title: International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice?
abstract: OBJECTIVE
  Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice.
  
  
  METHODS
  The members of three global radiation oncology professional organizations (American Society for Radiology Oncology [ASTRO], Canadian Association of Radiation Oncology [CARO], Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy.
  
  
  RESULTS
  A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status.
  
  
  CONCLUSIONS
  Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of previous randomized controlled trials. Our results have confirmed a delay in the incorporation of evidence into practice for palliative radiotherapy for painful bone metastases.
authors.affiliation: Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada. alysafai@cancerboard.ab.ca
authors.forename: Alysa
authors.initials: A
authors.lastname: Fairchild
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Edgar
authors.initials: E
authors.lastname: Ben-Josef
authors.forename: Daniel
authors.initials: D
authors.lastname: Roos
authors.forename: William
authors.initials: W
authors.lastname: Hartsell
authors.forename: Tanya
authors.initials: T
authors.lastname: Holt
authors.forename: Jackson
authors.initials: J
authors.lastname: Wu
authors.forename: Nora
authors.initials: N
authors.lastname: Janjan
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D001315:Australia; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D002170:Canada; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D020407:Internet; D008297:Male; D009520:New Zealand; D010146:Pain / Q000532:radiotherapy*; D010166:Palliative Care / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000473:pathology; D018787:Radiation Oncology / Q000592:standards*; D011879:Radiotherapy Dosage / Q000592:standards; D014481:United States