Proportion of people receiving single fraction radiotherapy for bone metastases

Why this indicator is important

Radiotherapy is a common treatment for people with many cancers.

Most radiotherapy cancer treatment is given as external beam radiotherapy (EBRT). 

EBRT is the recommended treatment for cancer that has spread (metastasised) to the bone and is causing pain without other complications.

Long-term evidence shows radiotherapy treatment using a single fraction (dose) is as effective as using multiple fractions for relieving bone pain for most people with pain and no complications.1 However, for a small number of people, multiple fractions can help reduce the need for retreatment.2

About this indicator

This indicator relates to radiotherapy as treatment for cancer-related bone pain.

The radiotherapy utilisation rate in the 12 months following diagnosis of cancer varied widely across NSW LHDs in 2015–2016.

Across public facilities in NSW between 2016 and 2019, multiple fraction radiotherapy treatment were most commonly used to treat patients with cancer that had spread to the bone.

Between 2016 to 2019, the use of single fractions varied widely across public facilities, ranging from 20% to 57% of patients.

Proportion of patients with bone metastases receiving single or multiple fractions of external beam radiotherapy with palliative treatment intent in NSW public facilities, with median age, by local health district (LHD) (ranked), 2016–2019

N = Number of treatments

R = Range of LHD proportions


  1. Data source: NSW Outpatient Radiation Oncology Dataset.
  2. Fractions were estimated using an operational definition. The programming logic to estimate fractions is complex owing to differences in the recording of treatment between individual radiotherapy centres.
  3. New centres and closures in the reporting period: Blacktown Cancer and Haematology Centre became operational in April 2016.
  4. Bone metasases: Cancer invasion of the bone from another part of the body.
  5. Palliative treatment: Given primarily for the purpose of pain relief or other symptom control.


  1. Price P, Hoskin PJ, Easton D, Austin D, Palmer SG, Yarnold JR. Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases. Radiother Oncol 1986 Aug;6(4):247–55.
  2. Sze WM, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. Cochrane Database Syst Rev 2004;(2):CD004721.