Why don't British radiotherapists give single fractions of radiotherapy for bone metastases?

A sample of 42 out of 80 delegates at RADIOLOGY '87 were asked about their treatment of a hypothetical patient with bone metastases from carcinoma of the breast. Details of their experience, the proportion of palliative work performed and the location of their centre were obtained. Only 36% gave a single fraction of radiotherapy, whereas 64% used multiple fractions. This confirms that despite many publications suggesting single fractions of radiotherapy are more cost effective and as good as fractionated treatment schedules in terms of pain relief, the need for retreatment and side-effects, the majority of British radiotherapists still use multiple fractions. Of the group using multiple fractions, 67% gave training as a reason for not using a single fraction, departmental policy being the second most quoted reason. Fear of recurrence, problems of retreatment and acute nausea were more of an influence than initial response or long-term effects. The presence of neurological signs or symptoms made the majority of delegates choose multiple fractions. An increased use of single fractions was noted in the Midlands and North of England compared with the South. Practice is unlikely to change unless there is an increased emphasis on palliative techniques in training.