Review of patterns of practice and patients' preferences in the treatment of bone metastases with palliative radiotherapy.
BACKGROUND
Since the 1980s, randomized clinical trials showed that single fraction radiotherapy (RT) provided equal pain relief as multiple fractions of RT in the treatment of bone metastases.


METHODS
Using Medline, a literature search was conducted on patterns of practice among radiation oncologists and patients' preferences of dose fractionations for the treatment of bone metastases.


CONCLUSIONS
Fifteen studies on international patterns of practice published between 1966 and May 2006 were identified. Surveys of Canadian radiation oncologists indicated approximately 85% preferred multiple fractions, most often as 20 Gray in five fractions (20 Gy/5). Surveys in the United States indicated that 30 Gy/10 was most commonly used, and 90-100% of these oncologists preferred multiple over single fraction RT. Multiple fractions were most commonly used in the United Kingdom, Western Europe, Australia and New Zealand, and India; however, more radiation oncologists in these countries would prescribe a single fraction than in North America. Three studies investigated patients' preferences of dose fractionations. In the Australian study, most patients favored single fraction RT as long as long-term outcomes were not compromised. Durability of pain relief was considered more important than short-term convenience factors. In the Singapore study, 85% of patients would choose extended courses of RT (24 Gy/6) compared to a single 8 Gy. In the Canadian study, most patients (76%) would choose a single 8 Gy over 20 Gy/5 of palliative RT due to greater convenience.


CONCLUSIONS
Despite strong evidence supporting the use of single fraction RT, current practices and preferences favor multiple fractions for the treatment of bone metastases. This has significant implications for the overall quality of life, RT department workload, costs to healthcare systems, and patient convenience.
Bradley
Nicole M E
NM
Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada.
Husted
Janice
J
Sey
Michael Sai Lai
MS
Husain
Amna F
AF
Sinclair
Emily
E
Harris
Kristin
K
Chow
Edward
E
D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D019583:Dose Fractionation, Radiation; D006801:Humans; D059408:Pain Management; D010166:Palliative Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D018787:Radiation Oncology; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage
D011868:Radioisotopes