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Palliative Radiation Therapy

  • Shayna E. Rich
  • Kavita V. DharmarajanEmail author
Chapter

Abstract

Radiation therapy is frequently delivered with palliative intent. It can reduce pain, neurological dysfunction, bleeding, fungating wounds, nausea, vomiting, or obstructive symptoms. Painful bone metastases are the most common reason for palliative radiation therapy, and radiation therapy has proven response rates of 70–80% in multiple clinical trials. Treatment of brain metastases can help control neurological symptoms. Palliative radiation can also be used to treat head and neck cancer, liver or pelvic tumors, superior vena cava syndrome, or skin cancer. Since palliative radiation is typically delivered at low doses, re-irradiation may be provided without much risk of additional toxicity.

Keywords

Bone metastases Stereotactic radiosurgery Hypofractionation Superior vena cava syndrome Re-irradiation 

References

  1. 1.
    Lutz ST, Jones J, Chow E. Role of radiation therapy in palliative care of the patient with cancer. J Clin Oncol. 2014;32(26):2913–9.CrossRefGoogle Scholar
  2. 2.
    Gutierrez Bayard L, Salas Buzon Mdel C, Angulo Pain E, de Ingunza Baron L. Radiation therapy for the management of painful bone metastases: results from a randomized trial. Rep Pract Oncol Radiother. 2014;19(6):405–11.CrossRefGoogle Scholar
  3. 3.
    Howell DD, James JL, Hartsell WF, Suntharalingam M, Machtay M, Suh JH, Demas WF, Sandler HM, Kachnic LA, Berk LB. Single-fraction radiotherapy versus multifraction radiotherapy for palliative of painful vertebral bone metastases-equivalent efficacy, less toxicity, more convenient: a subset analysis of Radiation Therapy Oncology Group trial 97–14. Cancer. 2013;119(4):888–96.CrossRefGoogle Scholar
  4. 4.
    Majumder D, Chatterjee D, Bandyopadhyay A, Mallick SK, Sarkar SK, Majumdar A. Single fraction versus multiple fraction radiotherapy for palliation of painful vertebral metastases: a prospective study. Indian J Palliat Care. 2012;18(3):202–6.CrossRefGoogle Scholar
  5. 5.
    Rich SE, Chow R, Raman S, Zeng KL, Lutz S, Lam H, Silva MF, Chow E. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol. 2018;126(3):547–57.CrossRefGoogle Scholar
  6. 6.
    Abeer Hussien A. Single Fraction versus multiple fraction radiotherapy for treatment of painful bone metastases: a Prospective Study; Mansoura experience. Forum Clin Oncol. 2015;6(2):8–13.CrossRefGoogle Scholar
  7. 7.
    Fairchild A, Barnes E, Ghosh S, Ben-Josef E, Roos D, Hartsell W, Holt T, Wu J, Janjan N, Chow E. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol Biol Phys. 2009;75(5):1501–10.CrossRefGoogle Scholar
  8. 8.
    Hird A, Zhang L, Holt T, Fairchild A, DeAngelis C, Loblaw A, Wong R, Barnes E, Tsao M, Danjoux C, Chow E. Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiation therapy for symptomatic bone metastases: a phase II study. Clin Oncol (R Coll Radiol). 2009;21(4):329–35.CrossRefGoogle Scholar
  9. 9.
    Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy for bone metastases: a systematic review. J Clin Oncol. 2007;25(11):1423–36.CrossRefGoogle Scholar
  10. 10.
    Chow E, Zeng L, Salvo N, Dennis K, Tsao M, Lutz S. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol). 2012;24(2):112–24.CrossRefGoogle Scholar
  11. 11.
    Meeuse JJ, van der Linden YM, van Tienhoven G, Gans RO, Leer JW, Reyners AK. Dutch bone metastasis study group. Efficacy of radiotherapy for painful bone metastases during the last 12 weeks of life: results from the Dutch bone metastasis study. Cancer. 2010;116(11):2716–25.PubMedGoogle Scholar
  12. 12.
    Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S, Sahgal A, Silverman L, von Gunten C, Mendel E, Vassil A, Bruner DW, Hartsell W. American Society for Radiation Oncology. Palliative radiotherapy for bone metastasis: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011;79(4):965–76.CrossRefGoogle Scholar
  13. 13.
    Khuntia D, Brown P, Li J, Mehta MP. Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol. 2006;24(8):1295–304.CrossRefGoogle Scholar
