Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription
Purpose: Bone metastases frequently occur during malignant disease. Palliative radiation therapy (PRT) is a crucial part of palliative care because it can relieve pain and improve patients’ quality of life. Often, a clinician's survival estimation is too optimistic. Prognostic scores (PSs) can...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-03-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109422002408 |
| _version_ | 1797960208854548480 |
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| author | Francesco Cellini, MD Alessia Di Rito, MD Giambattista Siepe, MD Francesco Pastore, MD Elisabetta Lattanzi, MD Ilaria Meaglia, MD Angelo Tozzi, MD Stefania Manfrida, MD Silvia Longo, MD Simonetta Saldi, MD Raffaele Cassese, MD Fabio Arcidiacono, MD Michele Fiore, MD Valeria Masiello, MD Ciro Mazzarella, MD Antonio Diroma, MD Francesco Miccichè, MD Francesca Maurizi, MD Luca Dominici, MD Marta Scorsetti, MD Mario Santarelli, MD Vincenzo Fusco, MD Cynthia Aristei, MD Francesco Deodato, MD Maria A. Gambacorta, MD, PhD Ernesto Maranzano, MD Paolo Muto, MD Vincenzo Valentini, MD Alessio G. Morganti, MD Lorenza Marino, MD Costanza M. Donati, MD Rossella Di Franco, MD |
| author_facet | Francesco Cellini, MD Alessia Di Rito, MD Giambattista Siepe, MD Francesco Pastore, MD Elisabetta Lattanzi, MD Ilaria Meaglia, MD Angelo Tozzi, MD Stefania Manfrida, MD Silvia Longo, MD Simonetta Saldi, MD Raffaele Cassese, MD Fabio Arcidiacono, MD Michele Fiore, MD Valeria Masiello, MD Ciro Mazzarella, MD Antonio Diroma, MD Francesco Miccichè, MD Francesca Maurizi, MD Luca Dominici, MD Marta Scorsetti, MD Mario Santarelli, MD Vincenzo Fusco, MD Cynthia Aristei, MD Francesco Deodato, MD Maria A. Gambacorta, MD, PhD Ernesto Maranzano, MD Paolo Muto, MD Vincenzo Valentini, MD Alessio G. Morganti, MD Lorenza Marino, MD Costanza M. Donati, MD Rossella Di Franco, MD |
| author_sort | Francesco Cellini, MD |
| collection | DOAJ |
| description | Purpose: Bone metastases frequently occur during malignant disease. Palliative radiation therapy (PRT) is a crucial part of palliative care because it can relieve pain and improve patients’ quality of life. Often, a clinician's survival estimation is too optimistic. Prognostic scores (PSs) can help clinicians tailor PRT indications to avoid over- or undertreatment. Although the PS is supposed to aid radiation oncologists (ROs) in palliative-care scenarios, it is unclear what type of support, and to what extent, could impact daily clinical practice. Methods and Materials: A national-based investigation of the prescriptive decisions on simulated clinical cases was performed in Italy. Nine clinical cases from real-world clinical practice were selected for this study. Each case description contained complete information regarding the parameters defining the prognosis class according to the PS (in particular, the Mizumoto Prognostic Score, a validated PS available in literature and already applied in some clinical trials). Each case description contained complete information regarding the parameters defining the prognosis class according to the PS. ROs were interviewed through questionnaires, each comprising the same 3 questions per clinical case, asking (1) the prescription after detailing the clinical case features but not the PS prognostic class definition; (2) whether the RO wanted to change the prescription once the PS prognostic class definition was revealed; and (3) in case of a change of the prescription, a new prescriptive option. Three RO categories were defined: dedicated to PRT (RO-d), nondedicated to PRT (RO-nd), and resident in training (IT). Interviewed ROs were distributed among different regions of the country. Results: Conversion rates, agreements, and prescription trends were investigated. The PS determined a statistically significant 11.12% of prescription conversion among ROs. The conversion was higher for the residents and significantly higher for worse prognostic scenario subgroups, respectively. The PS improved prescriptive agreement among ROs (particularly for worse-prognostic-scenario subgroups). Moreover, PS significantly increased standard prescriptive approaches (particularly for worse-clinical-case presentations). Conclusions: To the best of our knowledge, the PROPHET study is the first to directly evaluate the potential clinical consequences of the regular application of any PS. According to the Prophet study, a prognostic score should be integrated into the clinical practice of palliative radiation therapy for bone metastasis and training programs in radiation oncology. |
| first_indexed | 2024-04-11T00:42:43Z |
| format | Article |
| id | doaj.art-91d53d34b5564279a37da8db5bba6890 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-11T00:42:43Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-91d53d34b5564279a37da8db5bba68902023-01-06T04:17:32ZengElsevierAdvances in Radiation Oncology2452-10942023-03-0182101134Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment PrescriptionFrancesco Cellini, MD0Alessia Di Rito, MD1Giambattista Siepe, MD2Francesco Pastore, MD3Elisabetta Lattanzi, MD4Ilaria Meaglia, MD5Angelo Tozzi, MD6Stefania Manfrida, MD7Silvia Longo, MD8Simonetta Saldi, MD9Raffaele Cassese, MD10Fabio Arcidiacono, MD11Michele Fiore, MD12Valeria Masiello, MD13Ciro Mazzarella, MD14Antonio Diroma, MD15Francesco Miccichè, MD16Francesca Maurizi, MD17Luca Dominici, MD18Marta Scorsetti, MD19Mario Santarelli, MD20Vincenzo Fusco, MD21Cynthia Aristei, MD22Francesco Deodato, MD23Maria A. Gambacorta, MD, PhD24Ernesto Maranzano, MD25Paolo Muto, MD26Vincenzo Valentini, MD27Alessio G. Morganti, MD28Lorenza Marino, MD29Costanza M. Donati, MD30Rossella Di Franco, MD31Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy; Corresponding author: Cellini Francesco, MDRadiotherapy Unit - IRCCS Istituto Tumori 'Giovanni Paolo II' Bari - ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyRadiation Oncology, Fondazione Muto