Palliative radiotherapy at the end of life: A critical review

Abstract

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.

Trend in and Correlates of Undergoing Radiotherapy in Taiwanese Cancer Patients' Last Month of Life

“…3,11,16,17,19,20 Furthermore, consistent with U.S.-based reports, 3,11 receipt of EOL radiotherapy in Taiwan showed a decreasing trend over time, probably toward EOL radiotherapy more appropriately tailored to their illness trajectory and evidence-based guidelines. 2,10 As reported, facilitative correlates of Taiwanese cancer patients' undergoing EOL radiotherapy included male gender, 3,11,20 younger age, 3,11,16,17,19,20 lung cancer diagnosis, 3,11,15,19,20 metastatic disease, 9 death within two years of diagnosis, 20 low/no comorbidities, 3,11,15,17 and receiving primary care from medical oncologists or hematologists 20 and in a teaching hospital. 17 Our findings on these patients' greater probability of undergoing EOL radiotherapy may reflect differences in their perceived needs (i.e., younger, recently diagnosed patients) and expected benefits (i.e., patients with radio-sensitive cancer and a high propensity for bone/brain metastases [e.g., lung cancer]) and being evaluated by physicians with greater access to radiotherapy facilities, working in hospitals that tend to treat terminally ill M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 15 15 cancer patients more aggressively (i.e., teaching hospitals), or more experienced in using radiotherapy to manage symptoms (i.e., medical oncologists).…”

“…1 One treatment with a significant role in managing EOL patients' symptoms is palliative radiotherapy. 2 Indeed, half of all radiotherapy is palliative, 2,3 a modality suggested to be underutilized. 4 However, the benefits of radiotherapy may take weeks to manifest 5,6 and may be outweighed by the patient's limited life expectancy.…”

“…4 However, the benefits of radiotherapy may take weeks to manifest 5,6 and may be outweighed by the patient's limited life expectancy. 2,5 A significant proportion of terminally ill patients undergoes radiotherapy that may be inappropriately tailored to their illness trajectory and evidence-based guidelines, i.e., lengthy multi-fractionated therapy, 2,5,7,8 resulting in patients dying during/shortly after treatment, 3,5,7 and treatment being prematurely terminated without symptom improvement 5,7,10 because of patient decline. 5,7,9 Furthermore, more patients who received radiotherapy in the last month of life had emergency room visits or hospitalizations, longer hospitalizations, intensive care unit (ICU) admission, and higher health care costs than those without radiotherapy before death.…”

Palliative radiation therapy of bladder cancer

“…При этом вопрос об «оптимальном» и/или «универсаль-ном» режиме фракционирования при паллиативном лечении РМП остается открытым, так как при выборе режима фракционирования необходимо обеспечить приемлемый баланс между эффективностью и токсич-ностью лечения, его воспроизводимостью, доступно-стью и комфортом для больного, что влияет, в конеч-ном итоге, на результаты терапии и качество жизни пациентов [7,20]. Более того, необходимо оценивать прогноз заболевания у каждого больного и ожидаемую продолжительность жизни, которые могут определять индивидуальную программу лечения.…”

Radiation protection and secondary cancer prevention using biological radioprotectors in radiotherapy

“…3 Since about half of cancer patients receive radiotherapy as a part of their treatment in curative or palliative modes. 4,5 In this era, finding the best radiotherapy treatment planning, dose delivery techniques, adaptive radiotherapy tricks, radiation modification and optimization approaches are main concerns as to reduce normal tissues toxicities and increasing tumor control. [6][7][8][9] Many technological attempts have been made and many decisions have been achieved.…”