Elsevier

Seminars in Oncology

Volume 38, Issue 3, June 2011, Pages 443-449
Seminars in Oncology

Supportive care and palliative medicine
Palliative Radiotherapy—New Approaches

https://doi.org/10.1053/j.seminoncol.2011.03.015Get rights and content

Most cancer patients will require radiation therapy some time during their disease. Thirty percent to 50% of all radiation treatments are palliative, either to alleviate symptoms or prophylactic to prevent deterioration of quality of life from local progressive disease. Radiotherapy is a locally effective tool. It typically causes no systemic and mostly mild acute side effects. We will provide an overview of principles, decision-making, and new developments in palliative radiation therapy.

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:

  • Life expectancy and attitude to life

  • Aims and (hidden) expectations concerning the treatment

  • Probability of treatment success

  • 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

References (39)

  • Y.M. Van der Linden et al.

    Single fraction radiotherapy is efficacious: a further analysis of the Dutch Bone Metastasis Study controlling for the influence of retreatment

    Int J Radiat Oncol Biol Phys

    (2004)
  • S. Helweg-Larsen et al.

    Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients

    Int J Radiat Oncol Biol Phys

    (2000)
  • D. Rades et al.

    Final results of a prospective study of the prognostic value of the time to develop motor deficits before irradiation in metastatic spinal cord compression

    Int J Radiat Oncol Biol Phys

    (2002)
  • R.A. Patchell et al.

    Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial

    Lancet

    (2005)
  • D. Rades et al.

    Preliminary results of spinal cord compression recurrence evaluation (score-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression

    Int J Radiat Oncol Biol Phys

    (2009)
  • D. Rades et al.

    Comparison of 1 x 8 Gy and 10 x 3 Gy for functional outcome in patients with metastatic spinal cord compression

    Int J Radiat Oncol Biol Phys

    (2005)
  • W.J. Spanos et al.

    Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502)

    Int J Radiat Oncol Biol Phys

    (1994)
  • T. Van Kleefens et al.

    Claryfying the term ”palliative“ in clinical oncology

    Eur J Cancer Care

    (2004)
  • T. Lutz et al.

    A review of hypofractionated palliative radiotherapy

    Cancer

    (2007)
  • Cited by (49)

    • A pilot study of same-day MRI-only simulation and treatment with MR-guided adaptive palliative radiotherapy (MAP-RT)

      2023, Clinical and Translational Radiation Oncology
      Citation Excerpt :

      Approximately 30 to 70% of all radiotherapeutic treatments are for palliation [1–3], and external beam radiotherapy (EBRT) is a critical aspect in the palliation of lung [4,5] and abdominal metastases [6,7], amongst others.

    • Treatment planning in palliative radiotherapy

      2023, Palliative Radiation Oncology
    • Management of pain

      2023, Palliative Radiation Oncology
    View all citing articles on Scopus

    The authors confirm that there are no primary financial relationships with any companies.

    View full text