title: Patterns of practice in palliative radiotherapy for painful bone metastases: a survey in Japan.
abstract: OBJECTIVE
  To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT).
  
  
  METHODS
  Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT.
  
  
  RESULTS
  A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: "time until first increase in pain" (85%), "incidence of spinal cord compression" (50%), and "incidence of pathologic fractures" (29%).
  
  
  CONCLUSIONS
  Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.
authors.affiliation: Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan. naokinak@luke.or.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Naoto
authors.initials: N
authors.lastname: Shikama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Wada
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Harada
authors.forename: Miwako
authors.initials: M
authors.lastname: Nozaki
authors.forename: Hisayasu
authors.initials: H
authors.lastname: Nagakura
authors.forename: Masao
authors.initials: M
authors.lastname: Tago
authors.forename: Masahiko
authors.initials: M
authors.lastname: Oguchi
authors.forename: Nobue
authors.initials: N
authors.lastname: Uchida
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D001943:Breast Neoplasms; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000532:radiotherapy; D010146:Pain / Q000209:etiology / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D018787:Radiation Oncology / Q000592:standards*; D011879:Radiotherapy Dosage / Q000592:standards; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary