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Miscellaneous: Palliative RT: single-fraction bone metastases

Free question published 03 October 2026

MiscellaneousPalliative RT: single-fraction bone metastases

A 74-year-old woman with metastatic breast cancer has a painful lytic deposit in the right ilium causing localised pain but no neurological deficit, no impending fracture and no soft-tissue mass. She has an estimated prognosis of a few months and finds travelling to hospital difficult. She is referred for palliative radiotherapy to the iliac deposit. Which regimen and counselling point is most appropriate?

  1. ASingle 8 Gy fraction, advising it gives significantly better pain relief and substantially lower retreatment rate than multifraction treatments
  2. B30 Gy in 10 fractions, because single-fraction treatment gives inferior pain relief
  3. CStereotactic ablative radiotherapy, as conventional palliative RT is ineffective for bone pain
  4. DNo radiotherapy, as analgesia alone is equivalent for uncomplicated bone metastases
  5. ESingle 8 Gy fraction, with equivalent pain relief to longer courses but roughly double the retreatment rate

Why E is correct

Randomised trials and systematic reviews show a single 8 Gy fraction gives equivalent pain relief to multifraction regimens such as 20 Gy in 5 or 30 Gy in 10 fractions for uncomplicated painful bone metastases, with the main difference being a roughly doubled retreatment rate after single-fraction treatment. For a patient with limited prognosis and difficulty travelling, a single 8 Gy fraction is the most convenient and sensible choice, with appropriate counselling about the higher chance of needing retreatment.

And why the others are not

  • AIncorrect on the facts: pain relief is equivalent, not superior, and the retreatment rate is higher, not lower, than multifraction treatment.
  • B30 Gy in 10 fractions is not superior for pain relief and is less convenient; single-fraction pain response is equivalent.
  • CSABR is not required for an uncomplicated painful deposit; conventional palliative RT is effective and far simpler.
  • DPalliative radiotherapy is more effective than analgesia alone for localised painful bone metastases and should be offered.

Source Single-fraction versus multifraction palliative radiotherapy for painful bone metastases — Chow E, Zeng L, Salvo N, et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol). 2012;24(2):112-124; and Chow R, et al. Ann Palliat Med systematic review and meta-analysis.

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