Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 10;62(2):356-363.
doi: 10.1093/jrr/rraa133.

Practice patterns for postoperative radiation therapy in patients with metastases to the long bones: a survey of the Japanese Radiation Oncology Study Group

Hikaru Kubota  1 , Naoki Nakamura  2 , Naoto Shikama  3 , Ayako Tonari  4 , Hitoshi Wada  5 , Hideyuki Harada  6 , Hisayasu Nagakura  7 , Joichi Heianna  8 , Kei Ito  9 , Miwako Nozaki  10 , Masao Tago  11 , Masato Fushiki  12 , Nobue Uchida  13 , Norio Araki  14 , Shuhei Sekii  1 , Takashi Kosugi  15 , Takeo Takahashi  16 , Terufumi Kawamoto  3 , Tetsuo Saito  17 , Kazunari Yamada  18
Affiliations

Practice patterns for postoperative radiation therapy in patients with metastases to the long bones: a survey of the Japanese Radiation Oncology Study Group

Hikaru Kubota et al. J Radiat Res. .

Abstract

Evidence regarding postoperative radiation therapy (PORT) for metastases to the long bones is lacking. Characterizing the current practice patterns and identifying factors that influence dose-fractionation schedules are essential for future clinical trials. An internet-based survey of the palliative RT subgroup of the Japanese Radiation Oncology Study Group was performed in 2017 to collect data regarding PORT prescription practices and dose-fractionation schedules. Responders were also asked to recommend dose-fractionation schedules for four hypothetical cases that involved a patient with impending pathological fractures and one of four clinical features (poor prognosis, solitary metastasis, radio-resistant primary tumor or expected long-term survival). Responders were asked to indicate their preferred irradiation fields and the reasons for the dose fractionation schedule they chose. Responses were obtained from 89 radiation oncologists (67 institutions and 151 RT plans) who used 22 dose-fractionation schedules, with the most commonly used and recommended schedule being 30 Gy in 10 fractions. Local control was the most common reason for preferring longer-course RT. High-dose fractionated schedules were preferred for oligometastasis, and low-dose regimens were preferred for patients with a poor prognosis; however, single-fraction RT was not preferred. Most respondents recommended targeting the entire orthopedic prosthesis. These results indicated that PORT using 30 Gy in 10 fractions to the entire orthopedic prosthesis is preferred in current Japanese practice and that single-fraction RT was not preferred. Oligometastasis and poor prognosis influenced the selection of high- or low-dose regimens.

Keywords: bone metastases; long bones; oligometastasis; patterns of practice; postoperative radiation therapy.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Dose-fractionation regimens used at the Japanese Radiation Oncology Study Group institutions. Single fraction: 14.4 Gy (BED10); fractionated low dose: 22.5–37.5 Gy; 30 Gy in 10 fractions: 39 Gy (BED10); fractionated intermediate dose: 39.2–59.5 Gy; fractionated high dose: ≥60 Gy.
Fig. 2.
Fig. 2.
Dose-fractionation regimens recommended for hypothetical cases. The black bar represents case 1 (relatively limited survival), the gray bar represents case 2 (presence of oligometastasis), the dotted bar represents case 3 (radio-resistant primary tumor), and the hatched bar represents case 4 (expected long survival). Single fraction: 14.4 Gy (BED10); fractionated low dose: 22.5–37.5 Gy; 30 Gy in 10 fractions: 39 Gy (BED10); fractionated intermediate dose: 39.2–59.5 Gy; fractionated high dose: ≥60 Gy.
Fig. 3.
Fig. 3.
Respondents’ reasons for not recommending 8 Gy in 1 fraction or 20 Gy in 5 fractions for hypothetical case 1. Multiple response were allowed for this question. A total of 68 respondents recommended longer-course radiation therapy for case 1.
Fig. 4.
Fig. 4.
Recommended irradiation fields for postoperative radiation therapy.
See this image and copyright information in PMC

References

    1. Schulman KL, Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer 2007;109:2334–42. - PubMed
    1. Chow E, Nguyen J, Zhang L et al. International field-testing of the reliability and validity of the EORTC QLQ-BM22 module to assess health-related quality of life in patients with bone metastases. Cancer 2012;118:1457–65. - PubMed
    1. Tubiana-Hulin M. Incidence, prevalence and distribution of bone metastases. Bone 1991;12:S9–10. - PubMed
    1. Rich SE, Chow R, Raman S et al. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol 2018;126:547–57. - PubMed
    1. Saito T, Toya R, Oya N. Pain response rates after conventional radiation therapy for bone metastases in prospective nonrandomized studies: A systematic review. Pract Radiat Oncol 2019;9:81–8. - PubMed