Palliative radiotherapy

Palliative radiotherapy offers a quick, inexpensive, and effective way of reducing many of the focal symptoms of advanced, incurable cancer, whether these arise from the primary tumour or from metastatic deposits. It can improve quality of life while being associated with limited treatment burden in terms of both hospital attendances and side effects. The average UK general practice oversees care for around 20 patients with terminal cancer each year with higher numbers seen in secondary care, 3 while a Canadian survey of general practitioners found that 85% had provided care for patients with advanced cancer within the previous month. This article aims to update non-specialists on the benefits, practicalities, and side effects of palliative radiotherapy to ensure that patients are considered and referred for these treatments when appropriate. Sources and selection criteria

[1]  Joe Y. Chang,et al.  Stereotactic ablative radiotherapy for oligometastatic non-small cell lung cancer. , 2018, Journal of thoracic disease.

[2]  E. Rakovitch,et al.  Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. , 2018, The Cochrane database of systematic reviews.

[3]  K. Black,et al.  Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. , 2017, The Cochrane database of systematic reviews.

[4]  Y. Soon,et al.  Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis , 2017, Oncotarget.

[5]  V. Khoo,et al.  122: CORE: A randomised trial of COnventional care versus Radioablation (stereotactic body radiotherapy) for Extracranial oligometastases , 2017 .

[6]  M. Malekzadeh,et al.  Acute Side Effects of Radiation Therapy , 2017, Springer International Publishing.

[7]  H. Verkooijen,et al.  Comparing conVEntional RadioTherapy with stereotactIC body radiotherapy in patients with spinAL metastases: study protocol for an randomized controlled trial following the cohort multiple randomized controlled trial design , 2016, BMC Cancer.

[8]  Ruth E Langley,et al.  Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial , 2016, The Lancet.

[9]  A. Fairchild,et al.  Radiation-induced esophagitis in lung cancer , 2016, Lung Cancer.

[10]  D. Rades,et al.  Radiotherapy With 4 Gy × 5 Versus 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression: Final Results of the SCORE-2 Trial (ARO 2009/01). , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  S. Schmidt,et al.  [Pharmacological treatments for fatigue associated with palliative care]. , 2016, Der Urologe. Ausg. A.

[12]  S. Fosså,et al.  Palliative pelvic radiotherapy for symptomatic rectal cancer – a prospective multicenter study , 2016, Acta oncologica.

[13]  P. Lambin,et al.  Stereotactic versus conventional radiotherapy for pain reduction and quality of life in spinal metastases: study protocol for a randomized controlled trial , 2016, Trials.

[14]  K. Ding,et al.  Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. , 2015, The Lancet. Oncology.

[15]  A. Hackshaw,et al.  A Multicenter Randomized Trial of Ibandronate Compared With Single-Dose Radiotherapy for Localized Metastatic Bone Pain in Prostate Cancer. , 2015, Journal of the National Cancer Institute.

[16]  A. Newsham,et al.  30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes , 2015, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[17]  M. Bennett,et al.  Cancer induced bone pain , 2015, BMJ : British Medical Journal.

[18]  J. Lester,et al.  Palliative radiotherapy regimens for patients with thoracic symptoms from non-small cell lung cancer. , 2015, The Cochrane database of systematic reviews.

[19]  Independent Cancer Taskforce.  Achieving world-class cancer outcomes: a strategy for England 2015-2020 , 2015 .

[20]  Xiong-Fei Pan,et al.  Interventions for dysphagia in oesophageal cancer. , 2014, The Cochrane database of systematic reviews.

[21]  Antonio DeRosa,et al.  Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: a meta-analysis. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  David A. Palma,et al.  The oligometastatic state—separating truth from wishful thinking , 2014, Nature Reviews Clinical Oncology.

[23]  Joshua Jones,et al.  Role of radiation therapy in palliative care of the patient with cancer. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  D. McGuire,et al.  MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy , 2014, Cancer.

[25]  Xingqiong Meng,et al.  Referring advanced cancer patients for palliative treatment: a national structured vignette survey of Australian GPs. , 2014, Family practice.

[26]  Bingshu E. Chen,et al.  Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. , 2014, The Lancet. Oncology.

[27]  N. Zeitouni,et al.  Patterns of skin metastases: a review of 25 years' experience at a single cancer center , 2014, International journal of dermatology.

[28]  S. Fosså,et al.  Palliative pelvic radiotherapy of symptomatic incurable prostate cancer - a systematic review. , 2014, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[29]  P. Herst,et al.  Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study , 2014, Supportive Care in Cancer.

[30]  M. Williams,et al.  Routine clinical data predict survival after palliative radiotherapy: an opportunity to improve end of life care. , 2013, Clinical oncology (Royal College of Radiologists (Great Britain)).

