Differences in palliative radiotherapy for bone metastases within Western European countries

Purpose: To evaluate the differences in palliative radiotherapy for painful bone metastases amongst different Western European countries. Materials and methods: A questionnaire was sent to 565 radiotherapy centres in 19 Western European countries, based on the 1997 ESTRO directory. In th is questionnaire the current local palliative radiotherapy practice for bon e metastases was assessed in terms of total dose, fractionation, treatment complexity (use of shielding blocks, frequency of isodose calculations, fie ld set-up) and type of machine used. The differences were analyzed accordin g to the country and to the type and size of radiotherapy centre. Results: A total of 205 centres (36%) returned the questionnaire, of which 198 could be further analyzed. The most frequently used antalgic fractionat ion schedule is 30 Gy in ten daily fractions of 3 Gy (50%), single fraction s and conventional 2 Gy fractions being used in a minority of the centres ( respectively, 11 and 9%). Most antalgic treatments are performed on a linea r accelerator (67% of the centres uses linear accelerators) and 64% of the centres predominantly uses a two-field set-up. The majority of the centres uses shielding blocks and per-forms isodose calculations in less than 50% o f the patients, (respectively, 88 and 81%). There is a correlation between the centre size and the palliative irradiation practice, the largest centre s using more hypofractionation (chi(2): P = 0.001; logit: P = 0.0003) and a less complex treatment set up as expressed by the use of isodose calculati ons (chi(2): P = 0.027; logit: P = 0.0161). There is also a tendency to use less shielding blocks (P = 0.177). The same goes for university centres as compared with private centres: university centres use shorter fractionatio n schedules (chi(2): P = 0.008, logit: P = 0.0094), less isodoses (chi(2): P = 0.010; logit: P = 0.0115) and somewhat less shielding blocks (P = 0.151 , Amongst the analyzed countries different tendencies in fractionation (P = 0.001) and treatment complexity are observed (use of isodoses: P = 0.014, use of shielding blocks: P = 0.001). Conclusion: These data suggest that beside work-load and clinical evidence, country-related factors such as tradition and habits, past teaching, the n ational organization of health care and reimbursement criteria may influenc e the local practice. (C) 2000 Elsevier Science Ireland Ltd. All rights res erved.