  14. 14.
    Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Gaspar LE, Sperduto PW, Vogelbaum MA, Radawski JD, Wang JZ, Gillin MT, Mohideen N, Hahn CA, Chang EL. Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2012;2(3):210–25.CrossRefGoogle Scholar
  15. 15.
    Eichler AF, Loeffler JS. Multidisciplinary management of brain metastases. Oncologist. 2007;12(7):884–98.CrossRefGoogle Scholar
  16. 16.
    Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. 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. Int J Radiat Oncol Biol Phys. 2008;70(2):510–4.CrossRefGoogle Scholar
  17. 17.
    Kak M, Nanda R, Ramsdale EE, Lukas RV. Treatment of leptomeningeal carcinomatosis: current challenges and future opportunities. J Clin Neurosci. 2015;22(4):632–7.CrossRefGoogle Scholar
  18. 18.
    Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys. 2000;47(2):291–8.CrossRefGoogle Scholar
  19. 19.
    Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1980;6(1):1–9.CrossRefGoogle Scholar
  20. 20.
    Borgelt B, Gelber R, Larson M, Hendrickson F, Griffin T, Roth R. Ultra-rapid high dose irradiation schedules for the palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1981;7(12):1633–8.CrossRefGoogle Scholar
  21. 21.
    Gelber RD, Larson M, Borgelt BB, Kramer S. Equivalence of radiation schedules for the palliative treatment of brain metastases in patients with favorable prognosis. Cancer. 1981;48(8):1749–53.CrossRefGoogle Scholar
  22. 22.
    Sneed PK, Mendez J, Vemer-van den Hoek JG, Seymour ZA, Ma L, Molinaro AM, Fogh SE, Nakamura JL, McDermott MW. Adverse radiation effect after stereotactic radiosurgery for brain metastasis: incidence, time course, and risk factors. J Neurosurg. 2015;123(2):373–86.CrossRefGoogle Scholar
  23. 23.
    Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.CrossRefGoogle Scholar
  24. 24.
    Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280(17):1485–9.CrossRefGoogle Scholar
  25. 25.
    Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head and neck mucosal site treated with radiation therapy with palliative intent. Radiother Oncol. 2001;59:319–21.CrossRefGoogle Scholar
  26. 26.
    Corry J, Peters LJ, Costa ID, Milner AD, Fawns H, Rischin D, Porceddu S. The “QUAD SHOT”—a phase II study of palliative radiotherapy for incurable head and neck cancer. Radiother Oncol. 2005;77(2):137–42.CrossRefGoogle Scholar
  27. 27.
    Soliman H, Ringash J, Jiang H, Singh K, Kim J, Dinniwell R, Brade A, Wong R, Brierley J, Cummings B, Zimmermann C, Dawson LA. Phase II trial of palliative radiotherapy for hepatocellular carcinoma and liver metastases. J Clin Oncol. 2013;31(31):3980–6.CrossRefGoogle Scholar
  28. 28.
    Russell AH, Clyde C, Wasserman TH, Turner SS, Rotman M. Accelerated hyperfractionated hepatic irradiation in the management of patients with liver metastases: results of the RTOG dose escalating protocol. Int J Radiat Oncol Biol Phys. 1993;27(1):117–23.CrossRefGoogle Scholar
  29. 29.
    Hoyer M, Swaminath A, Bydder S, Lock M, Mendez Romero A, Kavanagh GKA, Okunieff P, Dawson LA. Radiotherapy for liver metastases: a review of evidence. Int J Radiat Oncol Biol Phys. 2012;82(3):1047–57.CrossRefGoogle Scholar
  30. 30.
    Herman J, Messersmith W, Suh WW, Blackstock W, Cosman BC, Mohiuddin M, Poggi MM, Regine WF, Saltz L, Small W Jr, Zook J, Konski AA. ACR appropriateness criteria: rectal cancer-metastatic disease at presentation. Curr Probl Cancer. 2010;34(3):201–10.CrossRefGoogle Scholar
  31. 31.
    Halle JS, Rosenman JG, Varia MA, Fowler WC, Walton LA, Currie JL. 1000 cGy single dose palliation for advanced carcinoma of the cervix or endometrium. Int J Radiat Oncol Biol Phys. 1986;12(11):1947–50.CrossRefGoogle Scholar
  32. 32.
    Spanos WJ Jr, Perez CA, Marcus S, Poulter CA, Doggett RL, Steinfeld AD, Grigsby PW. Effect of a rest interval on tumor and normal tissue response—a report of phase III study of accelerated split course palliative radiation for advanced pelvic malignancies (RTOG-8502). Int J Radiat Oncol Biol Phys. 1993;25(3):399–403.CrossRefGoogle Scholar
