Single-fraction RT underutilized for metastatic prostate cancer

Single-fraction radiotherapy for bone metastases from prostate cancer is not widely used despite its comparable efficacy and lower cost in relation to multiple-fraction treatment, according to a recent study.

“Increased use of single-fraction treatment would achieve the Holy Grail of health reform, which is real improvements in patient care at substantial cost savings,” said lead author Justin E. Bekelman, MD, of the University of Pennsylvania’s Abramson Cancer Center, Philadelphia. Yet so far, “Despite the evidence, single fraction treatment is used rarely and it’s reserved for patients with the poorest prognosis,” he said.

For the study, which was published in JAMA (2013; 310:1501-2), Dr. Bekelman and his colleagues examined a group of 3,050 patients 65 years of age and older from the Surveillance, Epidemiology and End Results-Medicare database who were treated with radiotherapy for advanced prostate cancer and bone metastases. For each patient, the authors identified the initial outpatient course of radiotherapy following the first diagnosis of bone metastasis (index course) and determined the dates and number of radiotherapy fractions based on Medicare claims for radiation delivery.

The authors found that only 3% of patients studied received single-fraction treatment, and nearly half the patients had more than 10 treatments.

The costs of the excess treatments were substantial. Mean 45-day radiotherapy-related expenditures were 62% lower for patients who received one treatment: $1,873 for single versus $4,967 for multiple fractions.

 “Whether you get more or less radiation for bone metastases has nothing to do with survival. When clear and consistent evidence exists that supports single fraction treatment, we should proceed with the treatment that has equivalent pain control, is more convenient, and gets patients out of treatment quicker,” Dr. Bekelman said.

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