Palliation and Benign Conditions

Chapter

Abstract

This chapter will cover brain metastases, bone metastases, spinal cord compression, liver metastases, airway obstruction, superior vena cava obstruction, and gynecologic bleeding.

Keywords

Palliation Brain metastases Spinal cord compression 

Notes

Acknowledgment

We thank Stuart Y. Tsuji MD, PhD, and William M. Wara MD for their work on the prior edition of this chapter.

References

  1. Aiken KL, Hawkins MA. Stereotactic body radiotherapy for liver metastases. Clin Oncol. 2015;27:307–15.CrossRefGoogle Scholar
  2. Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363:1665–72.CrossRefGoogle Scholar
  3. Anker CJ, Grossmann KF, Atkins MB, et al. Avoiding severe toxicity from combined BRAF inhibitor and radiation treatment: consensus guidelines from the eastern cooperative oncology group (ECOG). Int J Radiat Oncol Biol Phys. 2016;95:632–46.CrossRefGoogle Scholar
  4. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295(21):2483–91.CrossRefGoogle Scholar
  5. Atalar B, Modlin LA, Choi CYH, et al. Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2013;87:713–8.CrossRefGoogle Scholar
  6. Berenson J, Pflugmacher R. Balloon kyphoplasty vs nonsurgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicenter raondomized controlled trial. Lancet Oncol. 2011;12(3):225–35.CrossRefGoogle Scholar
  7. Blitzer PH. Reanalysis of the RTOG study of the palliation of symptomatic osseous metastasis. Cancer. 1985;55:1468–72.CrossRefGoogle Scholar
  8. Borgelt B, Gelber R, Kramer S, et al. The palliation of brain metastases: Final results fo the first two studies by the radiation therapy oncology group. Int J Radiat Oncol Biol Phys. 1980;6:1–9.CrossRefGoogle Scholar
  9. Borgelt B, Gelber R, Larson M, et al. Ultra-rapid high dose irradiation schedules for the Palliarion of brain metastases: Final results of the first two studies by the radiation therapy oncology group. Int J Radiat Oncol Biol Phys. 1981;7:1633–8.CrossRefGoogle Scholar
  10. Brennan C, Yang TJ, Hilden P, et al. A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys. 2014;88:130–6.CrossRefGoogle Scholar
  11. Brown PD, Pugh S, Laack NN, et al. Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro-Oncol. 2013;15:1429–37.CrossRefGoogle Scholar
  12. Brown PD, Ballman KV, Cerhan J, et al. N107C/CEC.3: A phase III trial of postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease. ASTRO Annual Meeting, Boston, MA; Sept 2016a, LBA-1.Google Scholar
  13. Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016b;316:401–9.CrossRefGoogle Scholar
  14. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10:1037–44.CrossRefGoogle Scholar
  15. Choi CYH, Chang SD, Gibbs IC, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases: prospective evaluation of target margin on tumor control. Int J Radiat Oncol Biol Phys. 2012;84:336–42.CrossRefGoogle Scholar
  16. Chow E, Zheng L, et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol. 2012;24(2):112–24.CrossRefGoogle Scholar
  17. Cox BW, et al. International spine radiosurgery consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. IJROBP. 2012;83(5):e597–605.Google Scholar
  18. De Puysseleyr A, Van De Velde J, Speleers B, et al. Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial. Radiat Oncol. 2014;9:170.CrossRefGoogle Scholar
  19. Ferrell BR, Temel JS et al. Integration of palliative care into standard oncology care: american society of clinical oncology clinical practice guideline update. Journal of Clinical Oncology 2017 35:1, 96–112 CrossRefGoogle Scholar
  20. Flickinger JC, Kano H, Niranjan A. Dose selection in stereotactic radiosurgery. Prog Neurol Sur. 2013;27:49–57.Google Scholar
  21. Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745–51.CrossRefGoogle Scholar
  22. Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000;47:1001–6.CrossRefGoogle Scholar
  23. Gerszten PC, Burton SA, Ozhasoglu C. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine. 2007;32:193–9.CrossRefGoogle Scholar
  24. Goldberg SB, Gettinger SN, Mahajan A, Chiang AC, Herbst RS, Sznol M, et al. Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. Lancet Oncol. 2016;17:976–83.CrossRefGoogle Scholar
