• Charles E Rutter, James B Yu, Lynn D Wilson, and Henry S Park.
• Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut. Electronic address: charles.rutter@yale.edu.
• Int. J. Radiat. Oncol. Biol. Phys. 2015 Mar 1;91(3):548-55.

PurposeTo characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions.Patients And MethodsThe National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details.ResultsWe included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05).ConclusionsSingle-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such that evidence-based and cost-conscious care becomes more commonplace.Copyright © 2015 Elsevier Inc. All rights reserved.

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