Palliative Radiation Oncology: Moving Beyond the Single Fraction.

Abstract

The use of single-fraction radiation therapy (SFRT) for uncomplicated bone metastases continues to dominate conversation regarding palliative care within radiation oncologydcare that certainly includes but is far more complex than appropriate dose fractionation. However, despite multiple randomized trials (1, 2), meta-analyses (3), and support by the American Society for Radiation Oncology “Choosing Wisely” campaign (4), the use of SFRT (8 Gy) for palliation of uncomplicated bone metastases remains low. Although SFRT rates in Canada and Europe are 40% to 50%, rates in the United States are less than 10% (5-8). Quality improvement (QI) measures in the care of patients with advanced cancer are needed to resolve this deficiency in evidence-based care as part of a comprehensive, evidence-based approach to patientcentered palliative care within radiation oncology. Reported in this issue of the International Journal of Radiation Oncology, Biology, Physics are 2 Canadian studies aiming to improve the quality of palliative care within radiation oncology by promoting SFRT utilization in the management of bone metastases. Ashworth et al (7) evaluated the impact of provincial practice guidelines, published in 2004, endorsing SFRT for uncomplicated bone metastases on fractionation patterns. Although an initial increase in the rate of SFRT was seen after guideline publicationdfrom 42.3% in years 1999-2003 to 52.6% in