Palliative radiotherapy
Short courses of radiation, often a single treatment, to relieve pain from bone metastases, stop bleeding, open blocked airways or protect the spinal cord. Among the most cost-effective treatments in cancer.
About 40% of radiotherapy courses are palliative. Trials established that a single 8 Gy fraction equals multi-fraction regimens for uncomplicated bone metastases (RTOG 9701, Dutch Bone Metastasis Study; ~60% pain response), that 8 Gy ×1 or 20 Gy ×5 suffices for spinal cord compression in poor-prognosis patients (SCORAD III, ICORG), and that whole-brain radiotherapy adds little for poor-performance NSCLC brain metastases (QUARTZ) while SRS replaces it for limited metastases. Other indications: haemostasis (bladder, gynaecologic, lung), airway and oesophageal obstruction, SVC syndrome, hepatic pain, skin fungation. Underuse of single fractions persists in fee-for-service systems; rapid-access palliative clinics shorten time to treatment.
How it works
Deliver a biologically sufficient dose for symptom control with minimum visits and toxicity, using simple techniques (parallel-opposed or 3D) or SBRT where oligometastatic ablation is intended.
- Single fraction as good as multiple for bone pain
- Fast, cheap, widely available
- Effective for bleeding, obstruction, cord compression
- Underuse of single fractions and overuse of long courses
- Pain flare in ~30%
- Retreatment limits with prior high doses
Latest papers
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