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Unassessed Response After Palliative Radiotherapy: A Retrospective Study of Evaluable but Not Evaluated (EBNE)
Hiroshi Tanaka1, Soichiro Abe2, Kohei Wakabayashi3
1Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan; Department of Radiation Oncology, Gamma Knife Center, Shiokawa Hospital, Suzuka, Japan.
Purpose:
Palliative radiation therapy (RT) is widely used for symptom control across diverse clinical settings. In routine practice, however, post-treatment evaluation may not be consistently documented. We examined real-world patterns of response documentation after palliative RT and identified episodes that were clinically evaluable but not formally evaluated.
Methods And Materials:
We retrospectively reviewed 309 treatment episodes of palliative RT delivered between September 2018 and March 2019. Clinical records were examined to determine whether radiation oncologist-authored documentation was present within 16 weeks after RT. Follow-up duration was compared between radiation oncologists and non- radiation oncology providers. Episodes were classified as evaluated, nonevaluable (death or loss to follow-up within 60 days), or evaluable but not evaluated (EBNE; survival beyond 60 days with continued institutional follow-up but no radiation oncologist-authored documentation within 16 weeks).
Results:
Among 309 treatment episodes (median age, 64.5 years), radiation oncologist-authored documentation was observed in 199 episodes (64.4%). Follow-up duration ranged from 0 to 413 days (median, 75 days) for radiation oncologists and from 0 to 418 days (median, 110.5 days) for non-radiation oncology providers (log-rank P < .0001). Forty-seven episodes (15.2%) were classified as nonevaluable. Among the remaining 262 evaluable episodes, 63 (24.0% of evaluable; 20.4% of total) had no radiation oncologist-authored documentation within 16 weeks despite survival beyond 60 days and were categorized as EBNE. EBNE occurred across treatment sites, including bone and brain indications.
Conclusions:
A substantial proportion of clinically evaluable palliative RT episodes lacked radiation oncologist-authored documentation. The EBNE framework offers a reproducible method to separate documentation-based nonevaluation from clinical infeasibility, improving transparency in the interpretation of real-world palliative RT outcomes.
