Palliative radiotherapy: history, recent advances, and future directions

Abstract

Radiotherapy has been used to palliate cancer symptoms since shortly after the time that X rays were discovered late in the 1800's. The 20 th century witnessed improvements in treatment planning and delivery that permitted radiotherapy to serve as a successful, timely, and cost-efficient palliative intervention. Palliative radiation oncology has risen to the level of its own subspecialty, as evidenced by the formation of palliative radiation oncology clinical services and dedicated palliative radiotherapy guidelines, while additional changes have begun to alter the very definition and goals of palliative radiotherapy. Local treatment may now be offered with dual goals of symptom relief and the potential for increased disease-free or overall survival. While these new directions show great promise, novel strategies must be formulated to manage the increased complexity, workload, and cost of these approaches.

An Italian survey on “palliative intent” radiotherapy

“…Considering the wide range of utilization in this clinical scenario, often there are differences in the therapeutic choice among radiation oncologists who treat metastatic cancer patients. The line between purely “palliative” and “curative” treatment is often not well defined with the consequence that palliative RT may include concurrent goals of symptoms relief, symptoms prevention, local tumor control, and possible cure [ 4 , 5 ]. So, facing the same scenario of a patient with metastatic disease, therapeutic intent and RT prescription can be different depending on the radiation oncologist who takes care of the patient.…”

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

“…In the context of palliative radiotherapy prescribed to improve cancer-related symptoms, short-course treatment offers a convenient yet efficacious approach [1]. Nevertheless, unplanned termination of short multi-fraction regimens might still occur, mainly as a consequence of the rapid deterioration of patient's performance status (PS) [2,3].…”

The LabBM score is an excellent survival prediction tool in patients undergoing palliative radiotherapy

“…Patients with distressing symptoms from malignant tumors often experience considerable relief after moderate doses of palliative radiotherapy and therefore such treatment should be readily available in clinical cancer care [1][2][3]. Patients in need of palliative radiotherapy represent a tremendously heterogeneous group.…”