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

Published online by Cambridge University Press:  16 May 2013

N. Bhalla ,
H. Wong ,
A. Ibrahim  and
J. A. Green
N. Bhalla*
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
H. Wong
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
A. Ibrahim
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
J. A. Green
Affiliation:
Clatterbridge Centre for Oncology, NHS Foundation Trust, Bebington, UK
*
Correspondence to: Neeraj Bhalla, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK. Tel: 0151 334 1155. E-mail: [email protected]
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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 χ2 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 = 0·038, 2006: p = 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.

Keywords

adverse skeletal eventsbone metastasesdose-fractionationpainpalliationradiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 12 , Issue 3 , September 2013 , pp. 208 - 217
Copyright
Copyright © Cambridge University Press 2013 

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