Evaluation of 30-day mortality after palliative radiotherapy of 8 Gy in a single fraction as a quality criteria of patient management in a university hospital

Abstract

Purpose

Palliative radiotherapy aims to relieve cancer-related complications (pain, bleeding, external compression) and improve patients’ quality of life. The 8 Gy single-fraction regimen is the most commonly used, as it is effective and convenient to patients. Given that the therapeutic effect of palliative radiotherapy may take several weeks to manifest, a 30-day mortality rate below 16 % is considered a quality criteria, since a higher mortality rate would indicate overtreatment of patients who would not benefit from radiotherapy. Our objective was to determine the 30-day mortality rate following single-fraction 8 Gy palliative radiotherapy in the radiotherapy department of Pitié-Salpêtrière hospital (Paris, France) during the year 2023.

Material and method

We conducted a retrospective study including patients treated between January 2nd and December 31st, 2023, regardless of the primary cancer type or the indication for palliative radiotherapy. Mortality was assessed 30 days after radiotherapy. Factors associated with earlier death were analysed using univariate and multivariate analyses, including the following variables: primary cancer type, gender, 3–4 performance status (according to the World Health Organisation), number of systemic treatment lines received, radiotherapy indication, need for hospitalization, and multiple irradiation sites.

Results

A total of 125 patients were included in the study. Among them, 18 patients (14.4 %) received two treatments within the year, leading to a total of 143 radiation treatments delivered. Radiotherapy was primarily intended for pain relief in more than 86 % of cases (94 % for bone metastases, 6 % for epiduritis), while haemostatic and decompressive indications accounted for 3 % of cases each. In this cohort, the 30-day mortality rate was 11 %. However, in the subgroup of 11 patients treated with haemostatic intent, the 30-day mortality rate was significantly higher (46 %). A performance status greater than 2 was significantly associated with a higher 30-day mortality rate (odds ratio: 2.6, P < 0.01).

Conclusion

Our study estimates the 30-day mortality rate at 11 % following single-fraction 8 Gy palliative radiotherapy among the 125 patients treated for this indication at Pitié-Salpêtrière Hospital in 2023. This study demonstrates the feasibility of using this simple quality criteria as an indicator for internal or external audit evaluations.