title: Factors affecting the use of single-fraction radiotherapy for the palliation of bone metastases in Australia.
abstract: OBJECTIVE
  Palliative radiotherapy for bone metastases remains an important treatment in patients with metastatic malignancy. Previous studies have indicated a reluctance to adopt single-fraction treatment despite considerable evidence. This study aims to describe the factors determining the use of palliative radiotherapy in patients with bone metastases and assess whether fractionation patterns have changed over time with emerging evidence.
  
  
  METHODS
  A retrospective review of radiotherapy databases at Liverpool/Macarthur Cancer Therapy Centre and the Royal Brisbane and Women's Hospital was conducted for the period 1997-2009. Patients receiving palliative radiotherapy for bony metastases were identified and treatment sites were grouped into 'spine', 'limb', 'multiple' or 'other'. Treatment courses were divided into single- or multiple-fraction treatments. The effects of socioeconomic and geographical factors on radiotherapy utilisation and fractionation were assessed.
  
  
  RESULTS
  In total, 5683 patients were identified in the cohort; they received a total of 8211 bone treatments. The overall proportion of single-fraction radiotherapy was 29%, with significant variation over the study period (P < 0.001). Age under 70 years and spine or multiple treatment sites were all associated with lower usage of single-fraction radiotherapy on multivariate analysis. Prostate and lung primary sites were associated with higher usage of single-fraction treatment. The proportion of single-fraction treatment remained low (35%), even for patients who survived less than 22 days from their last treatment. Socioeconomic and geographical factors had little effect on the number of fractions used.
  
  
  CONCLUSIONS
  The rate of single-fraction radiotherapy for bone metastases has remained low in two large Australian institutions, despite considerable evidence that single-fraction treatment provides equivalent pain relief to fractionated therapy. This trend towards fractionated treatment was largely maintained, even in patients with limited life expectancy. Further measures to increase the rate of single-fraction therapy are needed.
authors.affiliation: Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia. Electronic address: alexpetrushevski@gmail.com.
authors.forename: A N
authors.initials: AN
authors.lastname: Petrushevski
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: G S
authors.initials: GS
authors.lastname: Gabriel
authors.affiliation: Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia; Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: T P
authors.initials: TP
authors.lastname: Hanna
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.affiliation: Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: R W
authors.initials: RW
authors.lastname: Allison
authors.affiliation: Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia; Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: M B
authors.initials: MB
authors.lastname: Barton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
keywords: Bone; fractionation; metastasis; palliative; radiotherapy