[31]  D. Tait,et al.  Variations in radiotherapy delivery in England - evidence from the national radiotherapy dataset. , 2013, Clinical oncology (Royal College of Radiologists (Great Britain)).

[32]  R Jena,et al.  Radiotherapy demand and activity in England 2006-2020. , 2013, Clinical oncology (Royal College of Radiologists (Great Britain)).

[33]  I Syndikus,et al.  Alpha emitter radium-223 and survival in metastatic prostate cancer. , 2013, The New England journal of medicine.

[34]  James D. Murphy,et al.  Patterns of care in palliative radiotherapy: a population-based study. , 2013, Journal of oncology practice.

[35]  Bernard Rachet,et al.  Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004–2007 , 2013, Thorax.

[36]  B. Yaremko,et al.  Stereotactic ablative radiotherapy for comprehensive treatment of oligometastatic tumors (SABR-COMET): Study protocol for a randomized phase II trial , 2012, BMC Cancer.

[37]  L. Zeng,et al.  Update on the systematic review of palliative radiotherapy trials for bone metastases. , 2012, Clinical oncology (Royal College of Radiologists (Great Britain)).

[38]  B. Doble,et al.  Prophylaxis of radiation-induced nausea and vomiting using 5-hydroxytryptamine-3 serotonin receptor antagonists: a systematic review of randomized trials. , 2012, International journal of radiation oncology, biology, physics.

[39]  D. Brazeau,et al.  Effects of methylphenidate on fatigue and depression: a randomized, double-blind, placebo-controlled trial. , 2012, Journal of pain and symptom management.

[40]  W. Allum,et al.  Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer , 2011, Gut.

[41]  A. Fyles,et al.  A hypofractionated radiotherapy regimen (0-7-21) for advanced gynaecological cancer patients. , 2011, Clinical oncology (Royal College of Radiologists (Great Britain)).

[42]  Tarek Mekhail,et al.  Adjuvant Whole-Brain Radiotherapy Versus Observation after Radiosurgery or Surgical Resection of One to Three Cerebral Metastases: Results of the EORTC 22952-26001 Study , 2011, Current oncology reports.

[43]  M. McQuestion,et al.  Evidence-based skin care management in radiation therapy: clinical update. , 2011, Seminars in oncology nursing.

[44]  L. Stalpers,et al.  Validation of a score predicting post-treatment ambulatory status after radiotherapy for metastatic spinal cord compression. , 2011, International journal of radiation oncology, biology, physics.

[45]  C. Coyle,et al.  The role of split-course hypofractionated palliative radiotherapy in head and neck cancer. , 2011, Clinical oncology (Royal College of Radiologists (Great Britain)).

[46]  G. Thomas,et al.  Palliative radiotherapy for cervical carcinoma, a systematic review. , 2011, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[47]  F. Roila,et al.  Management of oral and gastrointestinal mucositis: ESMO Clinical Practice Guidelines. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[48]  Anne Littlewood,et al.  Interventions for preventing oral mucositis for patients with cancer receiving treatment. , 2011, The Cochrane database of systematic reviews.

[49]  T. Chattopadhyay,et al.  Palliative Stenting With or Without Radiotherapy for Inoperable Esophageal Carcinoma: A Randomized Trial , 2012, Journal of Gastrointestinal Cancer.

[50]  A. Molassiotis,et al.  Radiotherapy-induced nausea and vomiting (RINV): MASCC/ESMO guideline for antiemetics in radiotherapy: update 2009 , 2011, Supportive Care in Cancer.

[51]  S. Nag,et al.  Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell oesophageal cancer: a prospective multi-centre randomized trial of the International Atomic Energy Agency. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[52]  D. Breen,et al.  Palliative radiotherapy for non-melanoma skin cancer. , 2010, Clinical oncology (Royal College of Radiologists (Great Britain)).

[53]  J. Sloan,et al.  Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[54]  L. Stalpers,et al.  Validation and simplification of a score predicting survival in patients irradiated for metastatic spinal cord compression , 2010, Cancer.

[55]  S. Kumar,et al.  Management of skin toxicity during radiation therapy: A review of the evidence , 2010, Journal of medical imaging and radiation oncology.

[56]  T. Schultheiss,et al.  Radiation dose-volume effects in the spinal cord. , 2010, International journal of radiation oncology, biology, physics.

[57]  Diana Gosálvez Prados.  The European Association for Palliative Care (EAPC) , 2010 .

[58]  A. Molassiotis,et al.  Interventions for cough in cancer. , 2010, The Cochrane database of systematic reviews.

[59]  D. Kondziolka,et al.  The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline , 2009, Journal of Neuro-Oncology.

