Radiotherapy for bone metastases: Practice in Norway 1997–2007. A national registry-based study

Figures & data

Table I. Baseline characteristics.

Number of treatment episodes	14 380
Number of patients	8685
Age mean (SD)	63.2^a (12.4)
Sex
Men	59.3%^a (n = 5150)
Women	40.7% (n = 3535)
Vital status at 31.03.2010
Dead	94.8%^a (n = 8232)
Alive, settled in Norway	5.1% (n = 445)
Emigrated	0.1% (n = 8)
Treatment centre^c
Oslo University Hospital, The Norwegian Radium Hospital, Oslo	48.2%^b (n = 6927)
St. Olavs Hospital, University Hospital of Trondheim, Trondheim	12.7% (n = 1832)
Oslo University Hospital, Ullevål, Oslo	11.7% (n = 1677)
University Hospital of North Norway, Tromsø	10.3% (n = 1480)
Stavanger University Hospital, Stavanger (data included from 1998)	8.3% (n = 1192)
Haukeland University Hospital, Bergen	6.9% (n = 998)
Ålesund Hospital, Ålesund (data included from 2005)	1.6% (n = 226)
Nordland Hospital, Bodø (data included from 2007)	0.3% (n = 48)
Primary diagnose
Prostate cancer	32.1%^b (n = 4622)
Breast cancer	23.4% (n = 3367)
Lung cancer	11.6% (n = 1672)
Myelomatosis	7.6% (n = 1092)
Colorectal and anal cancers	5.0% (n = 723)
Kidney cancer	2.9% (n = 412)
Cancer in other urinary organs	2.0% (n = 287)
Skin cancer	1.9% (n = 278)
Lymphomas	1.3% (n = 187)
Cancer in female reproductive organs	1.1% (n = 165)
Head and neck cancers	1.0% (n = 139)
Cancer in other digestive organs and peritoneum/retroperitoneum	0.9% (n = 123)
Cancer in stomach and small intestine	0.7% (n = 98)
Hematopoietic cancers	0.6% (n = 81)
Cancer in male reproductive organs	0.2% (n = 27)
Other and unspecified types of cancer	7.7% (n = 1106)
Anatomical region
Column	55.8%^b (n = 8020)
cervical column	4.3% (n = 613)
thoracic column	17.2% (n = 2472)
lumbosacral column	19.1% (n = 2748)
multiple parts or unknown part of the column^d	15.2% (n = 2187)
Pelvis	12.2% (n = 1751)
Upper limbs	6.4% (n = 915)
Lower limbs	14.0% (n = 2012)
Caput	1.4% (n = 201)
Other^e	9.0% (n = 1296)
Multiple regions^f	0.6% (n = 91)
Unknown region^g	0.7% (n = 94)
Fractionation schedule
3 Gy × 10	68.7%^b (n = 9886)
8 Gy × 1	31.3% (n = 4494)

^aCalculated from total number of patients; ^bCalculated from total number of treatment episodes; ^cThe treatment centers at Stavanger University Hospital in Stavanger, Ålesund Hospital in Ålesund, and Nordland Hospital in Bodø were set up during the study period, with the first treatment episodes included from 1998, 2005, and 2007, respectively;

^dWhen the irradiated segment of the column crossed several segments, or was not specified;

^eMainly irradiations to thorax, sternum, scapula, clavicle and ribs;

^fWhen two or more anatomical regions of bone were irradiated and in the case of half body irradiations;

^gWhen no other information than ‘skeletal’ or ‘myelomatosis’ was given.

Figure 1. Proportions of 8 Gy × 1 treatments by calendar year during 1997–2007.

Table II. The distribution of single fraction treatment regarding sex, treatment centre, primary diagnose and region irradiated^a crude relative risk of 8 Gy × 1 and relative risk of 8 Gy × 1 adjusted for other variables^b.

