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ORIGINAL RESEARCH article
Front. Oncol.
Sec. Radiation Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1432916
Implications of Primary Tumor Site and Fraction Size on Outcomes After Palliative Radiation for Osseous Metastases
Provisionally accepted- 1 Cancer Center, University of Arizona, Tucson, United States
- 2 University of California, Irvine, Irvine, California, United States
This study reviewed the palliative radiation therapy (RT) practices, outcomes, and compared the percentage of remaining life spent receiving RT (PRLSRT) for patients treated with RT for osseous metastases.A retrospective analysis was conducted using the National Cancer Database from 2010-2016, including metastatic patients who received palliative bone RT. Common palliative RT schemes were evaluated to determine treatment patterns and outcomes. Palliative outcomes of median PRLSRT, RT completion, and mortality rates were calculated. A binary logistic regression was performed to identify factors affecting RT completion and a scoring system to identify patients with potential poor palliative outcomes was created.50,929 patients were included, predominantly with NSCLC (45.2%), breast (15.1%), and prostate (10.8%). Median overall survival after palliative RT was 5.74 months. Patients receiving lower dose per fraction (2.5Gy/Fx) tended to be younger, healthier, and yet experienced worse palliative outcomes. Binary logistic regression indicated age, race, income quartile, and Gy/Fx were significant factors affecting RT completion. Median PRLSRTs were: 14.95% GI NOS, 9.89% upper GI, 9.46% NSCLC, 8.67% skin, 7.06% SCLC, 6.10% lower GI, 5.59% GYN, 5.44% GU, 5.35% HNC, 2.05% endocrine, 2.03% prostate, and 1.82% breast. Those receiving 2.5Gy/Fx and 3Gy/Fx were less likely to complete RT vs 4Gy/Fx, (OR 1.429 and 3.780 respectively, p<0.001). Age, comorbidities, primary tumor, target location, and metastatic burden were associated with PRLSRT ≥25%.Dose regimens and patient selection impacts palliative bone RT outcomes. Both should be considered to minimize the burden of care and maximize benefits of treatment.
Keywords: PRLSRT, palliative radiation, NCDB (national cancer database), Metastatic bone disease, palliative RT fractionation
Received: 14 May 2024; Accepted: 03 Mar 2025.
Copyright: © 2025 McDougall, Ho, Hsu and Robbins. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jared Rex Robbins, Cancer Center, University of Arizona, Tucson, United States
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