Palliative radiotherapy for bone metastases: assessment of factors influencing dose-fractionation schedules at a UK cancer centre

Abstract

Context: Meta-analyses demonstrate single-fraction radiotherapy to be as effective as multi-fraction treatment in palliating painful bone metastases, although surveys suggest reluctance in prescribing single fractions.Aims: Assess the factors influencing the choice of dose-fractionation regimen in an unselected population; examine retreatment rates and subsequent skeletal events.Methods: Data were extracted from case notes for 120 patients treated in 2000 and 2006 in a single centre serving a defined population; analysis used x 2 and Fisher's exact statistical tests.Results: An 8 Gy fraction was the commonest regimen prescribed (single-fraction delivery rate 53?6%). Tumour site was a significant factor in choice of dose-fractionation schedule. Patients with metastatic breast carcinoma were significantly less likely to receive single-fraction treatment compared with those with metastatic lung carcinoma (year 2000: p 5 0?038, 2006: p 5 0?001). There was a significantly higher retreatment rate following single-fraction compared with multi-fraction treatment (11% versus 3%). There were two subsequent neural axis compressions and four pathological fractures.Conclusions: Single-fraction treatment is the commonest regimen but multiple fractions are still frequently delivered. Better prognosis groups appear more likely to receive multi-fraction treatment, possibly to avoid the need for retreatment. Subsequent skeletal events are rare but carry high morbidity when they occur.

International patterns of practice in radiotherapy for bone metastases: A review of the literature

“…Of a total of 613 articles generated by the search, 26 met the inclusion criteria. The articles were published from 2003 to 2014: 11 were Canadian [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , 8 were European [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , 6 were American [33] , [34] , [35] , [36] , [37] , [38] , and 1 was Australian [39] . The use of SFRT to treat bone metastases was widely variable among the studies examined, ranging from as low as 3.3% to as high as 75% [36] , [39] .…”

“…European studies were very heterogeneous in the prescription of SFRT, with Central and Southern European countries [26] , [28] , [31] generally prescribing a lower proportion of SFRT and Northern and Western European countries [25] , [27] , [29] , [30] , [32] prescribing a greater proportion. A Polish study examined 1754 irradiated bone metastases from 1995 to 2002, of which 19% were treated with SFRT [26] .…”

“…In this population, SFRT was prescribed to 37% of bone metastases. The prescription of SFRT was slightly greater in a United Kingdom study, which examined 120 patients per year between 2000 and 2006 who were treated for bone metastases [29] . SFRT was prescribed in 35% of RT courses.…”

“…Sixteen of the 26 included studies reported on predictive factors for the use of SFRT [14] , [17] , [18] , [21] , [22] , [23] , [24] , [26] , [27] , [29] , [33] , [34] , [36] , [37] , [38] , [39] . The most common significant predictive factors were increased age [14] , [17] , [18] , [21] , [24] , [27] , poor patient prognosis [14] , [17] , [18] , [23] , [24] , [27] , [36] , [38] , irradiation to non-spine locations [14] , [18] , [23] , [24] , [26] , [34] , and patients with primary prostate cancer [18] , [21] , [23] , [27] .…”

“…The most common significant predictive factors were increased age [14] , [17] , [18] , [21] , [24] , [27] , poor patient prognosis [14] , [17] , [18] , [23] , [24] , [27] , [36] , [38] , irradiation to non-spine locations [14] , [18] , [23] , [24] , [26] , [34] , and patients with primary prostate cancer [18] , [21] , [23] , [27] . SFRT was also more likely to be prescribed to those living a greater distance from the treatment center [14] , [18] , [24] , [27] , those with a lung primary [26] , [27] , [29] , when the prescribing physicians had greater experience [18] , [21] , [23] , and when the treatment center was an academic as opposed to community practice [20] , [34] . The significance of some factors, such as the age of patients, treatment site, and physician experience, was contradictory as they were reported in two studies to not be significant [29] , [34] , [37] .…”