Single-fraction radiotherapy as the default for painful bone metastases
One radiotherapy session relieves bone pain as well as ten, according to many trials, yet most patients still get the longer course. Making one session the default would spare patients trips and free machines.
Multiple randomised trials and meta-analyses show a single 8 Gy fraction is as effective as multi-fraction schedules for pain from uncomplicated bone metastases, with a higher retreatment rate but no difference in overall pain control. Despite guidelines, single-fraction use remains a minority in many countries because of habit and reimbursement. A default protocol with an opt-out justification, plus payment neutrality, would align practice with evidence and release capacity.
- Pain relief and palliative care are unavailable to most · Most people who die of cancer worldwide do so without adequate pain relief.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
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