409 / 1096
S394
ESTRO 36
_______________________________________________________________________________________________
respectively. The directives were reviewed with physician
staff within in the first week of enactment; directives
were allowed to be edited at the physician’s discretion if
an alternative fx was indicated. Patients treated with
SBRT were excluded from analysis. Retrospective chart
review of patients treated between 1/2012 and 9/2016
revealed 1233 treatment courses (888 unique patients).
Statistical analysis included the Chi square test.
Results
Following implementation, treatment directives were
used for 89% of cases (n=125) and were modified to an
alternative prescription in 17 cases. Among directive-
based treatments, 27% were simple metastases and 73%
were complex. Single fx use increased from 17% to 25%
among palliative bone metastasis treatments (p=0.02) and
hypofractionation (1 or 5 fx) utilization increased from 72%
to 88% (p<0.001)(Figure 1). Among simple and complex
treatments, the default fractionations (1 fx or 5 fx,
respectively) were selected in 84% and 87% of cases.
Conclusion
Setting defaults for palliative treatment through an
institution-wide adoption of evidence-based, treatment-
guiding directives proved to be a straightforward and
successful intervention, which significantly increased the
utilization of hypofractionation. Our data suggests that
treatment directives may be a useful approach in
overcoming resistance to other hypofractionated
treatment paradigms. Further palliative treatment
directive use is planned within our institution for other
sites (lung, pelvis). We believe that widespread
examination and adoption of evidence-based directives
can be used to improve value and reduce overtreatment
in palliative oncologic care.
Poster: Clinical track: Elderly
PO-0748 Efficacy of radiotherapy for painful bone
metastases in elderly patients
J. Cacicedo
1
, A. Gomez-Iturriaga
1
, L. Sanchez
2
, A.
Navarro
3
, V. Morillo
4
, P. Willisch
5
, C. Carvajal
6
, E.
Hortelano
7
, J. Lopez-Guerra
8
, A. Illescas
9
, F. Casquero
6
,
O. Del Hoyo
6
, R. Ciervide
10
, L. Martinez-Indart
11
, P.
Bilbao
6
1
Hospital Universitario de Cruces, Radiation Oncology-
Cruces University Hospital, Baracaldo-Vizcaya, Spain
2
Univesrsity of the Basque country, Medicine Faculty,
Barakado, Spain
3
Instituto Catalán de Oncologia, Radiation Oncology,
Hospitalet Barcelona, Spain
4
Hospital de Castellón, Radiation Oncology, Castellón,
Spain
5
Hospital Meixoeiro, Radiation Oncology, Vigo, Spain
6
Hospital Universitario de Cruces, Radiation Oncology,
Barakaldo, Spain
7
Hospital Txagorritxu, Radiation Oncology, Vitoria, Spain
8
Hospital Virgen del Rocio, Radiation Oncology, Sevilla,
Spain
9
Hospital Virgen Macarena, Radiation Oncology, Sevilla,
Spain
10
Hospital Sanchinarro, Radiation Oncology, Madrid,
Spain
11
Cruces University Hospital, Clinical Epidemiology Unit,
Barakaldo, Spain
Purpose or Objective
Elderly frequently receive different medical treatments
than younger patients because of fear of higher toxicity
and expected lower effectiveness. Painful bone
metastases have a major impact on quality of life of
cancer patients. We investigated whether age is a
predictor for pain response after radiotherapy (RT) for
painful bone metastases.
Material and Methods
Between June 2010 and June 2014, 204 pati ents from ten
Radiation Oncology Departments in Spain parti cipated in
a prospective observational study* to evaluat e the flare
effect in patients with bone metastasis undergoing
palliative RT. The pre-treatment evaluation con sisted of
a full history and physical examination, administration of
Brief Pain Inventory (BPI) and record of analgesic
consumption within the previous 24 h.
A follow-up visit was scheduled 4-weeks after the end of
the RT. At this time the BPI was again administered, and
analgesic consumption was recorded.
From this cohort, 128 patients (62.7%) completed the BPI
at the first visit and in the follow-up (4-weeks after RT),
and therefore were evaluable for treatment response in
the present study. Pain response was measured using the
International Bone Metastases Consensus from 2002. Worst
pain was recorded using the Brief Pain Inventory (BPI):
ranged from 0–10.
To identify which variables predicted pain
response
and
in particular to determine whether age is a predictor, Cox
proportional hazard models were used. The preselected
baseline variables, were age (cohorts ≤65
(A)/
65-
75
(B)/
>75
(C)
), gender, Eastern Cooperative Oncology
Group (ECOG) performance status scale (0-1/≥2), pain
score (≤4/5–7/8–10), treatment schedule (single
fraction/multiple), primary tumor (prostate / breast /
lung / other cancer types), presence of visceral
metastases (yes/no), concomitant systemic chemotherapy
(yes/no) and concomitant bisphosphonates (yes/no).
Results
Table 1
shows patient characteristics. Median age was 66
years (38-89). Overall treatment response (including
partial and complete responses) was 61.7%.
According to univariate analysis pain response was
significantly better in patients > 75(C) years: 53.6% in (A)
versus 60.9% in (B) (OR, 1.3; 95% CI, 0.6-2.9; p=0.459) and
80.8% in (C) (OR, 3.6; 95% CI, 1.2-11.0;
p=0.022
). Patients
receiving multiple fractions presented better response
(70.5%) that those receiving a single fraction (49.5%) of 8
Gy (OR, 2.8; 95% CI, 1.2-6.1;
p=0.01
). Moreover, patients
presenting a pain score of 8-10 before RT presented better
response (70.8%) than those with a pain score <8 (50%)
after palliative RT (OR, 2.4; 95% CI, 1.1-5.0; p=
0.017
). No
other factors previously mentioned were found
statistically significant.
The multivariate analysis showed that only the treatment
schedule (p = 0.005) and the pain score >8 before RT (p =
0.011) were independent factors for pain response.The
age was not found a statistically significant factor.