Background: Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (SFRT) and multiple-fraction radiotherapy (MFRT) for the palliation of painful bone metastases, SFRT remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (CWC) that recommend SFRT. We assessed whether dissemination of the guidelines influenced SFRT use in Manitoba in 2016, and we identified factors associated with MFRT. Methods: All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with MFRT. Results: In 2016, 807 patients (mean age: 70 years; range: 35–96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, MFRT was used—a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (OR): 5.3] or lung primary (OR: 3.3), complicated bone metastasis (OR: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of MFRT use. Conclusions: Dissemination of cwc recommendations alone did not increase SFRT use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of SFRT in Manitoba.

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In early 2017, the Canadian Partnership Against Cancer and CancerCare Manitoba undertook a comprehensive knowledge translation (KT) campaign to improve the utilization of single fraction radiotherapy (SFRT) over multiple fraction radiotherapy (MFRT) for palliative management of bone metastases. The campaign significantly increased short-term SFRT utilization. We assess the time-dependent effects of KT-derived SFRT utilization 12–24 months removed from the KT campaign in a Provincial Cancer Program. This study identified patients receiving palliative radiotherapy for bone metastases in Manitoba in the 2018 calendar year using the provincial radiotherapy database. The proportion of patients treated with SFRT in 2018 was compared to 2017. Logistic regression analyses identified risk factors associated with MFRT receipt. In 2018, 1008 patients received palliative radiotherapy for bone metastasis, of which 63.3% received SFRT, a small overall increase in SFRT use over 2017 (59.1%). However, 41.1% of ROs demonstrated year-over-year decreases in SFRT utilization, indicative of a time-dependent loss of SFRT prescription habits derived from KT. Although SFRT use increased slightly overall in 2018, evidence of compliance fatigue was observed, suggestive of a time-perishing property of RO prescription behaviours derived from KT methodologies. Verification of the study’s findings in larger cohorts would be beneficial. These findings highlight the need for additional longitudinal KT reinforcement practices in the years following KT campaigns.

ObjectiveConformal radiation is the standard of care in treatment of glioblastoma. Although co‐registration of magnetic resonance imaging (MRI) with early contrast enhanced computed tomography (CECT) is recommended for target delineation by consensus guidelines, ground realities in developing countries often result in availability of less‐than‐ideal MR sequences for treatment planning. Purpose of this study is to analyze the impact of incorporation of delayed‐CECT sequences for radiation planning in glioblastomas, as an adjunct or alternative to MRI.MethodsCase records of all patients of glioblastoma treated at our center between 2011 and 2014 were retrospectively evaluated. Gross treatment volumes were delineated on T1 contrast MRI (m‐GTV), early CECT (e‐GTV) and delayed CECT (d‐GTV); volumetric comparisons were made using repeated measures analysis of variance and pair‐wise analysis.ResultsAlthough 96% of registered patients underwent postoperative MRI, only 38% of them had desirable sequences suitable for co‐registration. Median duration between acquisition of postoperative MRI and surgery was 45 days (range, 33–60), whereas that between MRI and treatment‐planning CT was 5 days (range, 1–10). Statistically significant differences (P < 0.0001) were obtained between mean volumes of e‐GTV (41.20cc), d‐GTV (58.09cc) and m‐GTV (60.52cc). Although the mean GTV increased by 46% between early CECT and MRI, the difference was only 4% between delayed CECT and MRI.ConclusionDelayed CECT is superior to early CECT for co‐registration with MRI for target delineation, especially when available MR sequences are less‐than‐ideal for treatment planning, and can be considered as the most appropriate adjunct as well as an alternative to MRI, compared to early CECT.