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Patterns of practice in palliative radiotherapy for bone metastases in UK centres

Published online by Cambridge University Press:  08 November 2018

Nida Khan Open the ORCID record for Nida Khan [Opens in a new window]  and
David Green
Nida Khan*
Affiliation:
Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK
David Green
Affiliation:
Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK
*
Author for correspondence: Nida Khan, E-mail: nida843@gmail.com
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Abstract

Background

There is abundant evidence of the comparative efficacy of single-fraction (SF) radiotherapy and multi-fraction (MF) radiotherapy when treating patients with bone metastases. Despite this, previous surveys have shown SF schedules to be underutilised.

Aim

To determine current patterns of practice in patients with bone metastasis and to investigate the factors that influence practice.

Method

An electronic audit was performed amongst 46 physicians, within 7 hospital trusts in the UK. The audit comprised of four hypothetical cases in which consultants and registrars chose which dose and fractionation they would recommend and their reasons for this recommendation.

Results

SF radiotherapy was the most common radiotherapy schedule in hypothetical cases 1, 3 and 4. SF radiotherapy was recommended by 65% of respondents in case 1, 47% in case 2, 89% in case 3 and 46% in case 4. For case 2, 50% proposed MF radiotherapy. For case 4, 22% of respondents recommended Stereotactic Body Radiotherapy (SABR). The following deciding factors were cited as influencing choice of an SF schedule: prognosis, published evidence, performance status and spinal cord compression.

Conclusion

The most common radiotherapy schedule selected was SF. However, there were inter-institution differences regarding the use of SF radiotherapy. Furthermore, the survey had shown that a third of respondents recommended an MF regime, despite evidence supporting the efficacy of an SF schedule.

Keywords

bone metastasesdose fractionationpalliative radiotherapypatterns of practice
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 2 , June 2019 , pp. 116 - 122
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Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Khan N, Green D. (2019) Patterns of practice in palliative radiotherapy for bone metastases in UK centres. Journal of Radiotherapy in Practice18: 116–122. doi: 10.1017/S1460396918000584

