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.

Dandena,Yonas(Ass.Prof.)Belay,Eskadmas(PhD)Gulilat,Addis2024-11-282024-11-282023-12https://etd.aau.edu.et/handle/123456789/3710Thepurposeofthisstudywastoevaluatedosimetricparametersofthree-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 hadtoxicitymighthavemissedduetoearlydeathen-USRadiotherapyDosimetrice 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.Thesis