  25. Gondi V, Pugh SL, Tome WA, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol. 2014;32:3810–6.CrossRefGoogle Scholar
  26. Hartsell WF, Scott CB, Bruner DW, et al. Randomized trial of short-versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97:798–804.CrossRefGoogle Scholar
  27. Howell DD, James JL, Hartsell WF, et al. Randomized trial of short-course versus long-course radiotherapy for palliation of painful vertebral bone metastases: a retrospective analysis of RTOG 97-14. J Clin Oncol. 2009;27:7s. ASCO 2009, abstractCrossRefGoogle Scholar
  28. Iuchi T, Shingyoji M, Sakaida T, et al. Phase II trial of gefitinib alone without radiation therapy for Japanese patients with brain metastases from EGFR-mutant lung adenocarcinoma. Lung Cancer. 2013;82:282–7.CrossRefGoogle Scholar
  29. Jabbari S, Gerszten P, Ruschin M, et al. Stereotactic body radiotherapy for spinal metastases: practical guidelines, outcomes, and risks. Cancer J. 2016;22(4):280–9.CrossRefGoogle Scholar
  30. Jensen CA, Chan MD, McCoy TP, et al. Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis. J Neurosurg. 2011;114:1585–91.CrossRefGoogle Scholar
  31. Johung KL, Yeh N, Desai NB, et al. Extended survival and prognostic factors for patients with ALK-rearranged non-small-cell lung cancer and brain metastasis. J Clin Oncol. 2016;34:123–9.CrossRefGoogle Scholar
  32. Kayama T, Sato S, Sakurata K, et al. JCOG0504: a phase III randomized trial of surgery with whole brain radiation therapy versus surgery with salvage stereotactic radiosurgery in paitnets with 1 to 4 brain metastases. Abstract only. J Clin Oncol. 2016;34:Suppl abst 2003.Google Scholar
  33. Knisely JPS, Yu JB, Flanigan J, et al. Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival. J Neurosurg. 2012;117:227–33.CrossRefGoogle Scholar
  34. Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011;29:134–41.CrossRefGoogle Scholar
  35. Kondziolka D, Patel A, Lunsford LD, et al. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys. 1999;45:427–34.CrossRefGoogle Scholar
  36. Kroeze SG, Fritz C, Hoyer M, et al. Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: a systematic review. Cancer Treat Rev. 2017;53:25–37.CrossRefGoogle Scholar
  37. Ling DC, Vargo JA, Wegner RE, et al. Postoperative stereotactic radiosurgery to the resection cavity for large brain metastases. Neurosurgery. 2015;76:150–7.CrossRefGoogle Scholar
  38. Lo SS, Ryu S, Chang EL, et al. ACR appropriateness criteria: metastatic epidural spinal cord compression and recurrent spinal metastases. J Palliative Med. 2015;8:573–84.Google Scholar
  39. Logie N, Jimenez RB, Pulenzas RB, et al. Recursive partitioning analysis to predict survival for patients receiving cranial re-irradiation for brain metastases. IJROBP. 2015;93(3 supp):S62–3.Google Scholar
  40. Lutz SJ, Balboni T, Jones J, Lo S, Petit J, et al. Palliative radiation therapy for bone metastases: update of an ASTRO evidence-based guideline. Prac Radiat Oncol. 2017;7(1):4–12.CrossRefGoogle Scholar
  41. Magnuson WJ, Lester-Coll NH, Wu AJ, et al. Management of Brain Metastases in tyrosine kinase inhibitor-Naïve epidermal growth factor receptor-mutant non-small-cell lung cancer: a retrospective multi-institutional analysis. J Clin Oncol. 2017;35(10):1070–7.CrossRefGoogle Scholar
  42. Mahajan A, Ahmed S, McAleer MF, et al. Postoperative stereotactic radiosurgery versus observation for completely resected brain metastases: results of a prostpective randomized study. Abstract only. IJROBP. 2016;96-2:s2.Google Scholar
  43. Mak KS, Gainor JF, Niemierko A, Oh KS, Willers H, Choi NC, et al. Significance of targeted therapy and genetic alterations in EGFR, ALK, or KRAS on survival in patients with non-small cell lung cancer treated with radiotherapy for brain metastases. Neuro-Oncol. 2015;17:296–302.CrossRefGoogle Scholar
  44. Margolin K, Ernstoff MS, Hamid O, et al. Ipilimumab in patients with melanoma and brain metastases: an open-label, phase 2 trial. Lancet Oncol. 2012;13:459–65.CrossRefGoogle Scholar
  45. McCarter MD, Fong Y. Metastatic liver Tumors. Semin Surgl Oncol. 2000;19:177–88.CrossRefGoogle Scholar
