Supportive care and palliative medicinePalliative Radiotherapy—New Approaches
Section snippets
Aims of Palliative Therapeutic Radiotherapy
A distinction is made between different aims1 of therapy in palliative radiotherapy. Palliative radiotherapy can be carried out in a purely symptom-oriented manner or directed toward signs of tumor disease. In both situations, quality of life is the most important consideration.
Methods and Treatments
Since the beginning of the 20th century, irradiation has been used for cancer treatment. It is usually done with a linear accelerator and high-energy photons or electrons. In a palliative situation, direct adjustment of the irradiation fields at the accelerator is possible. Complex target volumes require computed tomography (CT)–based three-dimensional (3D) planning. Modern high-precision radiotherapy techniques that require relatively long treatment sessions like stereotactic radiation therapy
Decision-Making
Decisions regarding palliative treatment always have to be made for each individual, with the patient or his/her relatives or both. Decisions made in a team such as in the context of an oncologic tumor board are desirable. When determining a treatment concept, the following need to be taken into consideration and integrated in an individual plan:
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Life expectancy and attitude to life
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Aims and (hidden) expectations concerning the treatment
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Probability of treatment success
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Previous treatment
Brain Metastases
Brain metastases occur in up to 40% of all cancer patients (predominantly breast and lung cancer). These numbers are growing, particularly because patients live until cerebral metastases occur due to improved systemic therapies. The prognosis for multiple brain metastases is about only 4 weeks if untreated.
The choice of treatment depends on whether brain metastases are solitary or multiple and on the patient's recursive partitioning analysis (RPA, see above) class. Those with a Karnofsky index
Bone Metastases
Bone metastases represent the most frequent indication. They occur especially in advanced breast, lung, or prostate cancer. Bone metastases can be osteolytic, osteoblastic, or mixed. In spite of their higher radiodensity, osteoblastic metastases are not considered stable in general. Regardless of their type, osseous metastases involve clinical symptoms and risks, which depend on their localization. Slowly increasing ostealgia that is hard to localize is most frequent. Radiotherapy of bone
Obstruction and Compression Syndromes
Superior vena cava syndrome is one indication that requires urgent radiotherapy, but if this condition is apparent before or at the time of cancer diagnosis, an attempt should be made to secure a histologic diagnosis before initiating radiotherapy. This is because in some lymphomas, germinative tumors, and small cell lung cancers, disease-oriented chemotherapy is more rational. In 60% to 80% of patients, a palliative effect can be achieved (improvement of results, symptom relief). For selected
Summary and Conclusion
In palliative medicine, radiotherapy is an important option. Both rapid and long-term effects associated with very low treatment-related toxicity can be achieved. Furthermore, radiotherapy is important for oncological emergencies like symptoms due to obstruction/compression, tumor bleeding, and spinal cord compression. Dose-fractionation and type of radiotherapy must be tailored individually taking into account the goal of treatment, localization of the tumor manifestations, and the patient's
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