Radiotherapy Dose-Fractionation Schedules: Hyperfractionation and Accelerated Treatment Regimens

Background: Sarcomas are rare and heterogeneous tumours with a large proportion of patients requiring palliative intervention. They are regarded as relatively radioresistant and therefore achieving good palliation with radiation may require larger doses than for more common solid tumour types. Limited data is available regarding appropriate palliative radiotherapy dose fractionation. This case series aims to assess the effectiveness of radiotherapy in providing symptomatic improvement for advanced sarcomas. Method: Data was retrospectively collected for patients treated with palliative radiotherapy between July 2010 and April 2019 at one institution. The primary outcome was documented symptomatic improvement following radiotherapy. Secondary outcome was overall survival. Results: One hundred and five patients had a total of 137 sites treated using 25 different dose fractionation schedules. The median patient age was 54 (range 8–90) years. Treated sites included 114 soft tissue and 23 bone sarcomas. Data on symptomatic improvement was available in 56% and 67% of cases respectively. A total of 70% of soft tissue and 55% of bone sarcoma patients reported symptomatic improvement. Symptomatic response rates appeared to increase to a biological effective dose (BED) of 50Grey4 (Gy4) (alpha beta ratio (α/β) = 4 for tumour) but did not continue to improve with further rises in dose beyond this. Conclusion: Palliative radiotherapy offers symptomatic improvement for sarcoma patients with two-thirds of patients reporting reduction in symptoms. These results are limited by the heterogeneous study population including different sarcoma subtypes each with a probable different radio-sensitivity, treated with different radiotherapy schedules. Further prospective data collection is needed considering sarcoma subtype radio-sensitivity, to determine appropriate palliative dose fractionation schedules.

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Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the UK in 2005

Clinical Oncology ◽

10.1016/j.clon.2007.03.011 ◽

2007 ◽

Vol 19 (5) ◽

pp. 273-286 ◽

Cited By ~ 35

Author(s):

M.V. Williams ◽

E.T. Summers ◽

K. Drinkwater ◽

A. Barrett

Keyword(s):

Waiting Times ◽

Dose Fractionation ◽

The Uk ◽

Radiotherapy Dose

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National survey of radiation oncologists’ practice patterns regarding hormone-naïve prostate cancer with bone metastases

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa111 ◽

2020 ◽

Vol 50 (10) ◽

pp. 1188-1194

Author(s):

Katsumasa Nakamura ◽

Hitoshi Ishikawa ◽

Tetsuo Akimoto ◽

Manabu Aoki ◽

Shinji Kariya ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Practice Patterns ◽

Primary Treatment ◽

Dose Fractionation ◽

Radiation Oncologists ◽

Multiple Bone Metastases ◽

Single Bone ◽

Radiotherapy Dose

Abstract Objective To explore radiation oncologists’ attitudes and practice patterns of radiotherapy for hormone-naïve prostate cancer with bone metastases in Japan. Methods An internet-based survey was distributed to board-certified radiation oncologists of the Japanese Society of Radiation Oncology. Three hypothetical cases were assumed: hormone-naïve prostate cancer with single, three or multiple non-symptomatic bone metastases. The respondents described their attitude regarding such cases, treatment methods and the radiotherapy dose fractionation that they would recommend. Results Among the 1013 board-certified radiation oncologists in Japan, 373 (36.8%) responded to the questionnaire. Most of the respondents (85.0%) believed that radiotherapy may be applicable as a primary treatment for hormone-naïve prostate cancer with bone metastases in some circumstances. For Case 1 (single bone metastasis), 55.0% of the respondents recommended radiotherapy for the prostate and bone metastasis. For Case 2 (three bone metastases), only 24.4% recommended radiotherapy for all lesions, and 31.4% recommended radiotherapy for the prostate only. For Case 3 (multiple bone metastases), 49.1% of the respondents stated that there was no indication for radiotherapy. However, 34% of the respondents still preferred to administer radiotherapy for the prostate. The radiotherapy techniques and dose fractionations varied widely among the respondents. Conclusion Most of the respondent radiation oncologists believed that radiotherapy may be beneficial for hormone-naïve prostate cancer with bone metastases.

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