TY - JOUR
T1 - Onsite versus offsite radiation treatment of malignant spinal cord compression
T2 - Lessons from a safety net health system
AU - Chen, Albert C.
AU - Bonnen, Mark D.
AU - Mok, Henry
N1 - Publisher Copyright:
© 2017 The Authors. Published by the British Institute of Radiology.
PY - 2017
Y1 - 2017
N2 - Objective: Metastatic spinal cord compression (MSCC) is an oncologic emergency that often warrants emergent treatment; but, it is unclear whether radiation treatment (RT) can be optimally managed from an offsite radiotherapy facility. Methods: Patient charts from consecutive patients with MSCC who were treated with radiotherapy alone at either an onsite hospital radiation department (from 2008 to 2012) or an offsite radiotherapy centre (2012-2015) were reviewed. Patient clinical parameters were compared across groups with either the χ2 test or Fisher's exact test, while survival curves were compared with the log-rank test. The primary end points were ambulatory rate over time, overall survival and cancer-specific survival. Results: A total of 45 patients were identified, with 19 patients treated onsite in the hospital department and 26 patients treated at the offsite radiotherapy centre with median follow-up of 42 days vs 48.5 days, respectively. The ambulatory rate over time, overall survival and cancer-specific survival were not significantly different between the two eras. Patients treated in-hospital were more likely to start treatment the same day as the consult ("sim and treat") (79% vs 27%, p = 0.006) and were more likely to not complete treatment (26% vs 4%, p = 0.029) as compared with those treated in the offsite centre. Conclusion: Patients with MSCC can be feasibly treated at an offsite radiotherapy centre with outcomes similar to those treated in-hospital. Advances in knowledge: This is the first study in literature to compare outcomes between onsite and offsite RT of MSCC.
AB - Objective: Metastatic spinal cord compression (MSCC) is an oncologic emergency that often warrants emergent treatment; but, it is unclear whether radiation treatment (RT) can be optimally managed from an offsite radiotherapy facility. Methods: Patient charts from consecutive patients with MSCC who were treated with radiotherapy alone at either an onsite hospital radiation department (from 2008 to 2012) or an offsite radiotherapy centre (2012-2015) were reviewed. Patient clinical parameters were compared across groups with either the χ2 test or Fisher's exact test, while survival curves were compared with the log-rank test. The primary end points were ambulatory rate over time, overall survival and cancer-specific survival. Results: A total of 45 patients were identified, with 19 patients treated onsite in the hospital department and 26 patients treated at the offsite radiotherapy centre with median follow-up of 42 days vs 48.5 days, respectively. The ambulatory rate over time, overall survival and cancer-specific survival were not significantly different between the two eras. Patients treated in-hospital were more likely to start treatment the same day as the consult ("sim and treat") (79% vs 27%, p = 0.006) and were more likely to not complete treatment (26% vs 4%, p = 0.029) as compared with those treated in the offsite centre. Conclusion: Patients with MSCC can be feasibly treated at an offsite radiotherapy centre with outcomes similar to those treated in-hospital. Advances in knowledge: This is the first study in literature to compare outcomes between onsite and offsite RT of MSCC.
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U2 - 10.1259/bjr.20160922
DO - 10.1259/bjr.20160922
M3 - Article
C2 - 28181815
AN - SCOPUS:85016581761
SN - 0007-1285
VL - 90
JO - British Journal of Radiology
JF - British Journal of Radiology
IS - 1072
M1 - 20160922
ER -