OnCo
ideasIdea

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.

Hypothesis
Departments adopting single-fraction default will raise single-fraction use for uncomplicated bone metastases above 70% and reduce time to treatment start for palliative referrals, with no change in patient-reported pain response.
Rationale
The evidence is as strong as any in radiotherapy; the barrier is behavioural and financial, both addressable by policy.
What would test it
Audit fraction use, time to treatment, pain response, and retreatment rates before and after policy change across a national network.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
1
Bottlenecks it attacks

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