{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T22:48:01Z","timestamp":1782773281734,"version":"3.54.5"},"reference-count":35,"publisher":"Korean Society for Therapeutic Radiology and Oncology","issue":"2","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["e-roj.org"],"crossmark-restriction":true},"short-container-title":["Radiat Oncol J"],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:p>Purpose: Trials show similar pain outcomes for hypofractionated and multi-fraction regimens in bone metastases, yet clinical adoption of hypofractionation remains limited. The coronavirus disease 2019 (COVID-19) pandemic may have increased hypofractionation to minimize hospital visits and optimize resources. This study evaluated fractionation patterns before, during and after COVID-19 and compared pain outcomes between regimens in routine practice.Materials and methods: Data on treatment regimens for bone metastases between 2018 and 2022 were collected from 11 of 22 Dutch radiotherapy departments. Trends in utilization of hypofractionated (1\u20132 times 8 Gy) and multi-fraction (\u22655 fractions) regimens were analyzed. For a subset of patients (n = 278), self-reported pain scores were collected at baseline, 4 and 8 weeks, and 3 months. Pain scores and pain response were compared for hypofractionated and multiple-fraction regimens, with complete (pain score 0) or partial (reduction \u22652 points) response classified as responders.Results: A total of 17,336 patients were included, receiving 31,677 treatment regimens. The majority of the regimens were hypofractionated (n = 25,790, 81%). The use of hypofractionated regimens ranged from 34% to 99% between radiotherapy departments. A statistically significant increase in hypofractionated regimens was observed since the onset of the COVID-19 pandemic in 2020 (p &lt; 0.001). In an exploratory analysis of patients with available pain scores, pain response in the three months post-treatment did not differ significantly between hypofractionated and multi-fraction regimens (56% vs. 63%, p = 0.406). Conclusion: This study demonstrates a high adoption of hypofractionated regimens, with a slight increase since the COVID-19 pandemic, though considerable variation remains between departments. Pain outcomes were comparable between hypofractionated and multi-fraction regimens, suggesting equal palliation and less treatment burden with hypofractionation.<\/jats:p>","DOI":"10.3857\/roj.2026.00038","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T08:31:41Z","timestamp":1782203501000},"page":"107-116","update-policy":"https:\/\/doi.org\/10.3857\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in radiotherapy fractionation for bone metastases: a multi-center study of practice patterns before, during, and after COVID-19"],"prefix":"10.3857","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6018-660X","authenticated-orcid":true,"given":"Ellis","family":"Slotman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi P.","family":"Fransen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne","family":"Gal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne M.","family":"van der Velden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enja J.","family":"Bantema-Joppe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine G. 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