  33. 33.
    Smith SC, Koh WJ. Palliative radiation therapy for gynaecological malignancies. Best Pract Res Clin Obstet Gynaecol. 2001;15(2):265–78.CrossRefGoogle Scholar
  34. 34.
    Hymel R, Jones GC, Simone CB 2nd. Whole pelvic intensity-modulated radiotherapy for gynecological malignancies: a review of the literature. Crit Rev Oncol Hematol. 2015;94(3):371–9.CrossRefGoogle Scholar
  35. 35.
    McCurdy MT, Shanholtz CB. Oncologic emergencies. Crit Care Med. 2012;40(7):2212–22.CrossRefGoogle Scholar
  36. 36.
    Lonardi F, Gioga G, Agus G, Coeli M, Campostrini F. Double-flash, large-fraction radiation therapy as palliative treatment of malignant superior vena cava syndrome in the elderly. Support Care Cancer. 2000;10(2):156–60.CrossRefGoogle Scholar
  37. 37.
    Wan JF, Bezjak A. Superior vena cava syndrome. Emerg Med Clin North Am. 2009;27(2):243–55.CrossRefGoogle Scholar
  38. 38.
    Luppattelli M, Maranzano E, Bellavita R, Chionne F, Darwish S, Piro F, Latini P. Short-course palliative radiotherapy in non-small-cell lung cancer: results of a prospective study. Am J Clin Oncol. 2000;23(1):89–93.CrossRefGoogle Scholar
  39. 39.
    Harwood AR, Dancuart F, Fitzpatrick PJ, Brown T. Radiotherapy for nonlentiginous melanoma of the head and neck. Cancer. 1981;48(12):2599–605.CrossRefGoogle Scholar
  40. 40.
    Burmeister BH, Henderson MA, Ainslie J, Fisher R, Di Iulio J, Smithers BM, Hong A, Shannon K, Scolyer RA, Carruthers S, Coventry BJ, Babington S, Duprat J, Hoekstra HJ, Thompson JF. Adjuvant radiotherapy versus observation alone for patients at risk of lymph-node field relapse after therapeutic lymphadenectomy for melanoma: a randomized trial. Lancet Oncol. 2012;13(6):589–97.CrossRefGoogle Scholar
  41. 41.
    Mojica P, Smith D, Ellenhorn JD. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol. 2007;25(9):1043–7.CrossRefGoogle Scholar
  42. 42.
    Kaye FJ, Bunn PA Jr, Steinberg SM, Stocker JL, Ihde DC, Fischmann AB, Glatstein EJ, Schechter GP, Phelps RM, Foss FM, Parlette HL, Anderson MJ, Sausville EA. A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides. N Engl J Med. 1989;321(26):1784–90.CrossRefGoogle Scholar
  43. 43.
    Smith BD, Glusac EJ, McNiff JM, Smith GL, Heald PW, Cooper DL, Wilson LD. Primary cutaneous B-cell lymphoma treated with radiotherapy: a comparison of the European Organization for Research and Treatment of Cancer and the WHO classification systems. J Clin Oncol. 2004;22(4):634–9.CrossRefGoogle Scholar
  44. 44.
    Stratigos A, Garbe C, Lebbe C, Malvehy J, Del Marmol V, Pehamberger H, Peris K, Becker JC, Zalaudek I, Saiag P, Middleton MR, Bastholt L, Testori A, Grob JJ, European Dermatology Forum, European Association of Dermato-Oncology, European Organization for the Research and Treatment of Cancer. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer. 2015;51:1989–2007.CrossRefGoogle Scholar
  45. 45.
    Mendenhall WM. Radiotherapy for cutaneous squamous and basal cell carcinomas. In: Cognetta AB, Mendenhall WM, editors. Radiation therapy for skin cancer. New York: Springer; 2013. p. 160.Google Scholar
  46. 46.
    Huisman M, van den Bosch MA, Wijlemans JW, van Vulpen M, van der Linden YM, Verkooijen HM. Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2012;84(1):8–14.CrossRefGoogle Scholar
  47. 47.
    Chow E, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JS, Brundage MD, Nabid A, Tissing-Tan CJ, Oei B, Babington S, Demas WF, Wilson CF, Meyer RM, Chen BE, Wong RK. Single versus multiple fractions of repeat radiation for painful bone metastases: a randomized, controlled, non-inferiority trial. Lancet Oncol. 2014;15(2):164–71.CrossRefGoogle Scholar
  48. 48.
    Nieder C, Grosu AL, Andratschke NH, Molis M. Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys. 2006;66(5):1446–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Haven HospiceGainesvilleUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA

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