  46. Minniti G, Esposito V, Clarke E, et al. Multidose stereotactic radiosurgery (9 Gy × 3) of the postoperative resection cavity for treatment of large brain metastases. Int J Radiat Oncol Biol Phys. 2013;86:623–9.CrossRefGoogle Scholar
  47. Minniti G, D’Angelillo RM, Scaringi C, et al. Fractionated stereotactic radiosurgery for patients with brain metastases. J Neuro-Oncol. 2014;117(2):295–301.CrossRefGoogle Scholar
  48. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64.Google Scholar
  49. Mulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet. 2016;388:2004–14.CrossRefGoogle Scholar
  50. Navarria P, Pessina F, Cozzi L, et al. Hypo-fractionated stereotactic radiotherapy alone using volumetric modulated arc therapy for patients with single, large brain metastases unsuitable for surgical resection. Radiat Oncol. 2016;11:76.CrossRefGoogle Scholar
  51. Nousianinen M. Surgical management of bone metastases. In: Bone metastases, a translational and clinical approach, vol. 12. Dordrecht: Springer; 2009. p. 263–86.CrossRefGoogle Scholar
  52. Ou S-HI, Jänne PA, Bartlett CH, et al. Clinical benefit of continuing ALK inhibition with crizotinib beyond initial disease progression in patients with advanced ALK-positive NSCLC. Ann Oncol. 2014;25:415–22.CrossRefGoogle Scholar
  53. Pan C, Kavanagh B, et al. Radiation associated liver injury. IJROBP. 2010;76(3):S94–S100.Google Scholar
  54. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494–500.CrossRefGoogle Scholar
  55. Patchell RA, Tibbs PA, Regine WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain. JAMA. 1998;280:1485–9.CrossRefGoogle Scholar
  56. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.CrossRefGoogle Scholar
  57. Park SJ, Kim HT, Lee DH, et al. Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutation. Lung Cancer. 2012;77:556–60.CrossRefGoogle Scholar
  58. Porter AT, McEwan AJ, Powe JE, et al. Results of a randomized phase III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the Management of Endocrine Resistant Metastatic Prostate Cancer. Int J Radiat Oncol Biol Phys. 1993;25:805–13.CrossRefGoogle Scholar
  59. Rades D, Rudat V, Veninga T, et al. Prognostic factors for functional outcome and survival after Reirradiation for in-field recurrences of metastatic spinal cord compression. Cancer. 2008;113:1090–6.CrossRefGoogle Scholar
  60. Rades D, Lange M, Veniga T, et al. Final results of a prospective study comparing the local control of short course and long course radiotherapy for metastatic spinal cord compression. IJROBP. 2011a;79(2):524–30.Google Scholar
  61. Rades D, Stalpers LJA, Hulshof MC, et al. Comparison of 1 x 8 Gy and 10 x 3 Gy for functional outcome in patients with metastatic spinal cord compression. Int J Radiat Oncol Biol Phys. 2005;62:514–8.CrossRefGoogle Scholar
  62. Rades D, Panzner A, Rudat V, et al. Dose escalation of radiotherapy for metastatic spinal cord compression in patients with relativel favorable survival prognosis. Strahlenther Onkol. 2011b;187(11):729–35.CrossRefGoogle Scholar
  63. Rades D, Segedin B, Conde-Moreno A, et al. Radiotherapy with 4 Gy x 5 versus 3 Gy x 10 for metastatic epidural spinal cord compression: Final results of the SCORE-2 trial (ARO2009/01). J Clin Oncol. 2016;34(6):597–602.CrossRefGoogle Scholar
  64. Redmond KJ, Robertson S, Lo S, Soltys S, et al. Consensus contouring guidelines for postoperative stereotactic body radiation therapy for Metastastic solid tumor malignancies to the spine. Int J Radiat Oncol Biol Phys. 2017;97(1):64–74.CrossRefGoogle Scholar
  65. Reveiz L, et al. Palliative endobroncial brachytherapy for non-small cell lung cancer. Cochrane Review. 2012;12:CD004284.Google Scholar
  66. Rodrigues G et al. Palliative thoracic radiotherapy in lung cancer: an american society for radiation oncology evidence-based clinical practice guideline. Practical Radiation Oncology 1.2 (2011): 60–71.CrossRefGoogle Scholar
  67. Rusthoven CG, Doebele RC. Management of Brain Metastases in ALK-positive non-small-cell lung cancer. J Clin Oncol. 2016;34:2814–9.CrossRefGoogle Scholar
  68. Rusthoven KE, Kavanagh BD, Cardenes H, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009;27(10):1572–8.CrossRefGoogle Scholar
