Differences in palliative radiotherapy for bone metastases within Western European countries

Abstract

Purpose: To evaluate the differences in palliative radiotherapy for painful bone metastases amongst different Western European countries. Materials and methods: A questionnaire was sent to 565 radiotherapy centres in 19 Western European countries, based on the 1997 ESTRO directory. In this questionnaire the current local palliative radiotherapy practice for bone metastases was assessed in terms of total dose, fractionation, treatment complexity (use of shielding blocks, frequency of isodose calculations, field set-up) and type of machine used. The differences were analyzed according to the country and to the type and size of radiotherapy centre. Results: A total of 205 centres (36%) returned the questionnaire, of which 198 could be further analyzed. The most frequently used antalgic fractionation schedule is 30 Gy in ten daily fractions of 3 Gy (50%), single fractions and conventional 2 Gy fractions being used in a minority of the centres (respectively, 11 and 9%). Most antalgic treatments are performed on a linear accelerator (67% of the centres uses linear accelerators) and 64% of the centres predominantly uses a two-field set-up. The majority of the centres uses shielding blocks and performs isodose calculations in less than 50% of the patients, (respectively, 88 and 81%). There is a correlation between the centre size and the palliative irradiation practice, the largest centres using more hypofractionation ( χ 2: P=0.001; logit: P=0.0003) and a less complex treatment set up as expressed by the use of isodose calculations ( χ 2: P=0.027; logit: P=0.0161). There is also a tendency to use less shielding blocks ( P=0.177). The same goes for university centres as compared with private centres: university centres use shorter fractionation schedules ( χ 2: P=0.008; logit: P=0.0094), less isodoses ( χ 2: P=0.010; logit: P=0.0115) and somewhat less shielding blocks ( P=0.151). Amongst the analyzed countries different tendencies in fractionation ( P=0.001) and treatment complexity are observed (use of isodoses: P=0.014, use of shielding blocks: P=0.001). Conclusion: These data suggest that beside work-load and clinical evidence, country-related factors such as tradition and habits, past teaching, the national organization of health care and reimbursement criteria may influence the local practice.