Dosimetrice valuation of Palliative Hypo fractionated Radiotherapy and its effect on clinical Outcome Inpatients With Vertebral Bone Metastasis Treated at Tikur Anbessa Specialized Hospital,Oncology Center, Addis Ababa,Ethiopia:An Institution -Based Retrospective Cross-Sectional Study.
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Date
2023-12
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Addis Ababa University
Abstract
Thepurposeofthisstudywastoevaluatedosimetricparametersofthree-dimensional
conformalradiotherapy(3D-CRT)andanalyzeitseffectonclinicaloutcomesincludingpain
controlandtoxicity.Assessmentofthetreatmentplansinthestudywascarriedoutbasedon
reporteddosimetricparameters,whereaspatientreportedpainscoreandtoxicitywereusedfor
assessingresponse.
Methods:Aninstitution-basedretrospectivecrosssectionalstudywasconductedfrom June–
Sept2023.ThedatawascollectedusingKobotoolboxandwasexportedtoSPSSversion26
foranalysis.Statisticaltestsandanalysiswasconducted.Variablesweretastedfor
significancep-value<0.05,andifp<0.02multiplelogisticregressionsanalysiswasdoneto
determinetheeffectoffactorsontheoutcomevariableandtocontroltheconfoundingfactors.
Atotalof97participantswhofulfilledtheinclusioncriteriawereselectedfrom thosepatients
treatedusingHypofractionatedradiotherapy(HEBRT)from June1-Sep1,2023.Theywere
retrospectivelyevaluatedat2monthsafterforRTpainandtoxicity.PatientreportedPain
responsewascalculatedaccordingtointernationalstandardsofpainindexwhichtooktheuse
ofanti-painintoaccount;calculatingdailyoralmorphineequivalentdose(OMED).
Dose–volumehistogramsforPTV,(V95%,Dmean,Dmin,Dmax,CIandHI),andDoseexposure
forOARswasassessed,(lungs,kidney,esophagusandbowl/intestine)dependingonwherethe
spinallesionwaslocated,thenresultswerecomparedwithstandardrecommendations.In
addition,effectofdosimetryonpainresponseandacutetoxicitywasassessed.
Results:Theoverallpainresponsewas63%withcompleteresponse(CR)rateof24.7%.Only
43(44.7%)ofpatientshadreceivedtherecommended95-107%ofprescribeddose.About
twentyfivepercent(24.7%)ofpatientshadDmax>110%,thelargestbeing117%.Acutetoxicity
wasseenin36(37.1%)ofpatientsfrom these23.4%wassevere.Theconformityindexwas
foundtobeb/n1-2in97%ofthecases.Incontrary,homogeneityindexwasdifferentfrom zero
in100%ofthecases.OfpatientswhosemeandosewasmeasuredlungDmeanwas>13GYin
2(4.4%)patientswhilekidneyDmeanwas>18GY(EQD2)in1(1.5%).Thereasonforpoor
coverage,highDmaxdoseandhighmeandoseforOARsmaybethewrongassumptionof
consideringallpalliativepatientsasshortterm survivors,andadvancedpresentationwith
diffusevertebralmetastasisresultingdifficultyonplanoptimization.
Conclusion:Adeviationfrom recommendedvaluewasseeninD95%,Dmax,DmeanandHI.This
suggestsasthereshouldbemoreefforttooptimizeplansandstrictlyevaluatetheDVH.Lack
ofsignificancerelationonmultivariateanalysismaybeduetosamplesizeandthosecasesthat
hadtoxicitymighthavemissedduetoearlydeath
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Keywords
Radiotherapy