Single- vs. Multiple-Fraction Radiotherapy for Bone Metastases

Robert Dreicer, MD, MS, FACP

Among patients with bone metastases from prostate cancer, far more receive multiple fractions, despite evidence supporting the use of single-fraction therapy.

Radiotherapy as a palliative intervention for painful bone metastases has long been considered a standard of care. Randomized trials in Europe and the U.S. have provided level-1 evidence that single-fraction therapy is as effective as longer courses for relieving pain in patients with uncomplicated bone metastases. Now, investigators have used Surveillance, Epidemiology and End Results Medicare data linked to longitudinal Medicare claims to assess whether single-fraction radiotherapy has been incorporated into the routine management of men with metastatic prostate cancer.

The study involved 3050 patients ≥65 years of age (median age, 78) with bone metastases from prostate cancer who received radiotherapy from 2006 to 2009. Patients were classified into single- or multiple-fraction treatment groups. The investigators compared prognoses by evaluating survival estimates and assessed costs of care.

Only 3.3% of patients received single-fraction radiotherapy, whereas 50.3% of patients received >10 fractions. Median survival after the index radiotherapy course was shorter in patients who received single-fraction treatment versus multiple fractions (5.0 vs. 11.9 months; P<0.001). Mean 45-day radiotherapy–related expenditures were 62% lower for patients who received single versus multiple fractions.

Citation(s):

Bekelman JE et al. Single- vs multiple-fraction radiotherapy for bone metastases from prostate cancer. JAMA 2013 Oct 9; 310:1501.