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#radonc Journal Club: Single vs Multifraction Radiation for Bone Metastasis

Welcome to the first organized radiation oncology chat on Twitter. We are starting with a journal club, and our first article is:

Olson RA, Tiwana MS, Barnes M, et al. Use of Single- versus Multiple-Fraction Palliative Radiation Therapy for Bone Metastases: Population-Based Analysis of 16,898 Courses in a Canadian Province. Int J Radiat Oncol Biol Phys 2014; Aug1;89(5):1092-9 

Pubmed ID: 25035213 


The lead author, Dr. Robert Olson, will be joining us for the live chat, scheduled Sunday 8/17 at 8PM Central Standard Time. You can follow him on Twitter at @DrOlsonOncology.

You can share any thoughts you have about the article from now until the end of our live chat. Use topics that the moderators will help focus the discussion along with Dr. Olson:

T1.    What is the role of RT in treating bone mets?
T2.   What was the purpose of this study?
T3.   Were the results of this study surprising? 
T4.   What have we learned about improving palliative care for our patients?

We would love your participation.

  • Here is the overview of how to participate
  • Here is Twitter 101 for chat participation
  • Read our disclaimer for ways to keep it rewarding and professional. If you’re not ready, just lurk and tune into the conversation.

Thank you in advance for joining us on our first journal club! Do you have any questions? If you have any suggestions on improvements, let us know.




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  • I’m glad that we’re discussing this paper – but also a little sad that it needs discussing!

    I would have thought thousands of patients in randomised trials, more than one meta-analysis, systematic reviews and a Cochrane review all concluding the same thing would have made the conversation redundant.

    The variations in single fraction prescribing described in this paper are huge in one geographic area of one country. We can too easily the variety in prescribing across the same continent or across the globe. These are not driven by different interpretations of the evidence – because the evidence is the same all over the world – they are driven by local, cultural and economic factors.

    That’s why I think a twitter debate is so good for this question – about geographic, global differences. The cited paper suggests that having a UK trained Oncologist like me around will bring your fraction numbers down – you will have to decide for yourself whether that’s a good thing or not but I’m already decided because:

    Single fractions are MUCH more convenient for patients (even if you factor in retreatments)

    They are as effective as multiple fraction treatments

    We still don’t have strong evidence that a 5 or 10 fraction treatment serves the ‘good prognosis’ patient any better.

    It’s good for capacity (the Royal Marsden Audit showed that correct use of a guideline to use single fractions would free one of their Linear Accelerators for one day a month – Palliative External Beam Radiotherapy for Painful Bone Metastases , I. Phillips, I. Locke, A. Kirby, F. Rahman Clinical Oncology, Vol. 26, S2–S3 June, 2014)

    • Richard, thank you so much for your perspective. The study shows variability in practice patterns, which we also heard as a global issue from our discussion on Twitter. You make a good point about the factors at play. The advantage of this study is its ability to demonstrate it’s not just financial though obviously it is a factor in some parts of the world.

      It will be interesting to see what value these Twitter discussions have, but I suspect it will be of some use. Your experience and testimony to the effectiveness of single fraction radiotherapy may help get that fraction number down for many.

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