Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription

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

Advances in Radiation Oncology (Mar 2023)

Prognostic Score in Radiotherapy Practice for Palliative Treatments (PROPHET) Study for Bone Metastases: An Investigation Into the Clinical Effect on Treatment Prescription

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

Affiliations

Francesco Cellini, MD: Dipartimento 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, MD
Alessia Di Rito, MD: Radiotherapy Unit - IRCCS Istituto Tumori 'Giovanni Paolo II' Bari - Italy
Giambattista Siepe, MD: Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Francesco Pastore, MD: Radiation Oncology, Fondazione Muto Onlus–Emicenter, Naples, Italy
Elisabetta Lattanzi, MD: Radiation Oncology Unit, University Hospital of Parma, Parma, Italy
Ilaria Meaglia, MD: Department of Radiotherapy, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
Angelo Tozzi, MD: Department of Radiotherapy, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
Stefania Manfrida, MD: Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
Silvia Longo, MD: Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
Simonetta Saldi, MD: Section of Radiation Oncology, Perugia General Hospital, Perugia, Italy
Raffaele Cassese, MD: Radiotherapy Unit, Ospedale San Camillo de Lellis, Rieti, Italy
Fabio Arcidiacono, MD: Radiation Oncology, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
Michele Fiore, MD: Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma
Valeria Masiello, MD: Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
Ciro Mazzarella, MD: Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
Antonio Diroma, MD: Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
Francesco Miccichè, MD: Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
Francesca Maurizi, MD: Radiation Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy
Luca Dominici, MD: Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
Marta Scorsetti, MD: Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
Mario Santarelli, MD: Radiotherapy Unit, Ospedale San Camillo de Lellis, Rieti, Italy
Vincenzo Fusco, MD: Radiotherapy Oncology Department, IRCCS CROB, Rionero In Vulture, Italy
Cynthia Aristei, MD: Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
Francesco Deodato, MD: Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy; Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, Italy
Maria A. Gambacorta, MD, PhD: Dipartimento 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
Ernesto Maranzano, MD: Radiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy; Department of Medicine and Surgery, University of Perugia, Perugia, Italy
Paolo Muto, MD: Department of Radiation Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy
Vincenzo Valentini, MD: Dipartimento 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
Alessio G. Morganti, MD: Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; DIMES, Alma Mater Studiorum–Bologna University, Bologna, Italy
Lorenza Marino, MD: Radiation Oncology Department, Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
Costanza M. Donati, MD: Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
Rossella Di Franco, MD: Department of Radiation Oncology, Istituto Nazionale Tumori–IRCCS–Fondazione G. Pascale, Napoli, Italy

Journal volume & issue: Vol. 8, no. 2
p. 101134

Abstract

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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.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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