title: Review of patterns of practice and patients' preferences in the treatment of bone metastases with palliative radiotherapy.
abstract: 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.
authors.affiliation: Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada.
authors.forename: Nicole M E
authors.initials: NM
authors.lastname: Bradley
authors.forename: Janice
authors.initials: J
authors.lastname: Husted
authors.forename: Michael Sai Lai
authors.initials: MS
authors.lastname: Sey
authors.forename: Amna F
authors.initials: AF
authors.lastname: Husain
authors.forename: Emily
authors.initials: E
authors.lastname: Sinclair
authors.forename: Kristin
authors.initials: K
authors.lastname: Harris
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: 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
chemical_list: D011868:Radioisotopes