Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine?

Table 7 Reasons for reticence in use of single fractions

Factor	Ref.
Patient-related
Neuropathic pain	[6]
Prevent or address neurologic symptoms	[46]
Maximize time to first increase in pain	[6]
Patient selection	[7]
Prognosis	[7]
Patient wishes	[7]
Fear of toxicity (acute/late)	[6]
Site of bone metastasis	[9]
Comorbidities	[9]
Physician-related
Influence of global opinion leaders	[52]
Presumed dose-response	[7]
Professional membership affiliation	[9]
Country of training	[9]
Country of practice	[9]
Lack of experience with large fraction sizes	[9]
Lack of participation in related trials	[6]
Disbelief of early trial results due to quality	[48]
Institution-related
Departmental policy	[9]
Longer wait times for RT delivery	[62]
Type of centre	[9]
Health care system-related
Retreatment more often required	[35]
Increased costs due to retreatment	[14]
Reimbursement system	[24]