Patterns of Practice in the Prescription of Palliative Radiotherapy for the Treatment of Bone Metastases at the Rapid Response Radiotherapy Program between 2005 and 2012

Abstract

Objective: We examined whether patterns of practice in the prescription of palliative radiation therapy for bone metastases had changed over time in the Rapid Response Radiotherapy Program (RRRP). Methods: After reviewing data from August 1, 2005, to April 30, 2012, we analyzed patient demographics, diseases, organizational factors, and possible reasons for the prescription of various radiotherapy fractionation schedules. The chi-square test was used to detect differences in proportions between unordered categorical variables. Univariate logistic regression analysis and the simple Fisher exact test were also used to determine the factors most significant to choice of dose–fractionation schedule. Results: During the study period, 2549 courses of radiation therapy were prescribed. In 65% of cases, a single fraction of radiation therapy was prescribed, and in 35% of cases, multiple fractions were prescribed. A single fraction of radiation therapy was more frequently prescribed when patients were older, had a prior history of radiation, or had a prostate primary, and when the radiation oncologist had qualified before 1990. Conclusions: For patients with bone metastasis, a single fraction of radiation therapy was prescribed with significantly greater frequency.

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

“…The findings of our study confirmed this hypothesis, consistent with prior reports on US practice patterns (13)(14)(15). Our results highlight a wide discrepancy between US patterns of care and trends in treatment abroad, as demonstrated by Figure 3 (2, [13][14][15][17][18][19][20][21][22][23][24][25][26][27]. This contrast underscores the need for more widespread adoption of SF-RT for bone metastases in the United States, in pursuit of more evidence-based, value-conscious care.…”

Are radiation oncologists following guidelines? An audit of practice in patients with uncomplicated bone metastases

“…We found that older age was correlated with higher rates of SFRT use, with greater use of MFRT (p = 0.042) in patients 70 years of age or younger. Several other studies have shown a similar correlation between age and choice of fractionation [14,[22][23][24][25][26][27]. We found too that performance status was a significant predictor for the choice of fractionation.…”

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] .…”

“…The most recent cohorts investigated were those by Thavarajah et al [21] and Olson et al [23] , from 2005 to 2012 and 2007 to 2011, respectively. Thavarajah et al [21] included 2549 RT to bone metastases, of which 65% were prescribed SFRT. These authors stated that there was no significant change in the prescription of SFRT over the study period.…”