A Brief History of Palliative Radiation Oncology

Jones, Joshua

doi:10.1002/9781118607152.ch1

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…For more than a century, palliative radiotherapy has been a cost-effective, time-efficient treatment to help patients manage the symptoms of advanced and metastatic cancer. 7 In the most general terms, palliative radiotherapy may be effective in controlling pain, neurologic symptoms, and obstructive symptoms and providing local control of tumors in any organ system in the body. Palliative radiotherapy may be considered in any patient in whom local tumor is causing symptoms ( Table 1).…”

Section: Introductionmentioning

confidence: 99%

Palliative radiotherapy at the end of life: A critical review

Jones

Lutz

Chow

et al. 2014

CA A Cancer J Clinicians

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When delivered with palliative intent, radiotherapy can help to alleviate a multitude of symptoms related to advanced cancer. In general, time to symptom relief is measured in weeks to months after the completion of radiotherapy. Over the past several years, an increasing number of studies have explored rates of radiotherapy use in the final months of life and have found variable rates of radiotherapy use. The optimal rate is unclear, but would incorporate anticipated efficacy in patients whose survival allows it and minimize overuse among patients with expected short survival. Clinician prediction has been shown to overestimate the length of survival in repeated studies. Prognostic indices can provide assistance with estimations of survival length and may help to guide treatment decisions regarding palliative radiotherapy in patients with potentially short survival times. This review explores the recent studies of radiotherapy near the end of life, examines general prognostic models for patients with advanced cancer, describes specific clinical circumstances when radiotherapy may and may not be beneficial, and addresses open questions for future research to help clarify when palliative radiotherapy may be effective near the end of life.

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Section: Introductionmentioning

confidence: 99%

Palliative radiotherapy at the end of life: A critical review

Jones

Lutz

Chow

et al. 2014

CA A Cancer J Clinicians

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“…These patients require long-term palliative care with frequent hospital visits, often resulting in repeat ward admissions and all the associated costs. Palliative radiotherapy also can be a cost-effective treatment in the management of symptoms due to advanced and metastatic disease [ 28 ]. We must also consider the long-term costs for medications to control pain and procedures geared at hemostasis, to name a few.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy in the Caribbean: a spotlight on the human resource and equipment challenges among CARICOM nations

Alleyne-Mike¹,

Sylvester²,

Henderson-Suite³

et al. 2020

Hum Resour Health

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Background There is limited data on access to radiotherapy services for CARICOM nations. Methods This was a descriptive mixed-methods observational study which used data collected via survey from staff working in Radiation Oncology in 14 CARICOM countries. Benchmark recommendations from the International Atomic Energy Agency were compared to existing numbers. The Directory of Radiotherapy Centers, World Bank, and Global Cancer Observatory databases were all accessed to provide information on radiotherapy machines in the region, population statistics, and cancer incidence data respectively. Both population and cancer incidence-based analyses were undertaken to facilitate an exhaustive review. Results Radiotherapy machines were present in only 50% of the countries. Brachytherapy services were performed in only six countries (42.9%). There were a total of 15 external beam machines, 22 radiation oncologists, 22 medical physicists, and 60 radiation therapists across all nations. Utilizing patient-based data, the requirement for machines, radiation oncologists, medical physicists, and radiation therapists was 40, 66, 44, and 106, respectively. Only four (28.6%) countries had sufficient radiation oncologists. Five (35.7%) countries had enough medical physicists and radiation therapists. Utilizing population-based data, the necessary number of machines, radiation oncologists, and medical physicists was 105, 186, and 96 respectively. Only one county (7.1%) had an adequate number of radiation oncologists. The number of medical physicists was sufficient in just three countries (21.4%). There were no International Atomic Energy Agency population guidelines for assessing radiation therapists. A lower economic index was associated with a larger patient/population to machine ratio. Consequentially, Haiti had the most significant challenge with staffing and equipment requirements, when compared to all other countries, regardless of the evaluative criteria. Depending on the mode of assessment, Haiti’s individual needs accounted for 37.5% (patient-based) to 59.0% (population-based) of required machines, 40.1% (patient-based) to 59.7% (population-based) of needed radiation oncologists, 38.6% (patient-based) to 58.3% (population-based) of medical physicists, and 42.5% (patient-based) of radiation therapists. Conclusion There are severe deficiencies in radiotherapy services among CARICOM nations. Regardless of the method of comparative analysis, the current allocation of equipment and staffing scarcely meets 50% of regional requirements.

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“…However, in the 1950s and 1960s, it was noted that fewer fractions of higher doses of radiotherapy could provide significant palliation of symptoms of advanced cancer without significant side effects. 1 Thus, multiple models for the use of palliative radiotherapy emerged: large single fractions that could provide palliation, but might also produce significant long-term side effects or multiple smaller fractions that more closely resembled curative treatment approaches. Improved imaging with computed tomography (CT) scans and magnetic resonance imaging (MRI) in the 1980s and 1990s and advances in radiation treatment planning allowed further refinements in the delivery of radiotherapy.…”

Section: Palliative Radiotherapy Overviewmentioning

confidence: 99%

“…1 Over time, developments in radiobiology, physics, imaging, and treatment planning have allowed for clear differentiation between radiotherapy with a goal of radical or curative intent versus palliative intent. Radiotherapy given with palliative intent is most often given to patients with advanced or metastatic cancer with the goal of rapid and durable symptom relief.…”

mentioning

confidence: 99%