title: Radiotherapeutic management of osseous metastases: a survey of current patterns of care.
abstract: OBJECTIVE
  Radiotherapy plays a major role in the management of painful osseous metastases. This survey was conducted to study the current approaches to this clinical problem in the radiotherapy community.
  
  
  METHODS
  A questionnaire was sent to 2500 members of the American Society for Therapeutic Radiology and Oncology. It consisted of 30 multiple-choice questions regarding four hypothetical clinical scenarios likely to be encountered in daily practice. Questions related to the technique of choice [local field (LF) vs. hemibody radiotherapy (HBI)], the use of systemic radionuclides (SR), fractionation schemes, dose, the integration of modalities, and the follow-up of these patients. The analysis is based on 817 (33%) responses received regarding 3268 cases.
  
  
  RESULTS
  Local field is the most common form of therapy. Overall, LF was used, alone or in combination with other forms of therapy, in 54% and 74% of patients, respectively. LF was used more frequently in patients with breast cancer than in patients with prostate cancer (79% vs. 45%; p = 0.0001). Long fractionation schemes were used by 90% of physicians in 96% of cases. Short fractionation schemes were used by 7% of physicians in 4% of cases. This tendency was more pronounced in private practice than in the university or government/ multidisciplinary settings (p = 0.008) and in physicians starting their practice before 1982 (p = 0.05). The most common schedule was 30 Gy in 10 fractions, used by 77% of physicians in 64% of cases. HBI was used, alone or in combination with other forms of therapy, in 1% and 2% of patients, respectively. It was used more frequently in patients with prostate cancer than in patients with breast cancer (1.2% vs. 0.1%, respectively; p < 0.0001). SR were used alone or in combination with local-field irradiation in 21% and 40% of cases, respectively. SR were used more frequently in patients with prostate cancer than in those with breast cancer (28% vs. 0.2%, respectively;p < 0.00001). The most common radionuclide in use is Sr-89 (99%) at a dose of 4 mCi (73%) or 10.8 mCi (26%).
  
  
  CONCLUSIONS
  Although LF remains the mainstay of therapy, our results demonstrate the emergence of a new pattern of practice: LF to the painful site in combination with SR for clinically occult metastases. Despite an ongoing academic debate regarding fractionation schemes, the vast majority of American practitioners advocate long schedules.
authors.affiliation: Department of Radiation Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: E
authors.initials: E
authors.lastname: Ben-Josef
authors.forename: F
authors.initials: F
authors.lastname: Shamsa
authors.forename: A O
authors.initials: AO
authors.lastname: Williams
authors.forename: A T
authors.initials: AT
authors.lastname: Porter
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D019538:Health Care Surveys; D017619:Hemibody Irradiation / Q000706:statistics & numerical data; D006801:Humans; D010146:Pain / Q000532:radiotherapy; D010166:Palliative Care / Q000706:statistics & numerical data; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States