	N	n (8 Gy × 1)	% (8 Gy × 1)	Crude RR	p	95% CI	Adjusted RR**	p	95% CI
Sex
Males	8396	2934	35.0	1.00			1.00
Females	5994	1560	26.0	0.74	< 0.001	(0.69, 0.80)	1.04	0.466	(0.93, 1.16)
Treatment centre
Oslo University Hospital, The Norwegian Radium Hospital, Oslo	6927	1735	25.0	1.00			1.00
St. Olavs Hospital, University Hospital of Trondheim, Trondheim	1832	826	45.1	1.80	< 0.001	(1.63, 1.98)	1.67	< 0.001	(1.51, 1.85)
Oslo University Hospital, Ullevål, Oslo	1677	443	26.4	1.05	0.373	(0.94, 1.19)	1.03	0.593	(0.91, 1.17)
University Hospital of North Norway, Tromsø	1480	746	50.4	2.01	< 0.001	(1.82, 2.23)	1.79	< 0.001	(1.59, 2.01)
Stavanger University Hospital, Stavanger (data included from 1998)	1192	307	25.8	1.03	0.688	(0.90, 1.18)	1.02	0.837	(0.88, 1.17)
Haukeland University Hospital, Bergen	998	319	32.0	1.28	< 0.001	(1.11, 1.46)	1.29	0.001	(1.11, 1.50)
Ålesund Hospital, Ålesund (data included from 2005)	226	92	40.7	1.63	< 0.001	(1.27, 2.08)	1.49	0.002	(1.15, 1.92)
Nordland Hospital, Bodø (data included from 2007)	48	26	54.2	2.16	0.002	(1.34, 3.50)	1.62	0.054	(0.99, 2.66)
Primary diagnoses
Breast cancer	3367	744	22.1	1.00			1.00
Prostate cancer	4622	1753	37.9	1.72	< 0.001	(1.56, 1.89)	1.55	< 0.001	(1.33, 1.81)
Lung cancer	1672	662	39.6	1.79	< 0.001	(1.59, 2.02)	1.71	< 0.001	(1.48, 1.97)
Cancer in male reproductive organs	27	12	44.4	2.01	0.045	(1.01, 3.99)	1.87	0.089	(0.91, 3.83)
Cancer in female reproductive organs	165	51	30.9	1.40	0.042	(1.01, 1.93)	1.51	0.016	(1.08, 2.11)
Kidney cancer	412	97	23.5	1.07	0.597	(0.84, 1.35)	0.93	0.559	(0.72, 1.20)
Cancer in other urinary organs	287	110	38.3	1.73	< 0·001	(1.37, 2.19)	1.59	< 0.001	(1.23, 2.05)
Head and neck cancers	139	51	36.7	1.66	0.003	(1.19, 2.31)	1.60	0.008	(1.13, 2.28)
Cancer in stomach and small intestine	98	45	45.9	2.08	< 0.001	(1.45, 2.98)	1.91	0.001	(1.29, 2.81)
Colorectal- and anal cancers	723	217	30.0	1.36	< 0.001	(1.14, 1.61)	1.35	0.002	(1.12, 1.64)
Ca. in other digestive organs, peritoneum and retroperitoneum	123	50	40.7	1.84	< 0.001	(1.31, 2.58)	1.84	0.001	(1.28, 2.64)
Skin cancer	278	74	26.6	1.20	0.174	(0.92, 1.57)	1.36	0.034	(1.02, 1.81)
Lymphomas	187	28	15.0	0.68	0.06	(0.45, 1.02)	0.57	0.009	(0.38, 0.87)
Hematopoietic cancers	81	10	12.3	0.56	0.085	(0.29, 1.08)	0.65	0.206	(0.33, 1.27)
Myelomatosis	1092	273	25.0	1.13	0.118	(0.97, 1.32)	1.00	0.973	(0.84, 1.19)
Other and unspecified types of cancer	1106	317	28.7	1.84	0.001	(0.12, 1.50)	1.41	< 0.001	(1.20, 1.67)
Anatomical region
Column	8020	1522	19
cervical column	613	73	12	1.00			1.00
thoracic column	2472	411	17	1.40	0.013	(1.07, 1.82)	1.35	0.026	(1.04, 1.77)
lumbosacral column	2748	667	24	2.04	< 0.001	(1.58, 2.64)	1.96	< 0.001	(1.51, 2.54)
multiple parts/unknown part of the column	2187	371	17	1.42	0.009	(1.09, 1.86)	1.40	0.014	(1.07, 1.83)
Pelvis	1751	736	42	3.53	< 0.001	(2.73, 4.57)	3.46	< 0.001	(2.67, 4.49)
Upper limbs	915	475	52	4.36	< 0.001	(3.34, 5.69)	4.62	< 0.001	(3.53, 6.06)
Lower limbs	2012	789	39	3.29	< 0.001	(2.55, 4.25)	3.38	< 0.001	(2.61, 4.38)
Caput	201	23	11	0.96	0.874	(0.59, 1.58)	1.09	0.723	(0.66, 1.80)
Other	1296	883	68	5.72	< 0.001	(4.42, 7.40)	5.47	< 0.001	(4.21, 7.09)
Multiple regions	91	35	39	3.17	< 0.001	(2.00, 5.04)	3.14	< 0.001	(1.96, 5.02)
Unknown region	94	31	33	2.77	< 0.001	(1.73, 4.44)	2.71	< 0.001	(1.65, 4.44)
Age (per 10 years)				1.10	< 0.001	(1.07, 1.13)	1.07	< 0.001	(1.04, 1.10)
Travel distance (per 100 km)				1.08	< 0.001	(1.06, 1.10)	1.05	< 0.001	(1.03, 1.07)

^aCalculated from total number of treatment episodes; ^bAdjusted for treatment centre, age, sex, primary diagnosis (16 categories), anatomical region irradiated (11 categories) and travel distance (continuous).

Table III. Proportion of treatment episodes of 8 Gy × 1 according to treatment centre and time interval.

		1997–1999		2000–2002		2003–2005		2006–2007
Treatment centre	Total no. of episodes	3 Gy × 10/ 8 Gy × 1	8 Gy × 1	3 Gy × 10/ 8 Gy × 1	8 Gy × 1	3 Gy × 10/ 8 Gy × 1	8 Gy × 1	3 Gy × 10/ 8 Gy × 1	8 Gy × 1
Oslo University Hospital, The Norwegian Radium Hospital, Oslo	6927	1055/157	13%	1173/391	25%	1676/610	27%	1288/577	31%
St. Olavs Hospital, University Hospital of Trondheim, Trondheim	1832	362/188	34%	269/191	42%	258/277	52%	117/170	59%
Oslo University Hospital, Ullevål, Oslo	1677	21/1	5%	248/108	30%	486/199	29%	479/135	22%
University Hospital of North Norway, Tromsø	1480	159/53	25%	160/101	39%	231/259	53%	184/333	64%
Stavanger University Hospital, Stavanger (data included from 1998)	1192	95/4	4%	286/32	10%	339/132	28%	165/139	46%
Haukeland University Hospital, Bergen	998	129/28	18%	172/92	35%	256/90	26%	122/109	47%
Ålesund University Hospital, Ålesund (data included from 2005)	226	−	−	−	−	50/12	19%	84/80	49%
Nordland Hospital, Bodø
(data included from 2007)	48	−	−	−	−	−	−	22/26	54%
Overall	14 380	1821/431	19%	2308/915	28%	3296/1579	32%	2461/1569	39%