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Large variation in radiation therapy fractionation for multiple myeloma in Australia
Author(s) -
Ong Wee Loon,
MacManus Michael,
Milne Roger L.,
Foroudi Farshad,
Millar Jeremy L.
Publication year - 2023
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.13783
Subject(s) - fractionation , medicine , population , dose fractionation , multivariate analysis , multiple myeloma , radiation therapy , nuclear medicine , chemistry , environmental health , organic chemistry
Aim To evaluate the patterns of use of different radiation therapy (RT) fractionation for multiple myeloma (MM) bone disease. Methods This is a population‐based cohort of patients with MM who had RT between 2012 and 2017 as captured in the statewide Victorian Radiotherapy Minimum Data Set in Australia. Data linkage was performed to identify subsets of RT delivered within 3 months of death. RT fractionation was classified into four groups: single‐fraction (SFRT), 2–5, 6–10, and > 10 fractions. Changes in RT fractionation use over time were evaluated with the Cochran–Armitage test for trend. Factors associated with RT fractionation were evaluated using multivariate logistic regressions. Results Nine hundred and sixty‐seven courses of RT were delivered in 623 patients. The proportion of SFRT, 2–5, 6–10 and > 10 fractions RT was 18%, 47%, 28%, and 7%, respectively. There was an increase in the use of 2–5 fractions, from 48% in 2012 to 60% in 2017 ( p ‐trend < .001), with corresponding decrease in the use of 6–10 fractions, from 26% in 2012 to 20% in 2017 ( p ‐trend = .003). Nine percent (40/430) of RT courses at private institutions were SFRT, compared to 25% (135/537) in public institutions ( p < .001). In multivariate analyses, treatment in private institution was the strongest predictor of multifraction RT use. SFRT use was more common closer to the end of life–18%, 14%, and 33% of RT within 2–3, 1–2, < 1 month of death, respectively. Conclusion There is increasing use of shorter course RT (2–5 fractions) for MM over time. SFRT use remains low, with large variation in practice.