The influence of national attitudes on the use of radiotherapy in advanced and metastatic cancer, with particular reference to differences between the United Kingdom and the United States of America: implications for future studies.

Recent publications have suggested significant variation in dose and number of fractions of radiotherapy given to palliate advanced and metastatic cancer. Four types of published study are considered: multicenter trials, retrospective studies, patterns of care studies, and surrogate studies. These suggest that there are significant differences in the characteristics of patients considered incurable, the aims and expectations of palliative treatment, the predicted survival of patients treated palliatively, and the influence of clinical trials. Future studies are proposed to confirm such variation.