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Dosimetric and clinical impact of 3D vs. 2D planning in palliative radiotherapy for bone metastases

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Abstract

Purpose

The incorporation of three-dimensional (3D) planning for the treatment of bone metastases has been embraced in many North American practices with assumed superior tumor targeting, sparing of normal structures, and improvement in patient outcomes. The goal of our project was to evaluate the dosimetric and clinical impact of 3D vs. two-dimensional (2D) planning for patients who require simple palliative radiotherapy techniques (≤2 beams) for bone metastases.

Methods

Patients undergoing palliative radiation therapy for bone metastases were eligible. The study oncologists first documented the intended treatment target, defined the treatment target/field using digital radiographs (2D), followed by using full 3D planning computerized tomography volumetric datasets. Treatment plans were compared dosimetrically, and patient-reported outcomes (pain, fatigue, anorexia, and nausea) were compared against a historical cohort treated with 2D plans.

Results

Eighty-five patients were enrolled in the study group. Review of the 3D datasets led to changes in the target area of interest in 44/85 (52 %) of cases, of which 21/85 (25 %) were clinically significant. 3D plans resulted in superior target coverage and normal tissue sparing. There was no significant difference in patient-reported outcomes however.

Conclusion

3D radiotherapy planning resulted in superior treatment plans but we were unable to demonstrate a significant benefit in clinical outcomes. Prospective study designs are needed to describe the contemporary expectation of palliative radiotherapy for bone metastases in the modern era of 3D planning.

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Acknowledgments

This study was supported in part by the Kerbel Research Fund. The authors would like to thank Ms. Shawde Harris for her editorial support.

Conflict of interest

The authors have no conflict of interest to report. The authors have full control of all primary data. The authors would allow the journal to review data if requested.

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Authors and Affiliations

  1. Palliative Radiation Oncology Program, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Kathy Pope, David Fitzpatrick, Andrew Potter, Michael Holwell, Michelle Lau, Wilfred Levin, Michael McLean, Laura Zurawel Balaura, Andrea Bezjak & Rebecca K. S. Wong

  2. Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Lisa Wang

  3. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Kathy Pope

  4. St Luke’s Hospital, Rathgar, Dublin, Ireland

    David Fitzpatrick

  5. Beaumont Hospital, Beaumont, Dublin, Ireland

    David Fitzpatrick

  6. Royal Adelaide Hospital Cancer Centre, Adelaide, South Australia, Australia

    Andrew Potter

  7. Department of Radiation Oncology, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario, M5G 2M9, Canada

    Rebecca K. S. Wong

Authors
  1. Kathy Pope
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  2. David Fitzpatrick
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  3. Andrew Potter
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  4. Michael Holwell
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  5. Lisa Wang
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  6. Michelle Lau
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  7. Wilfred Levin
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  8. Michael McLean
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  9. Laura Zurawel Balaura
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  10. Andrea Bezjak
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  11. Rebecca K. S. Wong
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Corresponding author

Correspondence to Rebecca K. S. Wong.

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Pope, K., Fitzpatrick, D., Potter, A. et al. Dosimetric and clinical impact of 3D vs. 2D planning in palliative radiotherapy for bone metastases. Support Care Cancer 21, 2229–2235 (2013). https://doi.org/10.1007/s00520-013-1777-8

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  • DOI: https://doi.org/10.1007/s00520-013-1777-8

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