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Sometimes palliative radiotherapy (pRT) is not always used appropriately. In our institution, radiation oncologists started to participate the palliative care conferences from September 2021. Between September 2021 and August 2022, 26 (7.6%) of 341 patients presented at this conference were considered candidates for pRT. Finally, 11 patients (3.2%) underwent pRT (ulcerative breast cancer, 2; metastatic spinal cord compression, 1; re-irradiation, 6; peritoneal dissemination, 1; multiple liver metastases, 1). The participation of radiation oncologists at the palliative care conference is thought to facilitate the treatment option of palliative radiotherapy.
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Palliative radiotherapy, when properly administered, contributes to improving the quality of life of patients. Although the usefulness of radiotherapy has been increasingly recognized, the need for palliative radiotherapy from home healthcare institutions has not yet been met. Although there are patients undergoing home care who would benefit from radiotherapy to improve their quality of life, it is difficult to determine the indication in the home care setting, where diagnostic imaging tests are not readily available. In addition, patients undergoing treatment at home often have a lowered performance status, making frequent visits to the hospital difficult and limiting their means of transportation. Under these circumstances, we have been providing palliative radiotherapy in cooperation with home care clinics.
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Objective@#This study aimed to describe the clinical profile and treatment outcomes of patients treated with a short course (<10 fractions) of palliative radiotherapy during the first year of the COVID-19 pandemic. Another aim of the study is to compare patients treated with short-course and long-course palliative radiotherapy in terms of the site and volume irradiated.@*Methods@#An ambispective study comprised 23 patients treated with short-course palliative radiotherapy from March 2020 to February 2021. The retrospective aspect of this study included a review of medical records and radiotherapy plans, while the prospective part involved communication with patients or legally authorized representatives via phone call. Demographic, clinical, and treatment-related information were gathered.@*Results@#Of 92 patients receiving palliative radiotherapy, 23 were treated with a short course, while 69 were planned for at least ten fractions. Of the 23 patients receiving short-course radiotherapy, most had colorectal (35%) and head and neck (26%) primary malignancies. The most commonly treated sites were the pelvis (24%), vertebral bones (21%), and head and neck masses (21%), and the most common indications were pain (45%) and bleeding (32%). The majority were treated with 20 Gy in 5 fractions (42%) and 25 Gy in 5 fractions (38%). Complete resolution of symptoms was observed in 43% of cases, and more than half reported no side effects (58%). Median survival was 71 days. All patients treated in the lung, stomach, and brain underwent a long course of palliative radiotherapy. Patients with a long course also had higher mean irradiated volumes (1871 cm3 vs. 2150 cm3).@*Conclusion@# In this single institution review, a short course of palliative radiotherapy was proven to provide good symptom control with few side effects. During the COVID-19 pandemic, its use should be strongly considered, especially in patients with poor performance status, transportation difficulties, and limited life expectancy.
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COVID-19RESUMEN
Although there have been studies reporting the efficacy of palliative radiation in treating liver tumors, there are very few reports in Japan. Therefore, this study aimed to evaluate the effect of palliative radiation on pain in patients with liver tumors. Between December 2014 and November 2016, 15 patients received palliative radiotherapy of 8 Gy in a single fraction for primary or metastatic liver tumors. Among them, 12 patients were assessed for pain before and after the radiation therapy using the Numeric Rating Scale (NRS). A decrease in the NRS score post radiation therapy was reported in all cases. No grade 3 or higher acute phase adverse events were observed. In conclusion, palliative irradiation managing pain due to liver tumors is possibly effective in relieving pain and well tolerated.
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Objective@#This study aimed to describe the clinical profile and treatment outcomes of patients treated with a short course (<10 fractions) of palliative radiotherapy during the first year of the COVID-19 pandemic. Another aim of the study is to compare patients treated with short-course and long-course palliative radiotherapy in terms of the site and volume irradiated. @*Methods@#An ambispective study comprised 23 patients treated with short-course palliative radiotherapy from March 2020 to February 2021. The retrospective aspect of this study included a review of medical records and radiotherapy plans, while the prospective part involved communication with patients or legally authorized representatives via phone call. Demographic, clinical, and treatment-related information were gathered. @*Results@#Of 92 patients receiving palliative radiotherapy, 23 were treated with a short course, while 69 were planned for at least ten fractions. Of the 23 patients receiving short-course radiotherapy, most had colorectal (35%) and head and neck (26%) primary malignancies. The most commonly treated sites were the pelvis (24%), vertebral bones (21%), and head and neck masses (21%), and the most common indications were pain (45%) and bleeding (32%). The majority were treated with 20 Gy in 5 fractions (42%) and 25 Gy in 5 fractions (38%). Complete resolution of symptoms was observed in 43% of cases, and more than half reported no side effects (58%). Median survival was 71 days. All patients treated in the lung, stomach, and brain underwent a long course of palliative radiotherapy. Patients with a long course also had higher mean irradiated volumes (1871 cm3 vs. 2150 cm3). @*Conclusion@#In this single institution review, a short course of palliative radiotherapy was proven to provide good symptom control with few side effects. During the COVID-19 pandemic, its use should be strongly considered, especially in patients with poor performance status, transportation difficulties, and limited life expectancy.
