A review of patterns of practice and clinical guidelines in the palliative radiation treatment of uncomplicated bone metastases

Vithusha Ganesh, Stephanie Chan, Srinivas Raman, Ronald Chow, Peter Hoskin, Henry Lam, Bo Angela Wan, Leah Drost, Carlo DeAngelis, Edward Chow

Research output: Contribution to journalReview articlepeer-review


BACKGROUND AND PURPOSE: Single fraction radiation treatment (SFRT) is recommended for its equivalence to multiple-fraction (MF) RT in the palliation of uncomplicated bone metastases (BM). However, adoption of SFRT has been slow.

MATERIALS AND METHODS: Literature searches for studies published following 2014 were conducted using online repositories of gray literature, Ovid MEDLINE, Embase and Embase Classic, and the Cochrane Central Register of Controlled Trials databases.

RESULTS: A total of 32 articles detailing patterns of practice and clinical practice guidelines were included for final synthesis. The majority of organizations have released high level recommendations for SFRT use in treatment of uncomplicated BM, based on evidence of non-inferiority to MFRT. There are key differences between guidelines, such as varying strengths of recommendation for SFRT use over MFRT; contraindication in vertebral sites for SFRT; and risk estimation of pathologic fractures after SFRT. Differences in guidelines may be influenced by committee composition and organization mandate. Differences in patterns of practice may be influenced by individual center policies, payment modalities and consideration of patient factors such as age, prognosis, and performance status.

CONCLUSION: Although there is some variation between groups, the majority of guidelines recommend use of SFRT and others consider it to be a reasonable alternative to MFRT.

Original languageEnglish
Pages (from-to)38-44
Number of pages7
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Issue number1
Publication statusPublished - Jul 2017


  • Bone Neoplasms/radiotherapy
  • Fractures, Spontaneous
  • Humans
  • Palliative Care/methods
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Randomized Controlled Trials as Topic

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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