Review of international patterns of practice for the treatment of painful bone metastases with palliative radiotherapy from 1993 to 2013

Radiother Oncol. 2014 Apr;111(1):11-7. doi: 10.1016/j.radonc.2014.01.015. Epub 2014 Feb 20.


Background and purpose: Numerous randomized controlled trials and meta-analyses have affirmed that single and multiple fractions of radiotherapy provide equally efficacious outcomes in the palliation of painful, uncomplicated bone metastases (UBM). We aim to determine geographic, temporal and ancillary factors that influence the global patterns of practice in this setting.

Materials and methods: A literature search was conducted on Ovid MEDLINE and EMBASE. Studies were included if they disclosed prescription patterns of single fraction radiotherapy, either through hypothetical cases or actual patient data. Weighted analysis of variance was conducted for binary predictors while weighted linear regression analysis was performed for continuous parameters.

Results: Nine hypothetical case studies and thirteen actual patterns of practice articles were included from 301 search results. Radiation oncologists prescribed dose fractionations ranging from 3Gy×1 to 2Gy×30, with a median of 3Gy×10, for the palliation of UBM. Actual data demonstrated a weak, non-significant, negative linear relationship between the use of single fraction radiotherapy and the year of treatment. Geographical location of treatment was a key predictor of prescription patterns.

Conclusion: In the last twenty years, there was an overall global reluctance to practice evidence-based medicine by employing single fractions for UBM.

Keywords: Bone metastases; Dose fractionation; Palliative radiotherapy; Patterns of practice; Radiation oncology.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bone Neoplasms / radiotherapy*
  • Bone Neoplasms / secondary*
  • Dose Fractionation, Radiation
  • Humans
  • Pain / etiology*
  • Pain / radiotherapy*
  • Palliative Care / methods*
  • Practice Patterns, Physicians'
  • Radiation Oncology / statistics & numerical data
  • Randomized Controlled Trials as Topic