References

1. Heymann, D. (ed.) Bone Cancer: Primary Bone Cancers and Bone Metastases, 2nd edition. Burlington: Elsevier Science, 2014.Google Scholar
2. D’Antonio, C., Passaro, A., Gori, B. et al. Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies. Therap Adv Med Oncol 2014; 6 (3): 101–114.Google Scholar
3. Magné, N., Chargari, C., Mirimanoff, R. O. et al. European French-speaking study from the GEMO group on bone metastases management: a special focus on external beam radiotherapy practice survey. Support Care Canc 2011; 19 (10): 1565–1572.Google Scholar
4. Chow, E., Harris, K., Fan, G., Tsao, M., Sze, W. M. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007; 25 (11): 1423–1436.Google Scholar
5. Chung, Y., Koom, W. S., Ahn, Y. C. et al. A survey of patterns of practice on palliative radiation therapy for bone metastasis in Korea. J Canc Res Clin Oncol 2013; 139 (12): 2089–2096.Google Scholar
6. Fairchild, A., Barnes, E., Ghosh, S. et al. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol* Biol* Phys 2009; 75 (5): 1501–1510.Google Scholar
7. Nakamura, N., Shikama, N., Wada, H. et al. Patterns of practice in palliative radiotherapy for painful bone metastases: a survey in Japan. Int J Radiat Oncol Biol Phys 2011; 81 (2): S654–S655.Google Scholar
8. Sze, W. M., Shelley, M. D., Held, I., Wilt, T. J., Mason, M. D. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy—a systematic review of randomised trials. Clin Oncol 2003; 15 (6): 345–352.Google Scholar
9. AIRO (Italian Association of Radiation Oncology) and the AIRO Palliative Care Group. The INTER-ROMA Project—a survey among Italian radiation oncologists on their approach to the treatment of bone metastases. Tumori J 2011; 97 (2): 177–184.Google Scholar
10. Sheffield Hallam University. University research ethics committee: policy and procedures, 2016. https://www.shu.ac.uk/~/media/home/research/files/ethics/research-ethics-policy-and-procedures-v7-2016.pdf?la=en. Accessed September 2018.Google Scholar
11. Braithwaite, D., Emery, J., De Lusignan, S., Sutton, S. Using the Internet to conduct surveys of health professionals: a valid alternative? Family Pract 2003; 20 (5): 545–551.Google Scholar
12. Silverman, D. Doing Qualitative Research: A Practical Handbook, 3rd edition. London: Sage Publications, 2009.Google Scholar
13. Maltby, J. Research Methods for Nursing and Healthcare. Harlow: Pearson Education, 2010.Google Scholar
14. Andale A. Chi-square statistic: how to calculate it/distribution, 2017. http://www.statisticshowto.com/probability-and-statistics/chi-square/. Accessed September 2018.Google Scholar
15. Arnalot, P. F., Fontanals, A. V., Galcerán, J. C. et al. Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30 Gy in 10 fractions compared with 8 Gy in single fraction. Radiother Oncol 2008; 89 (2): 150–155.Google Scholar
16. Chow, E., Zeng, L., Salvo, N., Dennis, K., Tsao, M., Lutz, S. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol 2012; 24 (2): 112–124.Google Scholar
17. Wu, J. S., Wong, R., Johnston, M., Bezjak, A., Whelan, T., Cancer Care Ontario Practice Guidelines Initiative Supportive Care Group. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol* Biol* Phys 2003; 55 (3): 594–605.Google Scholar
18. Hartsell, W. F., Scott, C. B., Bruner, D. W. et al. Randomized trial of short-versus long-course radiotherapy for palliation of painful bone metastases. J Natl Canc Inst 2005; 97 (11): 798–804.Google Scholar
19. Howell, D. D., James, J. L., Hartsell, W. F. et al. Single‐fraction radiotherapy versus multifraction radiotherapy for palliation of painful vertebral bone metastases—equivalent efficacy, less toxicity, more convenient: a subset analysis of Radiation Therapy Oncology Group trial 97‐14. Cancer 2013; 119 (4): 888–896.Google Scholar
20. van der Linden, Y. M., Lok, J. J., Steenland, E. et al. Single fraction radiotherapy is efficacious: a further analysis of the Dutch Bone Metastasis Study controlling for the influence of retreatment. Int J Radiat Oncol Biol Phys 2004; 59 (2): 528–537.Google Scholar
21. Jhaveri, P., Teh, B. S., Bloch, C., Amato, R., Butler, E. B., Paulino, A. C. Stereotactic body radiotherapy in the management of painful bone metastases. Oncology 2008; 22 (7): 782–788.Google Scholar
22. Popovic, M., den Hartogh, M., Zhang, L. et al. Review of international patterns of practice for the treatment of painful bone metastases with palliative radiotherapy from 1993 to 2013. Radiother Oncol 2014; 111 (1): 11–17.Google Scholar
23. Bradley, N. M., Husted, J., Sey, M. S. et al. Review of patterns of practice and patients’ preferences in the treatment of bone metastases with palliative radiotherapy. Support Care Canc 2007; 15 (4): 373–385.10.1007/s00520-006-0161-3Google Scholar
24. Gebhardt, B. J., Rajagopalan, M. S., Gill, B. S. et al. Impact of dynamic changes to a bone metastases pathway in a large, integrated, National Cancer Institute–designated comprehensive cancer center network. Pract Radiat Oncol 2015; 5 (6): 398–405.Google Scholar
25. Lutz, S., Balboni, T., Jones, J. et al. Palliative radiation therapy for bone metastases: update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol 2017; 7 (1): 4–12.10.1016/j.prro.2016.08.001Google Scholar
26. Hoskin, P., Misra, V., Hopkins, K. et al. SCORAD III: randomized noninferiority phase III trial of single-dose radiotherapy (RT) compared to multifraction RT in patients (pts) with metastatic spinal canal compression (SCC). J Clin Oncol 2017; 35 (18): pp.LBA10004-LBA10004.Google Scholar