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Introduction: To evaluate the pattern of use of advanced radiation therapy techniques, including intensity modulated RT (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic RT (SRT) for the management of bone metastases (BM), and the associated factors in Victoria. Method(s): We used a population-based cohort of patients from the state-wide Victorian Radiotherapy Minimum Data Set (VRMDS) who received RT for BM between 2012 and 2017. The primary outcome was: proportion of RT courses using ART. The Cochran-Armitage test for trend was used to evaluate temporal trend in ART use. Multinomial logistic regression was used to identify factors associated with ART use. Result(s): 18,158 courses of RT were delivered to 10,956 patients-16,626 (92.6%) courses were 3D conformal RT, 857 (4.7%) IMRT/ VMAT, and 675 (3.7%) SRT. There was a sharp increase in IMRT/ VMAT use from <1% in 2012-2015, to 10.1% in 2016 and 16.3% in 2017 (P-trend<0.001). Increase in SRT use was more gradual-from 1.2% in 2012 to 4.8% in 2016 and 5.5% in 2017 for SRT (Ptrend< 0.001). In multivariate analyses, year of RT was the strongest predictor of IMRT/VMAT use (OR=41; 95%CI=25-67; P<0.001, comparing 2012-2013 and 2016-2017). Other factors associated with increased likelihood of IMRT/VMAT were: cancer type (breast cancer), site of BM (pelvis), remoteness of residency (major cities), and treatment centre (private and regional). Primary tumour type (prostate cancer) was the strongest predictor of SRT use (OR=6.07; 95%CI=4.19-8.80; P<0.001). Other factors associated with increased likelihood of SRT were: younger age, site of BM (pelvis, skull, rib), higher socioeconomic status, and treatment institutions (private and metropolitan). Conclusion(s): Overall, there was increasing trend in the use of advanced RT techniques for BM in Victoria, with distinct pattern for IMRT/VMAT compared to SRT-SRT uptake was more gradual while IMRT/VMAT uptake was abrupt, occurring contemporaneously with changes in Medi

Introduction: To evaluate the pattern of use of advanced radiation therapy techniques, including intensity modulated RT (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic RT (SRT) for the management of bone metastases (BM), and the associated factors in Victoria. Method(s): We used a population-based cohort of patients from the state-wide Victorian Radiotherapy Minimum Data Set (VRMDS) who received RT for BM between 2012 and 2017. The primary outcome was: proportion of RT courses using ART. The Cochran-Armitage test for trend was used to evaluate temporal trend in ART use. Multinomial logistic regression was used to identify factors associated with ART use. Result(s): 18,158 courses of RT were delivered to 10,956 patients-16,626 (92.6%) courses were 3D conformal RT, 857 (4.7%) IMRT/ VMAT, and 675 (3.7%) SRT. There was a sharp increase in IMRT/ VMAT use from <1% in 2012-2015, to 10.1% in 2016 and 16.3% in 2017 (P-trend<0.001). Increase in SRT use was more gradual-from 1.2% in 2012 to 4.8% in 2016 and 5.5% in 2017 for SRT (Ptrend< 0.001). In multivariate analyses, year of RT was the strongest predictor of IMRT/VMAT use (OR=41; 95%CI=25-67; P<0.001, comparing 2012-2013 and 2016-2017). Other factors associated with increased likelihood of IMRT/VMAT were: cancer type (breast cancer), site of BM (pelvis), remoteness of residency (major cities), and treatment centre (private and regional). Primary tumour type (prostate cancer) was the strongest predictor of SRT use (OR=6.07; 95%CI=4.19-8.80; P<0.001). Other factors associated with increased likelihood of SRT were: younger age, site of BM (pelvis, skull, rib), higher socioeconomic status, and treatment institutions (private and metropolitan). Conclusion(s): Overall, there was increasing trend in the use of advanced RT techniques for BM in Victoria, with distinct pattern for IMRT/VMAT compared to SRT-SRT uptake was more gradual while IMRT/VMAT uptake was abrupt, occurring contemporaneously with changes in Medi