Fewer Side Effects, Cost Savings, With Single-Fraction Radiotherapy for Bone Metastases

A new study has found that standardizing prescribing practices for single-fraction radiation therapy (SFRT) for palliation of bone metastases may result in cost savings and an improvement in patients' quality of life.

Robert A. Olson, MD, MSc

A new study has found that standardizing prescribing practices for single-fraction radiation therapy (SFRT) for palliation of bone metastases may result in cost savings and an improvement in patients’ quality of life.

The study, published in the International Journal of Radiation Oncology • Biology • Physics, found that the overall utilization rate of SFRT in British Columbia is 49.2%, a rate consistent with other Canadian and European data that show SFRT use ranges from 32% to 64%—a rate much higher than in the United States, where SFRT use ranges from only 3% to 13%.

“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,” lead study author Robert A. Olson, MD, MSc said in a statement. Olson is the research and clinical trials lead and a radiation oncologist at the BC Cancer Agency Centre for the North.

The study, one of the largest current studies on the use of SFRT, was designed to determine the use of SFRT in British Columbia.

For the study, patients who received palliative radiation therapy for bone metastases regardless of their primary cancer were identified using the BC Cancer Agency’s Cancer Agency Information System. The most common primary disease site was breast (23.4%), and the most frequently treated bony metastatic site was the spine (42.2%).

Between 2007 and 2011, 8601 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 divided into two categories: SFRT or multiple-fraction radiation therapy (MFRT).

SFRT was used to treat bone metastases in 49.2% (7097) of the radiation therapy courses. SFRT was most commonly used to treat bone metastases that originated from hematologic (56.6 percent) and prostate (56.1%) cancers; the most common bony metastatic sites treated with SFRT were the ribs (83%) and extremity (66.4%).

“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,” said Olson.