  69. Sahgal A, Ames C, Chou D, et al. Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys. 2009;74(3):723–31.CrossRefGoogle Scholar
  70. Scharp M, Hauswald H, Bischof M, et al. Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis. Radiat Oncol. 2014;9:4.CrossRefGoogle Scholar
  71. Sciuto R, Festa A, Rea S, et al. Effects of low-dose cisplatin on 89Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J Nucl Med. 2002;43:79–86.PubMedPubMedCentralGoogle Scholar
  72. Shaw E, Scott C, Souhami L, et al. 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;47:291–8.CrossRefGoogle Scholar
  73. Sirven JI, Wingerchuk DM, Drazkowski JF, et al. Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc. 2004;79:1489–94.CrossRefGoogle Scholar
  74. Sneed PK, Lamborn KR, Forstner JM, et al. Radiosurgery for brain metastases: is whole brain radiotherapy necessary? Int J Radiat Oncol Biol Phys. 1999;43:549–58.CrossRefGoogle Scholar
  75. Sneed PK, Suh JH, Goetsch SJ, et al. A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys. 2002;53:519–26.CrossRefGoogle Scholar
  76. Sneed PK, Mendez J, Vemer-van den Hoek JGM, Seymour ZA, Ma L, Molinaro AM, et al. Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg. 2015;123:373–86.CrossRefGoogle Scholar
  77. Soltys SG, Adler JR, Lipani JD, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2008;70:187–93.CrossRefGoogle Scholar
  78. Son CH, Jimenez R, Niemierko A, et al. Outcomes after whole brain reirradiation in patients with brain metastases. Int J Radiat Oncol Biol Phys. 2012;82:e167–72.CrossRefGoogle Scholar
  79. Spanos WT et al. Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502), IJROBP 29:5, 1994, P 961–967.Google Scholar
  80. Sperduto PW, Berkey B, Gaspar LE, et al. 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;70:510–4.CrossRefGoogle Scholar
  81. Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61.CrossRefGoogle Scholar
  82. Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30:419–25.CrossRefGoogle Scholar
  83. Stopeck AT. Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: a randomized, double blind study. JCO. 2010;28(35):5132–9.CrossRefGoogle Scholar
  84. Thibault I, Whyne C, Zhou S, Campbell M, et al. Volume of lytic vertebral body metastatic disease quantified using computer tomography-based image segmentation predicts fracture risk after spine stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2017;97(1):75–81.CrossRefGoogle Scholar
  85. Tremont-Lukats IW, Ratilal BO, Armstrong T, et al. Antiepileptic drugs for preventing seizures in people with brain tumors. Cochrane Database Syst Rev 2008;(16):CD004424.Google Scholar
  86. Tsao MN, Lloyd N, Wong RKS, et al. Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev 2012a;(18):CD003869.Google Scholar
  87. Tsao MN, Rades D, Wirth A, et al. Radiotherapeutic and surgical management for newly diagnosed brain metastases: an amarican society for radiation oncology evidence based guideline. Prac Radiat Oncol. 2012b;2(3):210–25.CrossRefGoogle Scholar
  88. Van der Linden YM, Dijkstra PD, Kroon HM, et al. Comparative analysis of risk factors for pathological fracture with femoral metastases. J Bone Joint Surg Br. 2004;86:566–73.CrossRefGoogle Scholar
  89. Wang TJC, Saad S, Qureshi YH, et al. Does lung cancer mutation status and targeted therapy predict for outcomes and local control in the setting of brain metastases treated with radiation? Neuro-Oncol. 2015;17:1022–8.CrossRefGoogle Scholar
  90. Weber JS, Amin A, Minor D, et al. Safety and clinical activity of ipilimumab in melanoma patients with brain metastases: retrospective analysis of data from a phase 2 trial. Melanoma Res. 2011;21:530–4.CrossRefGoogle Scholar
  91. Weickhardt AJ, Scheier B, Burke JM, et al. Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer. J Thorac Oncol. 2012;7:1807–14.CrossRefGoogle Scholar
  92. Wilson L, et al. Superior vena cava syndrome with malignant causes. NEJM. 2007;356:1862–9.CrossRefGoogle Scholar
  93. Yamamoto M, Serizawa T, Shuto T, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014;15:387–95.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Radiation Oncology, University of California San FranciscoSan FranciscoUSA

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