Single Fraction versus Multiple Fraction Radiotherapy for treatment of painful bone metastases: A Prospective Study; Mansoura experience

Metastatic bone disease is a commonly encountered problem in oncology practice. Many patients with cancer, though heavily treated, ultimately metastasise. One of the important sites of metastasis is bone. Bone metastases can cause severe and debilitating effects, including pain, pathological fracture, hypercalcaemia and spinal cord compression. [1] Palliative external beam radiotherapy (EBRT) is an effective treatment option for pain control from symptomatic bone metastases. Multiple randomised controlled studies, meta-analyses, and systematic reviews have all shown equivalence in pain response between single fraction (SF) radiotherapy and multiple fraction (MF) radiotherapy in cancer patients with bone metastases from a variety of primary malignancies.[2, 3, 4, 5, 6, 7]. Despite that high-level evidence, the use of single fractions for the management of painful bone metastases is not as widely practiced in the world as the evidence may suggest. This discordance between the results of randomised trials and patterns of practice has been highlighted in several practice-pattern surveys. [8, 9, 10] Radiotherapy is usually given as an outpatient treatment, which requires daily hospital attendance at a specialised centre that may be some distance from the patient’s home. A protracted course of RT may cause considerable problems for patients, especially those with poor performance status and limited life expectancy. It also increases the workload of the treatment centre. [11] A single fraction of treatment has the advantages that it is Forum of Clinical Oncology