International Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: Evidence-Based Practice?

Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States

“…We observed a widening gap in the rates of prescription of SF-RT between academic and nonacademic facilities, with patients treated at nonacademic sites being less likely to receive SF-RT. This relationship has been documented internationally, suggesting that this phenomenon is not limited to US practice alone (32)(33)(34). The most salient explanation for the association of treating facility type and fractionation patterns is that radiation therapy may be overutilized at free-standing sites (35,36).…”

Patterns of Care and Course of Symptoms in Palliative Radiotherapy

“…One reason for applying a more fractionated schedule might be the fact that stabilization was an additional treatment goal in 61% of these patients. In addition, Fairchild and colleagues documented an international withholding in using evidence-based hypofractionated palliative radiotherapy for painful bone metastases without naming reasons [9].…”

Choosing Wisely: The American Society for Radiation Oncology’s Top 5 list

“…17 Despite this, 1 practice pattern survey showed over 100 fractionation schemes in use for the treatment of bone metastases worldwide. 18 While retreatment rates are about 20% following single fraction treatment versus 8% after multifraction treatment, a second single fraction can succeed in providing palliation. 19 Additionally, single fraction therapy is safe for patients with spine bone metastases and exhibits the same pain relief durability as multifraction courses.…”