McDonald Rachel, Chow Edward, Lam Henry, Rowbottom Leigha, Soliman Hany
Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N3M5.
J Bone Oncol. 2014 Nov 7;3(3-4):96-102. doi: 10.1016/j.jbo.2014.10.003. eCollection 2014 Nov.
Radiation therapy is the standard treatment for symptomatic bone metastases. Several randomized control trials and meta-analyses have concluded a similar efficacy in pain relief when comparing single versus multiple fraction regimes. However, there continues to be reluctance to conform to published guidelines that recommend a single treatment for the palliation of painful bone metastases. The purpose of this literature review is to summarize international patterns of practice, and to determine if guidelines recommending single fraction treatment have been implemented in clinical care.
A literature search was conducted in Ovid Medline, Embase, and Cochrane Central. Search words included, 'bone metastases', 'radiation therapy', 'radiotherapy', 'patterns of practice', and 'dose fractionation'. Both prospective and retrospective studies that investigated the prescription of radiotherapy to bone metastases using actual patient databases were included. Articles were excluded if they investigated hypothetical scenarios.
Six hundred and thirteen results were generated from the literature search. Twenty-six articles met the inclusion criteria. Of these, 11 were Canadian, 8 were European, 6 were American, and 1 was Australian. The use of single fraction radiotherapy (SFRT) ranged from 3% to 75%, but was generally lower in American studies. Choice of fractionation depended on a variety of factors, including patient age, prognosis, site of irradiation, and physician experience.
Despite the publication of robust randomized control trials, meta-analyses, and clinical practice guidelines recommending the use of a single treatment to palliate uncomplicated bone metastasis, SFRT is internationally underutilized.
放射治疗是有症状骨转移的标准治疗方法。多项随机对照试验和荟萃分析得出结论，比较单次分割与多次分割方案时，在缓解疼痛方面疗效相似。然而，对于遵循已发表的指南推荐采用单次治疗来缓解疼痛性骨转移，仍存在抵触情绪。本文献综述的目的是总结国际上的实践模式，并确定推荐单次分割治疗的指南是否已在临床护理中得到实施。
在Ovid Medline、Embase和Cochrane Central进行文献检索。检索词包括“骨转移”“放射治疗”“放疗”“实践模式”和“剂量分割”。纳入使用实际患者数据库研究骨转移放疗处方的前瞻性和回顾性研究。如果研究调查的是假设情景，则将文章排除。
文献检索产生了613条结果。26篇文章符合纳入标准。其中，11篇来自加拿大，8篇来自欧洲，6篇来自美国，1篇来自澳大利亚。单次分割放疗（SFRT）的使用比例在3%至75%之间，但在美国的研究中通常较低。分割方式的选择取决于多种因素，包括患者年龄、预后、照射部位和医生经验。
尽管已发表了有力的随机对照试验、荟萃分析和临床实践指南，推荐采用单次治疗来缓解无并发症的骨转移，但国际上单次分割放疗的使用未得到充分利用。
