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Differences in palliative radiotherapy for bone metastases within Western European countries
Y Lievens1, K Kesteloot, A Rijnders
1Radiotherapy Department, University Hospital, Herestraat 49, 3000 Leuven, Belgium.
Summary
Palliative radiotherapy for bone metastases varies significantly across Western Europe. Country-specific factors like tradition and healthcare organization influence treatment practices, alongside clinical evidence.
Area of Science:
- Oncology
- Radiation Oncology
- Palliative Care
Background:
- Bone metastases are a common complication of cancer, often causing significant pain and reduced quality of life.
- Palliative radiotherapy is a crucial intervention for managing pain associated with bone metastases.
- Understanding variations in radiotherapy practices is essential for optimizing patient care and treatment standardization.
Purpose of the Study:
- To investigate and compare palliative radiotherapy practices for painful bone metastases across different Western European countries.
- To identify variations in treatment protocols, including dose, fractionation, and technical complexity.
- To analyze how country-specific factors and center characteristics influence these practices.
Main Methods:
- A questionnaire survey was distributed to 565 radiotherapy centers in 19 Western European countries.
- Data collected included total dose, fractionation schedules, treatment complexity (shielding blocks, isodose calculations, field setup), and machine type.
- Statistical analysis was performed to compare practices based on country, center type, and center size.
Main Results:
- A response rate of 36% (205 centers) was achieved, with 198 centers included in the analysis.
- The most common fractionation schedule was 30 Gy in 10 fractions (50% of centers). Linear accelerators were predominantly used (67%).
- Significant variations in fractionation (P=0.001) and treatment complexity (P=0.014 for isodoses, P=0.001 for shielding blocks) were observed between countries. Larger and university centers tended to use hypofractionation and less complex setups.
Conclusions:
- Palliative radiotherapy practices for bone metastases exhibit considerable heterogeneity across Western Europe.
- Factors beyond clinical evidence, such as national healthcare organization, reimbursement policies, tradition, and past teaching, appear to influence treatment decisions.
- Further research and international collaboration may be needed to promote evidence-based practice and reduce unwarranted variations.
