title: Patterns of care and survival outcomes of palliative radiation for prostate cancer with bone metastases: comparison of ≤5 fractions to ≥10 fractions.
abstract: BACKGROUND
  To review the palliative radiation fractionation regimens, trends and survival of men within the National Cancer Database (NCDB) diagnosed with prostate cancer and bony metastases.
  
  
  METHODS
  A total of 3,871 patients from the NCDB were included in the analysis (patients treated from 2004-2012). The following fractionation regimens were analyzed [8 Gy × 1, 4 Gy × 5 (short course radiation therapy)], were compared to 3 Gy × 10, 2.50 Gy × 14-15 and 2 Gy × 20-30 (long course radiation therapy). Descriptive statistics, multivariable logistic regression and multivariable cox regression analysis were utilized to assess the data.
  
  
  RESULTS
  Longer fractionation schemes were used for 91.7% of patients. Treatment at an academic center (OR, 2.93), increasing distance from treatment center (OR, 1.48-1.59), treatment to the ribs (OR, 2.47), and year of diagnosis 2009 or later (OR, 2.31-3.26) were associated with an increased likelihood of receiving short course radiation, while treatment to the spine (OR, 0.34) was associated with a decreased likelihood of short course radiation. On multivariable analysis, longer course of radiation was associated with increased overall survival (HR =0.66; 95% CI: 0.56-0.78, P<0.001.). However, on landmark analysis this difference disappeared once limiting the survival analysis to men who survived ≥18 months [HR =0.83; 95% CI: 0.62-1.11, P=0.21].
  
  
  CONCLUSIONS
  Fractionation schemes of ≥10 treatments remain the dominant palliative course of radiation therapy offered for metastatic prostate cancer. However, utilization of ≤5 fractions is slowly increasing, particularly at academic centers.
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Safdieh
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA; New York University School of Medicine, New York, NY, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA; SUNY Downstate Medical Center, Brooklyn, NY, USA. David.schreiber@va.gov.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D016208:Databases, Factual; D019583:Dose Fractionation, Radiation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000473:pathology*; D012272:Ribs; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary; D015996:Survival Rate
keywords: Palliative radiation; palliative care; prostate cancer