Variation in the use of single- versus multi-fractions palliative radiotherapy for bone metastases in Australia.

Abstract

To evaluate the use of single-fraction palliative radiotherapy (SFRT) for the management of bone metastases (BM) in Victoria, Australia METHODS AND MATERIALS: This is a population-based cohort of cancer patients who received RT for BM between 2012 and 2017 as captured in the Victorian Radiotherapy Minimum Data Set (VRMDS). The primary outcome was proportion of SFRT use. The Cochrane-Armitage test for trend was used to evaluate changes in practice over time. Multivariable logistic regression was used to assess factors associated with SFRT use. Of the 18,158 courses of RT for BM delivered in a total of 10,956 patients, 17% were SFRT. There was no significant change in SFRT use over time, from 18% in 2012 to 19% in 2017 (P=0.07). SFRT was less commonly given to skull (4%) and spine (14%), compared to shoulder (37%) and ribs (53%). Patients with lung cancer (21%) were most likely to receive SFRT, followed by those with prostate cancers (18%) and gastrointestinal cancers (16%). Patients from regional/remote areas were more likely to have SFRT compared to those in major cities (22% vs. 16%, P<0.001). Patients treated in public institutions were more likely to have SFRT compared to those treated in private institutions (22% vs. 10%, P<0.001). In multivariable analyses, increasing age, lung cancer, living in regional/remote areas, and being treated in public institutions were factors independently associated with increased likelihood of receiving SFRT. SFRT appears under-utilized for BM in Australia over time, with variation in practice by patient, tumor, geographical and institutional provider factors.