Variation in Practice Patterns of Korean Radiation Oncologists for Spine Metastasis between 2009 and 2014

Abstract

Purpose: The Korean Society of Radiation Oncologists (KOSRO) conducted the Patterns of Care Study (PCS) of radiotherapy (RT) for spine metastases in 2009. The current study was conducted to investigate current practice patterns and compare them with the results of the PCS.

Materials and methods: The survey questionnaire was composed of 10 questions regarding general information and seven questions for each of two clinical scenarios.

Results: Fifty-four members of the KOSRO answered at least one question on the web-based questionnaire. The yearly number of patients treated who underwent palliative spine RT was greater than 200 in 14 (25.9%), 51 to 100 in 13 (24.1%), and 31 to 50 in 11 respondents (20.4%). Scenario 1 described a patient presenting with cord compressive spine metastasis in multiple bones and liver metastasis from non-small cell lung cancer. Thirty gray (Gy) in 10 fractions was chosen by 35 respondents (64.8%). Scenario 2 described a case of a single spine metastasis without progression after targeted therapy. Thirty Gy in 10 fractions was chosen by 19 respondents (35.2%), and a single fraction or less than four fractions of stereotactic ablative radiotherapy (SABR) were selected by 18 respondents (33.3%). When compared with the 2009 PCS, practice patterns of Korean radiation oncologists had not changed significantly over 5 years, except that SABR emerged as a new treatment modality in the selected population.

Conclusion: The 2014 PCS demonstrated that multiple fraction RT is still preferred in a considerable proportion of Korean radiation oncologists.

Keywords: Data collection; Korea; Neoplasm metastasis; Physician’s practice patterns; Radiotherapy; Spine.

Fig. 1.

Practice pattern changes from 2009 to 2014 in similar scenarios with a short life expectancy. Preference for radiotherapy fractionation in a case with a Karnofsky performance status of 70 and T6-10 level spine metastases with multiple liver metastases in the current study (A). A similar case in the 2009 study with a similar performance status with L3 spine metastases and multiple liver and abdominal lymph nodes metastases (B) is presented. Many Korean radiation oncologists responded that they preferred the multiple fractionation regimen; these results were similar between the 2009 and 2014 studies.

Fig. 2.

Practice pattern changes from 2009 to 2014 in similar scenarios with favorable life expectancy. Preference for radiotherapy fractionation in the case with a Karnofsky performance status of 90 and solitary T9 level spine metastasis of renal cell carcinoma with stable disease of both lung and adrenal metastases after target therapy in the current study (A). A similar case of breast cancer with T6-7 spine only metastasis that had excellent performance status from the 2009 study (B) is displayed. Hypofractionation representing stereotactic ablative body radiotherapy was significantly increased compared with the results of the 2009 study, but the multiple fractionation scheme still accounted for a large proportion of answers.