[60]  D. Kondziolka,et al.  The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline , 2009, Journal of Neuro-Oncology.

[61]  K. Hess,et al.  Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. , 2009, The Lancet. Oncology.

[62]  V. Fusco,et al.  8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial. , 2009, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[63]  Elizabeth M. Kedge.  A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients , 2009 .

[64]  A. Bezjak,et al.  Palliative thoracic radiotherapy for lung cancer: a systematic review. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[65]  Walter Curran,et al.  A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. , 2008, International journal of radiation oncology, biology, physics.

[66]  Y. Ung,et al.  A phase I/II study to evaluate the toxicity and efficacy of accelerated fractionation radiotherapy for the palliation of dysphagia from carcinoma of the oesophagus. , 2008, Clinical oncology (Royal College of Radiologists (Great Britain)).

[67]  P. Stone,et al.  Fatigue in palliative care patients — an EAPC approach , 2008, Palliative medicine.

[68]  A. Chacko,et al.  Interventions for the treatment of metastatic extradural spinal cord compression in adults. , 2008, The Cochrane database of systematic reviews.

[69]  F. Cramp,et al.  Exercise for the management of cancer-related fatigue in adults. , 2008, The Cochrane database of systematic reviews.

[70]  H. Worthington,et al.  Interventions for treating oral mucositis for patients with cancer receiving treatment. , 2008, The Cochrane database of systematic reviews.

[71]  B. Hickey,et al.  Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment--"Hypo Trial". , 2007, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[72]  I. Graham,et al.  Barriers to palliative radiotherapy referral: A Canadian perspective , 2007, Acta oncologica.

[73]  U. Adderley,et al.  Topical agents and dressings for fungating wounds. , 2007, The Cochrane database of systematic reviews.

[74]  P. Warde,et al.  Pain flare in patients with bone metastases after palliative radiotherapy—a nested randomized control trial , 2007, Supportive Care in Cancer.

[75]  R. Coleman.  Clinical Features of Metastatic Bone Disease and Risk of Skeletal Morbidity , 2006, Clinical Cancer Research.

[76]  J. Malley,et al.  Younger Adults' Understanding of Questions for a Service User Experience Survey. Funded/commissioned by: The Health and Social Care Information Centre , 2006 .

[77]  I. Graham,et al.  Family physicians' perspectives regarding palliative radiotherapy. , 2006, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[78]  Radiotherapy dose fractionation , 2006 .

[79]  L. Peters,et al.  The 'QUAD SHOT'--a phase II study of palliative radiotherapy for incurable head and neck cancer. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[80]  H. Matsuzaki,et al.  A Revised Scoring System for Preoperative Evaluation of Metastatic Spine Tumor Prognosis , 2005 .

[81]  Geoff Delaney,et al.  The role of radiotherapy in cancer treatment , 2005, Cancer.

[82]  Mohammed Mohiuddin,et al.  Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial , 2005, The Lancet.

[83]  E. Maranzano,et al.  Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[84]  H. V. van Houwelingen,et al.  Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancer. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[85]  P. Hoskin,et al.  Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05). , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[86]  N. Janjan,et al.  Survey on use of palliative radiotherapy in hospice care. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[87]  J. Lau,et al.  Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. , 2004, Journal of the National Cancer Institute. Monographs.

[88]  Maria Werner-Wasik,et al.  Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial , 2004, The Lancet.

[89]  P. Fayers,et al.  Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[90]  M. Mason,et al.  Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. , 2003, The Cochrane database of systematic reviews.

[91]  S. Tyldesley,et al.  Factors affecting the use of palliative radiotherapy in Ontario. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[92]  S. Fosså,et al.  A randomized trial of hypofractionated schedules of palliative radiotherapy in the management of bladder carcinoma: results of medical research council trial BA09. , 2000, International journal of radiation oncology, biology, physics.

[93]  V. Budach,et al.  [Remineralization and pain relief in bone metastases after after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study]. , 1999, Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].

[94]  J. Yarnold.  8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-upOn behalf of the Bone Pain Trial Working Party , 1999 .

[95]  J Kievit,et al.  The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[96]  L Gaspar,et al.  Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. , 1997, International journal of radiation oncology, biology, physics.

[97]  D. Girling,et al.  Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party. , 1996, Clinical oncology (Royal College of Radiologists (Great Britain)).

[98]  H. Rosenthal,et al.  Role of postoperative radiation therapy after stabilization of fractures caused by metastatic disease. , 1995, International journal of radiation oncology, biology, physics.

[99]  H. Mirels.  Metastatic Disease in Long Bones A Proposed Scoring System for Diagnosing Impending Pathologic Fractures , 1989, Clinical orthopaedics and related research.