Palliative irradiation of bone metastases: patterns of care with focus on single fraction treatment

Abstract

Objectives

To evaluate the pattern of care in a large consecutive series of patients irradiated for bone metastates in one institution.

Materials and method

This series included 1754 bone metastases in 1165 patients treated between 1995 and 2002. The proportion of lesions assigned to one fraction or to fractionated radiotherapy was assessed in relation to periods of treatment and to clinical variables.

Results

Single fraction irradiation (8 Gy or 10 Gy) was applied in 327 locations (19%). The proportion of patients treated with one fraction was 28% in 2001–2002 as compared to 15–20% in previous periods (p<0.01). Single fraction was used more frequently in metastases to ribs (28%) and to long bones (21%) than in other locations (6–19%), and for small vs. large fields (p<0.01 for both comparisons). Lung and breast cancer patients were administered single fractions more frequently than prostate and renal cancer patients (p<0.04).

Conclusion

Despite clinical evidence of its efficacy, the use of a single fraction regimen in palliative radiotherpy of bone metastases has been increasing relatively slowly. This method is applied more frequently in patients with poor prognosis, in metastases to long bones and to ribs, as well as for small radiotherapy fields. Given the scarce resources of radiotherapy in Poland and satisfactory efficacy of single-fraction irradiation, this schedule should be recommended for wider use.