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COVID-19RESUMEN
Background: Large number of patients with head-and-neck cancer presents with factors such as advanced disease, poor general condition, and associated comorbidities due to which radical treatment is not recommended in these patients. In this scenario, the aim of the present study is to assess the role and feasibility of hypofractionated palliative radiotherapy in these patients. Subjects and Methods: This study was conducted on patients with histopathologically proven cases of squamous cell carcinoma of the head-and-neck region who were surgically unresectable. The quality of life (QOL) was assessed before and after 1 month of radiotherapy using University of Washington Quality of Life questionnaire version 4. All patients received 40 Gy in 10 fractions, twice weekly by two lateral fields covering primary and secondary disease. Response evaluation criteria in solid tumor criteria were used to assess the tumor response. Toxicity was assessed weekly using radiation therapy oncology group criteria. Results: A total of 50 patients were enrolled in this study, out of which 46 completed the planned treatment of 40 Gy in 10 fractions. Common complaints were distressing pain at the primary site (42%), neck swelling (30%), difficult in swallowing (18%), and change in voice (10%). Statistically significant improvements were observed in overall QOL (26.9 ± 9.63 to 55.65 ± 19.28) and none of them experienced Grade IV mucositis or skin toxicity. Good objective response was seen in 82.6% and 84.7% of patients at primary and nodal sites, respectively. Conclusions: This hypofractionated palliative radiotherapy regimen is a good treatment option in patients with Stage IV head-and-neck cancer, who are not fit for treatment with curative intent.
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Aim: Symptomatic relief following palliative radiotherapy for advanced cancers may take a few weeks up to a few months to achieve. Thus, accurate prognostication is important to avoid harm to these patients with limited lifespan. We conducted a retrospective cohort study to determine the median survival and 30-day mortality (30-DM) and factors associated with these parameters in our centre.
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PURPOSE: The purpose of the following study is to evaluate the efficacy of a twice‑weekly hypofractionated palliative radiotherapy schedule in locally very advanced head and neck cancers. MATERIALS AND METHODS: Patients with locally very advanced, head and neck cancers were prospectively evaluated after twice‑weekly palliative radiotherapy regimen of 32 Gy in 8 fractions. Median age was 55.5 years and the predominant primary site was oral cavity (46%). Majority (70.6%) had Stage IV B disease. Disease related distressing symptoms such as pain, bleeding, skin fungation, respiratory symptoms due to tumor burden, were prospectively assessed before the start of treatment, at conclusion and at 6‑12 weeks of completion of treatment. RESULTS: A total of 126 patients were enrolled in the study. Ninety three (73.8%) patients who completed the planned treatment of 32 Gy in 8 fractions were included in the symptom analysis. Overall response rates were 42% at primary disease and 55% at nodal disease. At conclusion of radiotherapy 76.3% of the patients reported improvement in pain scores (P = 0.001) and 42.8% patients reported improvement in anxiety and depression levels (P = 0.001). At first follow‑up after 6‑12 weeks significant improvement in pain scores (P = 0.001) and anxiety/depression levels (P = 0.001) persisted. The median survival of the patients was 5.5 months. Acute grade III mucositis was seen in one patient (1.2%) while none had grade III skin reactions. CONCLUSION: The proposed radiotherapy regimen is effective for sustained symptom palliation with low acute toxicity in locally very advanced head and neck cancers. It delivers a moderately high dose while being logistically simpler for the patient.
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Objective:To investigate the effect and toxicity of short-course and hypofractionated palliative thoracic radiotherapy (PTR) for advanced non-small cell lung cancer (NSCLC). Methods:A total of 25 patients with stageⅢB and stageⅣNSCLC, who underwent PTR from September 2010 to July 2006, were retrospectively analyzed. The PTR regime was 45 Gy in 15 fractions. Symptom relief, effect, and toxicity after completion of PTR were assessed. Survival was analyzed using the Kaplan-Meier method. Results:Except for one patient who completed only 36 Gy in 12 fractions, all other patients completed all plans. The thoracic symptoms of 18 patients were relieved. The response rates for the five main symptoms were:hemoptysis 87.5%(7/8), cough 70.6%(12/17), pain 73.3%(11/15), dyspnea 57.1%(8/14), and hoarseness 50%(1/2). The complete response and partial response after PTR was 28%, and no grade 3 or higher toxicities occurred. The median time of overall survival (OS) is 13 months (95%CI:6.6 months to 19.5 months), and one-year OS is 51.5%. According to the univariate analysis, KPS before PTR, the number of post-PTR was significantly related to the survival. Conclusion:For advanced NSCLC patients, the PTR regime given as 45 Gy in 15 fractions evidently relieved thoracic symptoms, improved OS, and shortened treatment time. Recent relevant adverse radiotherapy reactions are low, and more prospective clinical studies must be conducted.
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The aim of palliative radiotherapy (RT) is to control cancer-related local symptoms with minimal radiation reaction. About one third of all radiation treatments are given with palliative intent. Indications for RT in symptom palliation are as follows: Pain from bone metastasis, pressure symptom from brain and spinal cord, obstruction of bronchus, esophagus, superior vena cava and malignant cancer bleeding from bronchus, urinary tract, uterine cervix and rectum. In hospice palliative care, RT is very effective for symptom palliation and improvement of quality of life without influence on survival.
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Femenino , Encéfalo , Bronquios , Cuello del Útero , Esófago , Hemorragia , Hospitales para Enfermos Terminales , Metástasis de la Neoplasia , Cuidados Paliativos , Calidad de Vida , Recto , Médula Espinal , Sistema Urinario , Vena Cava SuperiorRESUMEN
Bone metastases represent an important and frequent clinical problem in patients with advanced cancers. Especially, painful bone metastases are common features in these patients. Radiotherapy is an effective tool for palliative aim of painful metastatic osseous lesions. Various treatment results have been previously reported. The present retrospective study was aimed to evaluate the efficacy of palliative irradiation on pain relief, with the goal of selecting appropriate irradiation dose schedule. Radiotherapy consisted of 5 times a week with a various fractional dose between 180 and 400cGy. The response of pain relief and the survival time after completion of radiotherapy are related to total dose and most of the patients have shown a similar response by the end of radiotherapy. The higher dose and the more aggressive multimodality treatment, the better pain control and the longer survival time.