Factors Affecting the Use of Single-Fraction Radiotherapy for the Palliation of Bone Metastases in Australia

Petrushevski, A.N.; Gabriel, Gabriel; Hanna, Timothy P.; Allen, S.; Allison, Roger; Bartoň, Michael

doi:10.1016/j.clon.2014.11.027

Cited by 19 publications

(14 citation statements)

References 31 publications

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“…3,4 However, the underutilization of single-fraction RT has been reported worldwide. [5][6][7][8][9] An analysis of the National Cancer Data Base showed that among patients treated for nonspinal or vertebral metastases, 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. 10 Radiation oncologists' continued reluctance to adopt single-fraction regimens may, at least in part, be attributable to the limitation of RCTs in terms of generalizability.…”

Section: Introductionmentioning

confidence: 99%

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Saitô

Yamaguchi

Toya

et al. 2019

Advances in Radiation Oncology

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PurposeSingle-fraction radiation therapy (RT) is a convenient and cost-effective regimen for the palliation of painful bone metastases, but is still underused. Randomized controlled trials comparing single- versus multiple-fraction RT are limited by generalizability. We compared the pain response rates after single- versus multiple-fraction RT in nonrandomized studies.Methods and MaterialsWe searched PubMed and Scopus from the inception of each database through August 2018. We sought to identify nonrandomized studies in which data on pain response rates could be extracted for single- and multiple-fraction RT. Our primary outcomes of interest were the overall and complete pain response rates in evaluable patients. The analysis was performed using a random-effects model with the Mantel-Haenszel method.ResultsOf the 3933 articles identified through our search, 9 met our inclusion criteria. Five of 9 included studies did not exclude patients with features of complicated bone metastases. A 1 × 8 Gy radiation schedule was frequently used in single-fraction therapy, and schedules of 5 × 4 Gy and 10 × 3 Gy were frequently used in multiple-fraction therapy. In the 9 studies, the overall response rate was 67% (884 of 1321 patients) for patients in the single-fraction arm and 70% (953 of 1360 patients) for those in the multiple-fraction arm (pooled odds ratio [OR]: 0.85; 95% confidence interval [CI], 0.66-1.08). In 5 studies, the complete response rate was 26% (195 of 753 patients) for patients in the single-fraction arm and 35% (289 of 821 patients) for those in the multiple-fraction arm (pooled OR: 0.89; 95% CI, 0.70-1.13).ConclusionsThere were no significant differences in the overall and complete response rates between single- and multiple-fraction RT. The effectiveness of single-fraction regimens was shown in nonrandomized settings, which better reflect daily practice than randomized studies. The CIs for the pooled ORs included clinically meaningful differences, and the study results are inconclusive.

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Section: Introductionmentioning

confidence: 99%

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Saitô

Yamaguchi

Toya

et al. 2019

Advances in Radiation Oncology

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“…We propose several explanations for this multiple fractionation preference: the possibility of RT-related fracture with or without neurologic progression; financial compensation; training and/or educational experience; concern for symptom redevelopment; and fear of the need for reirradiation. There was a clear difference in the patterns of fractionation for bone metastasis when comparing country, location of training, and practice site in the previously mentioned international studies [ 6 , 7 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 95%

Spine Metastasis Practice Patterns among Korean, Chinese, and Japanese Radiation Oncologists: A Multinational Online Survey Study

Park

Ahn

et al. 2017

Journal of Radiation Research

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This online survey of practising radiation oncologists from Korea, China and Japan was conducted to investigate the current practices in radiotherapy (RT) for spine metastasis and to compare these practices across the three countries. The questionnaire included nine general information questions and two clinical scenarios (representing ‘typical’ and ‘good’ prognosis spine metastasis), with seven questions for each scenario. An anonymous web-based survey using Google Docs® was undertaken from 2 September 2014 to 9 April 2015. A total of 54 Korean, 107 Chinese and 104 Japanese radiation oncologists participated in the study. The first scenario involved a typical case of spine metastasis (~25% expected 1-year survival rate), and the preferred fractionation scheme was 10 fractions of 3 Gy, though the pattern was slightly different in each country. The second scenario involved a good prognosis case (>50% expected 1-year survival rate), and 10 fractions of 3 Gy was the preferred practice in all three countries (however, use of a larger fraction dose with a smaller fraction number was more common in Korea). A more conformal RT technique was more prominent in China and Korea, especially for patients with a good prognosis. Avoidance of reirradiation was notable in China. In summary, a preference for multiple fractionation in RT for spine metastasis was observed in the majority of Korean, Chinese and Japanese radiation oncologists, although there were slight differences in practice preferences, especially for patients with a favorable prognosis.

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“…Accordingly, there are substantial practice changes among radiation oncologists treating bone metastases. Single fraction radiation remains frequently used in Europe, Canada and Australia,48–50 while multiple fraction radiation is likely advocated in the USA51 and China 52…”

Section: Discussionmentioning

confidence: 99%

Optimal dose-fractionation schedule of palliative radiotherapy for patients with bone metastases: a protocol for systematic review and network meta-analysis

Tang

Chen

et al. 2020

BMJ Open

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IntroductionThe optimal dose-fractionation schedule of palliative radiotherapy has been debated in patients with bone metastases. Our objective is to comprehensively compare multiple fraction schedules with single fraction radiotherapy in terms of efficacy and toxicities by performing a systematic review and network meta-analysis.Methods and analysisElectronic searches of titles/abstracts of palliative radiotherapy for bone metastases will be performed, using PubMed, Cochrane Library, Embase,clinical trials, American Society for Therapeutic Radiology and Oncology and European Society of Radiotherapy and Oncology. The primary outcome of interest is the incidence of skeletal-related event following palliative radiotherapy for bone metastases in prospective studies. The risk of bias and quality of evidence will be evaluated based on Cochrane Collaboration’s tool and Grades of Recommendation, Assessment, Development and Evaluation in the network meta-analysis. We will conduct subgroup analysis and sensitivity analysis regardless of heterogeneity estimates.Ethics and disseminationThis study will synthesise the evidence regarding dose-fractionation schedule of palliative radiotherapy in patients with bone metastases. We hope the findings from this study will help clinicians and patients select optimum palliative radiotherapy by identifying the optimal dose-fractionation schedule of palliative radiotherapy with the most value in terms of patient-important outcomes. The evidence obtained from network meta-analysis will help to guide head-to-head research in the future. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics review board is not required for this network meta-analysis.PROSPERO registration numberCRD42019135195.

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Factors Affecting the Use of Single-Fraction Radiotherapy for the Palliation of Bone Metastases in Australia

Cited by 19 publications

References 31 publications

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies

Spine Metastasis Practice Patterns among Korean, Chinese, and Japanese Radiation Oncologists: A Multinational Online Survey Study

Optimal dose-fractionation schedule of palliative radiotherapy for patients with bone metastases: a protocol for systematic review and network meta-analysis

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