title: Review of international patterns of practice for the treatment of painful bone metastases with palliative radiotherapy from 1993 to 2013.
abstract: OBJECTIVE
  Numerous randomized controlled trials and meta-analyses have affirmed that single and multiple fractions of radiotherapy provide equally efficacious outcomes in the palliation of painful, uncomplicated bone metastases (UBM). We aim to determine geographic, temporal and ancillary factors that influence the global patterns of practice in this setting.
  
  
  METHODS
  A literature search was conducted on Ovid MEDLINE and EMBASE. Studies were included if they disclosed prescription patterns of single fraction radiotherapy, either through hypothetical cases or actual patient data. Weighted analysis of variance was conducted for binary predictors while weighted linear regression analysis was performed for continuous parameters.
  
  
  RESULTS
  Nine hypothetical case studies and thirteen actual patterns of practice articles were included from 301 search results. Radiation oncologists prescribed dose fractionations ranging from 3Gy×1 to 2Gy×30, with a median of 3Gy×10, for the palliation of UBM. Actual data demonstrated a weak, non-significant, negative linear relationship between the use of single fraction radiotherapy and the year of treatment. Geographical location of treatment was a key predictor of prescription patterns.
  
  
  CONCLUSIONS
  In the last twenty years, there was an overall global reluctance to practice evidence-based medicine by employing single fractions for UBM.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Marko
authors.initials: M
authors.lastname: Popovic
authors.affiliation: Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, The Netherlands.
authors.forename: Mariska
authors.initials: M
authors.lastname: den Hartogh
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Poon
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Lam
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Bedard
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Pulenzas
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
authors.forename: Breanne
authors.initials: B
authors.lastname: Lechner
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada. Electronic address: Edward.Chow@sunnybrook.ca.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D019583:Dose Fractionation, Radiation; D006801:Humans; D010146:Pain / Q000209:etiology* / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods*; D010818:Practice Patterns, Physicians'; D018787:Radiation Oncology / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic
keywords: Bone metastases; Dose fractionation; Palliative radiotherapy; Patterns of practice; Radiation oncology