Onlus–Emicenter, Naples, ItalyRadiation Oncology Unit, University Hospital of Parma, Parma, ItalyDepartment of Radiotherapy, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, ItalyDepartment of Radiotherapy, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalySection of Radiation Oncology, Perugia General Hospital, Perugia, ItalyRadiotherapy Unit, Ospedale San Camillo de Lellis, Rieti, ItalyRadiation Oncology, Azienda Ospedaliera Santa Maria di Terni, Terni, ItalyResearch Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di RomaDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyDipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, ItalyDipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyRadiation Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro, ItalyDepartment of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, ItalyRadiotherapy Unit, Ospedale San Camillo de Lellis, Rieti, ItalyRadiotherapy Oncology Department, IRCCS CROB, Rionero In Vulture, ItalyRadiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, ItalyDipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy; Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, ItalyDipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyRadiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy; Department of Medicine and Surgery, University of Perugia, Perugia, ItalyDepartment of Radiation Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, ItalyDipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; DIMES, Alma Mater Studiorum–Bologna University, Bologna, ItalyRadiation Oncology Department, Humanitas Istituto Clinico Catanese, Misterbianco, Catania, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Alma Mater Studiorum Bologna University, Bologna, ItalyDepartment of Radiation Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, ItalyPurpose: Bone metastases frequently occur during malignant disease. Palliative radiation therapy (PRT) is a crucial part of palliative care because it can relieve pain and improve patients’ quality of life. Often, a clinician's survival estimation is too optimistic. Prognostic scores (PSs) can help clinicians tailor PRT indications to avoid over- or undertreatment. Although the PS is supposed to aid radiation oncologists (ROs) in palliative-care scenarios, it is unclear what type of support, and to what extent, could impact daily clinical practice. Methods and Materials: A national-based investigation of the prescriptive decisions on simulated clinical cases was performed in Italy. Nine clinical cases from real-world clinical practice were selected for this study. Each case description contained complete information regarding the parameters defining the prognosis class according to the PS (in particular, the Mizumoto Prognostic Score, a validated PS available in literature and already applied in some clinical trials). Each case description contained complete information regarding the parameters defining the prognosis class according to the PS. ROs were interviewed through questionnaires, each comprising the same 3 questions per clinical case, asking (1) the prescription after detailing the clinical case features but not the PS prognostic class definition; (2) whether the RO wanted to change the prescription once the PS prognostic class definition was revealed; and (3) in case of a change of the prescription, a new prescriptive option. Three RO categories were defined: dedicated to PRT (RO-d), nondedicated to PRT (RO-nd), and resident in training (IT). Interviewed ROs were distributed among different regions of the country. Results: Conversion rates, agreements, and prescription trends were investigated. The PS determined a statistically significant 11.12% of prescription conversion among ROs. The conversion was higher for the residents and significantly higher for worse prognostic scenario subgroups, respectively. The PS improved prescriptive agreement among ROs (particularly for worse-prognostic-scenario subgroups). Moreover, PS significantly increased standard prescriptive approaches (particularly for worse-clinical-case presentations). Conclusions: To the best of our knowledge, the PROPHET study is the first to directly evaluate the potential clinical consequences of the regular application of any PS. According to the Prophet study, a prognostic score should be integrated into the clinical practice of palliative radiation therapy for bone metastasis and training programs in radiation oncology.http://www.sciencedirect.com/science/article/pii/S2452109422002408 |
| spellingShingle | Francesco Cellini, MD Alessia Di Rito, MD Giambattista Siepe, MD Francesco Pastore, MD Elisabetta Lattanzi, MD Ilaria Meaglia, MD Angelo Tozzi, MD Stefania Manfrida, MD Silvia Longo, MD Simonetta Saldi, MD Raffaele Cassese, MD Fabio Arcidiacono, MD Michele Fiore, MD Valeria Masiello, MD Ciro Mazzarella, MD Antonio Diroma, MD Francesco Miccichè, MD Francesca Maurizi, MD Luca Dominici, MD Marta Scorsetti, MD Mario Santarelli, MD Vincenzo Fusco, MD Cynthia Aristei, MD Francesco Deodato, MD Maria A. Gambacorta, MD, PhD Ernesto Maranzano, MD Paolo Muto, MD Vincenzo Valentini, MD Alessio G. Morganti, MD Lorenza Marino, MD Costanza M. Donati, MD Rossella Di Franco, MD Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription Advances in Radiation Oncology |
| title | Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription |
| title_full | Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription |
| title_fullStr | Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription |
| title_full_unstemmed | Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription |
| title_short | Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription |
| title_sort | prognostic score in radiotherapy practice for palliative treatments prophet study for bone metastases an investigation into the clinical effect on treatment prescription |
| url | http://www.sciencedirect.com/science/article/pii/S2452109422002408 |
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