Single fraction radiation therapy (SFRT) is just as effective as multiple fraction radiation therapy (MFRT) at improving bone metastases patients' pain, function and quality of life, according to a multi-center, prospective study presented at this year's American Society for Radiation Oncology meeting.

Previous studies had shown that SFRT is equally as effective as MFRT, but they were controlled clinical trials that did not include patients with poor performance status, fractures or neurological damage. As a result, some oncologists decide not to choose SFRT because they don't think it applies to their patient.

For this new study, the researchers at BC Cancer Agency Centre for the North included a variety of patients who underwent RT for bone metastases. "We already know there is a lot of variation [in utilization] so we wanted something that would motivate people to change their practice," Dr. Robert A. Olson, lead author of the study, told DOTmed News.

A total of 648 patients — 226 with metastases complicated by fracture or neurological compromise — from all six of their centers were evaluated from May 2013 to December 2013. The treating oncologists decided whether the patients should receive SFRT or MFRT and as a result, 56 percent underwent SFRT and 44 percent underwent MFRT.

All of the patients filled out a questionnaire before and after their treatment. The questionnaire asked three questions to evaluate their perception of pain, function and quality of life. On a scale from zero to four — zero meaning "not at all" and four meaning "very much" — the patients rated the degree of their bone pain, how much the pain hindered their ability to care for themselves and how frustrated they were with their bone pain.

The researchers found that there was no significant difference in the answers provided by the patients treated with SFRT and those treated with MFRT. For pain, there was a 1.29 point improvement for SFRT patients and a 1.17 improvement for MFRT patients, for function, there were 0.80 and 0.95 improvements respectively, and for symptom distress there was a 1.26 improvement for both groups of patients.

Another reason Olson believes that SFRT is not as widely used is because MFRT is more profitable. "It's quite a controversial topic — I think the obvious elephant in the room is that there is higher remuneration to get more fractions," he said. "Somebody gets paid more to do two weeks of radiation over one treatment."

But he thinks that's going to change now. More studies are in the works and he thinks that his data and the data from the new studies will be used by insurance companies to advocate for SFRT.

"I think it will have an impact and I think it could save a lot of money and improve quality of life for patients," Olson said.

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