Palliative radiotherapy for bone metastases at the end of life in Victoria

Wee Loon Ong, Farshad Foroudi, Roger L Milne and Jeremy L Millar
Med J Aust 2021; 214 (5): . || doi: 10.5694/mja2.50954
Published online: 15 March 2021

To the Editor: Palliative radiotherapy is effective for symptomatic management of bone metastases in cancer patients. However, it may take 2–4 weeks after completion of radiotherapy to achieve maximal clinical response.1 Radiotherapy can be delivered as a single fraction treatment (SFRT), or over a more protracted course of multifraction treatment (MFRT).2 Randomised trials have consistently shown that SFRT and MFRT provide equally effective symptom control,3 and SFRT is associated with lower medical and societal cost,4 allowing for better health services utilisation. Hence, in patients with poor prognosis, the use of SFRT over MFRT should be encouraged to minimise the time patients spend on treatment at the end of life without compromising efficacy.

  • 1 Olivia Newton‐John Cancer and Wellness Centre, Austin Health, Melbourne, VIC
  • 2 University of Cambridge, Cambridge, UK
  • 3 Cancer Council Victoria, Melbourne, VIC
  • 4 Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
  • 5 Alfred Health, Melbourne, VIC
  • 6 Monash University, Melbourne, VIC



We thank the Centre for Victorian Data Linkage for performing data linkages and providing access to the dataset.

Competing interests:

No relevant disclosures.

  • 1. Steenland E, Leer JW, van Houwelingen H, et al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 1999; 52: 101–109.
  • 2. Lutz S, Balboni T, Jones J, et al. Palliative radiation therapy for bone metastases: Update of an ASTRO evidence‐based guideline. Pract Radiat Oncol 2017; 7: 4–12.
  • 3. Chow R, Hoskin P, Schild SE, et al. Single vs multiple fraction palliative radiation therapy for bone metastases: Cumulative meta‐analysis. Radiother Oncol 2019; 141: 56–61.
  • 4. van den Hout WB, van der Linden YM, Steenland E, et al. Single‐ versus multiple‐fraction radiotherapy in patients with painful bone metastases: cost‐utility analysis based on a randomized trial. J Natl Cancer Inst 2003; 95: 222–229.
  • 5. Krishnan MS, Epstein‐Peterson Z, Chen YH, et al. Predicting life expectancy in patients with metastatic cancer receiving palliative radiotherapy: the TEACHH model. Cancer 2014; 120: 134–141.


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