Economic Impact Of Palliative Radiation Therapy Of Bone Metastases With A Single Fraction Dose: A One-Institution Experience

Approximately a quarter of patients treated in a radiation oncology department are palliative patients. Bone metastases are one of the most common events during disease progression. It is estimated that this event appears from 15% to 70% of the overall oncology patients. Classical procedures to treat bone metastases are 20 Gray (Gy) in 5 fractions or 30Gy in 10 fractions. In recent years, a lot of data supports using a dose of 8Gy in 1 fraction (single-fraction radiation therapy (SFRT)) being as optimal as multifractionated radiation therapy (MFRT0) to palliate bone metastases symptoms. The RTOG trial 97-14 showed no difference between radiation delivered for painful bone metastases at a dose of 8Gy in 1 fraction SFRT and 30 Gy in 10 fractions [MFRT] in pain relief or narcotic use 3 months after randomization. SFRT for painful vertebral bone metastasis has not been well accepted, possibly because of concerns about efficacy and toxicity. We aimed to determine the total economic savings to our institution if SFRT becomes a standard treatment for selected patients. The number of palliative patients (stage IV) accepted to our department from January to December of 2014 was 263. One hundred and thirty six patients (51.71%) had bone metastases and were selected for our study. The exclusion criteria, following ASTRO recommendations, were: cortical affectation more than 3 cm, spinal cord compression, radicular compression, surgical fixation, caudal equine syndrome or same area previously irradiated. Total number of patients excluded was 32 (24%). Finally, 104 patients (76%) were selected for our study. Main features are shown in Table1. The total economic savings was estimated by multiplying the number of sessions given to patients if their schedules overcome more than 1 fraction by the stipulated cost of each RT session for that year. Total sessions that could have been saved were 591 fractions. The cost of one fraction of RT per case was estimated at $48.29, according to the law in force in 2014 for the prices of RT treatments and rates according to economic department from our institution. This translated into an annual saving of approximately $32,821. Radiation therapy provides an 80% pain relief in palliative patients. Since there are no conclusive differences between MFRT and SFRT on the literature, we have concluded that it might represents significant savings to the health care system if SFRT becomes a standard practice for palliative patients who accomplish ASTRO criteria; also by shortening the time of treatment, other aspects as patient discomfort, transportation issues and psychological distress will decrease as well.Abstract 3275; Table 1. Patients CharacteristicsVariablesN 104Men (n 72)Woman (n32)Mean age, years64.5 (6.36)66.3 (6.53)60.5 (5.96)Gender (%)69.230.8Site of primary tumor (%)Liver n 1 (0.98)Salivary gland n 1 (0.98)Gynecological n 1 (0.98)Paraganglioma n 3 (2.9)Myeloma n 4 (3.92)G.I n 13 (12.66)Breast n 16 (15.68)Lung n 29 (28.4)G.U n 34 (33.32) Open table in a new tab