Medical Student Duke University School of Medicine
Disclosure(s):
Tara Elizabeth Dalton, MD: No financial relationships to disclose
Introduction: Renal cell carcinoma (RCC) is the seventh most common cancer in the United States with 20% of newly diagnosed RCC cases resulting in death within 3-6 months. Additionally, further sequelae such as spine metastases can significantly affect survival. While spine metastases from RCC have typically been treated with conventional external beam radiotherapy (EBRT), stereotactic body radiation therapy (SBRT) has been shown to offer improved pain relief and local tumor control. Despite its efficacy, SBRT has historically been heavily contested by insurance payers which restricts its use. Although recent studies have shown improved alignment with commercial insurance policies and medical guidelines, there is limited understanding of the radiotherapy utilization patterns. The aim of this study is to elucidate the epidemiological patterns of radiotherapy use in spine metastases amongst RCC patients.
Methods: The PearlDiver national insurance claims database was retrospectively queried to include adult patients from 2010 to 2023 with spine metastases of renal cell origin. Patients were stratified into cohorts that either received SBRT or EBRT for the treatment of their spine metastases. Data on demographics and length of stay during radiotherapy were obtained. Pearson’s Chi-squared tests and Kruskal-Wallis rank tests were conducted for statistical analysis with p < 0.05 considered significant.
Results: A total of 345 patients were included, with 53 patients in the SBRT cohort and 292 patients in the EBRT cohort. The median age in the SBRT cohort was 62 (IQR =15) compared to 61 (IQR =16) in the EBRT cohort. Radiotherapy utilization did not differ by U.S region (p = 0.191) or gender (p = 0.945). Furthermore, the SBRT cohort had a significantly higher proportion of patients with commercial insurance (p = 0.029).
Conclusion : In this study, the use of commercial insurance was more prevalent in the SBRT cohort and radiotherapy utilization did not differ by region. This suggests improved policies for SBRT utilization among commercial insurance providers. Further research is warranted to strengthen policies for SBRT utilization.