Aims:
To study the variation of Single fraction Radiotherapy (SFRT) among patients with bone metastases in an academic radiation oncology practice. Guidelines recommend SFRT for palliation of uncomplicated bone metastases, but implementation is variable. We used SINS (spinal) & MIREL (non-spinal) scoring tools to determine uncomplicated bony metastases and assessed if scores correlate to clinical decision making.
Methods:
We retrospectively analysed all patients (52), with skeletal metastasis (92 sites) who received palliative radiotherapy (87 treatments), over a period of one year at the Illawarra Shoalhaven Cancer & Haematology Network. SINS and MIREL scores were awarded using historical data. We compared the distribution of single fraction vs multiple fractions radiotherapy (MFRT) received by these patients.
Results:
Of the 87 treatments, 50 had spinal and 37 had non-spinal metastasis. SFRT percentages reduced with increase in SINS Total score as well as Mirel total score (from 50% to 0 for scores 1 to 11 in both). Individual score of SINS- Pain, Location, Lesion and Mirel - Pain, lesion, Size also showed similar downward trend.
Conclusion:
Clinical judgment for SFRT follows expected trend for treatment of uncomplicated bony metastases in Illawarra Shoalhaven Cancer & Haematology Network. However even for the lowest score (1) not more than 50% patients received SFRT. Some of the discrepancies can be explained by patient factors like comorbidities, predicted survival, other sites of disease, activity level, bone mineral density, previous radiotherapy and primary soft tissue component of metastases. We aim to undertake a prospective trial to compare if using these scores would increase the accuracy of determining the right treatment and increase the number of SFRTs for uncomplicated bony metastases, thereby improving quality of life, reducing costs and patient burden.