Single-Fraction Radiotherapy for Palliation of Bone Metastases Improves Quality of Life

Standardizing prescribing protocols for single-fraction radiation therapy (SFRT) for palliation of bone metastases could lead to cost savings and improvement in bone cancer patients’ quality of life, according to recent research.

Bone metastases are a common manifestation of distant spread of disease, occurring most frequently in patients with prostate, breast, and lung cancers. Of these, two-thirds develop bone metastases to the spine, pelvis, or extremities. Radiation therapy is an effective form of palliative treatment for bone metastases. There are more than 25 randomized, controlled trials demonstrating that SFRT provides the same amount of pain control as multiple-fraction radiation therapy (MFRT); however, there is low use internationally of SFRT for bone metastases.

This project is one of the largest, current studies on the use of SFRT. The study was designed to determine the use of SFRT in British Columbia, a publicly funded health care system where there is no financial incentive for extended fractionation and all radiation therapy is provided by the BC Cancer Agency with no direct cost to patients.

Patients who received palliative radiation therapy for bone metastases, regardless of the primary cancer site at diagnosis, from 2007 to 2011 were identified using the BC Cancer Agency’s Cancer Agency Information System (CAIS). During the study period, 8,601 patients received 16,898 courses of radiation therapy. Patients who received re-irradiation for bone metastases were included, and patients who received more than one course of radiation therapy were considered independently for each course (patients could be counted more than once). Radiation therapy fractionation was sorted into two categories: SFRT or MFRT. The most common primary disease site was breast (23.4%), and the most frequently treated bony metastatic site was the spine (42.2%).

SFRT was employed to treat bone metastases in 49.2% (7,097) of the radiation therapy regimens. SFRT was most typically used to treat bone metastases that originated from hematologic (56.6%) and prostate (56.1%) cancers; the most typical bony metastatic sites treated with SFRT were the ribs (83%) and extremities (66.4%).

There was a substantial variation in the use of SFRT by each of the five cancer centers run by the BC Cancer Agency during the time of the study, with a range of 25.5%–73.4% (p < 0.001). The findings demonstrated that the overall utilization rate of SFRT in British Columbia is 49.2%, a rate consistent with other Canadian and European data that reveal SFRT use ranges from 32%–64%t. SFRT use is much higher, however, than in the United States, where SFRT use ranges from only 3%–13%. The study findings were published August 1, 2014, in the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO).

“Previous research has shown that single-fraction radiation therapy is equally as effective as longer multiple-fraction courses. Single-fraction radiation therapy offers greater convenience for patients, is associated with fewer side effects, and incurs a lower cost. Even a modest change in the frequency of single-fraction radiation therapy use, in Canada and America, could lead to meaningful cost-savings, improved patient convenience and reduced patient side effects, thereby increasing patients’ quality of life,” said Robert A. Olson, MD, MSc, lead author of the study, and the research and clinical trials lead and a radiation oncologist at the BC Cancer Agency Center for the North (Prince George, BC, Canada). “As a result of discussing our study outcomes among radiation oncologists in British Columbia, we have already seen an increase in the use of single-fraction radiation therapy for bone metastases. We are hopeful that these results will motivate practice change worldwide.”

Related Links:
BC Cancer Agency Center for the North