• Marko Popovic, Mariska den Hartogh, Liying Zhang, Michael Poon, Henry Lam, Gillian Bedard, Natalie Pulenzas, Breanne Lechner, and Edward Chow.
• Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
• Radiother Oncol. 2014 Apr 1;111(1):11-7.

Background And PurposeNumerous randomized controlled trials and meta-analyses have affirmed that single and multiple fractions of radiotherapy provide equally efficacious outcomes in the palliation of painful, uncomplicated bone metastases (UBM). We aim to determine geographic, temporal and ancillary factors that influence the global patterns of practice in this setting.Materials And MethodsA literature search was conducted on Ovid MEDLINE and EMBASE. Studies were included if they disclosed prescription patterns of single fraction radiotherapy, either through hypothetical cases or actual patient data. Weighted analysis of variance was conducted for binary predictors while weighted linear regression analysis was performed for continuous parameters.ResultsNine hypothetical case studies and thirteen actual patterns of practice articles were included from 301 search results. Radiation oncologists prescribed dose fractionations ranging from 3Gy×1 to 2Gy×30, with a median of 3Gy×10, for the palliation of UBM. Actual data demonstrated a weak, non-significant, negative linear relationship between the use of single fraction radiotherapy and the year of treatment. Geographical location of treatment was a key predictor of prescription patterns.ConclusionIn the last twenty years, there was an overall global reluctance to practice evidence-based medicine by employing single fractions for UBM.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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