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Radiotherapy (RT) is an effective palliative treatment in patients with bone metastases. However, many studies and clinical practice highlight a number of barriers hindering the use of RT: difficulty in traveling to reach a RT center for patients with advanced cancer, concern about the need for prolonged therapies, delay in consultations and in the treatment or complicated referral process or difficulty in contacting the radiation oncologists (ROs), difficulty in predicting prognosis in cancer patients, consequent risk of RT delivery near the end of life, and poor knowledge of RT by specialists in palliative care. Since 2015 in our center we have tried to remove some of these barriers to favor the use of palliative RT in this setting. The purpose of this report is to describe the methods and results of this experience.

This is a single-center observational study on patients undergoing RT for bone metastases (1065/2020/Oss/AOUBo). Starting from 2015, the following measures were adopted: i) simplification of RT referral and planning; ii) introduction of abbreviated treatments (single fraction, sterotactic RT, accelerated-hypofractionated RT with daily bifractionation); iii) assigning palliative treatments to a single ultra-specialized RO; iv) participation of the latter in a MDT for bone metastases. Data were collected on patient characteristics (age, gender, home site, use of systemic therapies), prescribing physicians, bone metastases, and RT dose and fractionations. Statistical analyses were performed with the SPSS package and R software.

During the reporting period, 1283 RT treatments were performed in 900 patients with bone metastases (Table 1). The analysis showed a significant and progressive increase in RT treatments of bone metastases from 129 cases in 2014 to 234 cases in 2021 (p<0.001). This increase was observed for all anatomical sites, for both complicated and non-complicated metastases, and particularly involved the shortest treatments. The most widely used regimen was based on 8 Gy single fraction which was the treatment with the greatest increase over the reporting period. Finally, a significantly increased use of palliative RT  was recorded within all analyzed subcategories.

Our analysis showed that simplifying procedures, accelerating planning and delivery, dedicating an RO to palliative RT, and intensifying interdisciplinary collaboration leads to significantly greater use of palliative RT in bone metastases.