 Gy and 8 Gy (median: 3.5 Gy). Time expense was reported with a median of 90 min. The outcome analysis based on the treatment results of 1 033 patients: There was an improvement of myelocompression in 50% of the cases, vena cava superior compression in 70%, bronchial obstruction in 70% and bleedings in 80%. A clear dose-response relationship could not be established, but single doses of over 3 Gy in vena cava superior syndrome exhibited a significant advantage. This study represents the largest database in literature on emergency RT. RT was shown to be fast, time sparing and a very effective treatment option for special oncological emergencies.