The developed models can potentially guide dose selection and provide prognostic information but still require external validation.

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23.6%), and breast (11.6%). Eighty patients (33.2%) received palliative RT with a total of 241 treatment courses [median courses: 2 (range 1 − 21), median fractions: 5 (range 1 − 26)]. The most common sites of palliative RT were the brain (41%), spine (13.8%), and long bone (10%). Approximately half of patients (48.8%) received their first course of palliative RT before EP-CT enrollment versus 47.5% (n = 38) following completion of EP-CT and 3.7% (n = 3) during EP-CT. Median time on EP-CT by timing of first palliative RT treatment was 63 days (pre-EP-CT), 68.5 days (after EP-CT), and 156 days (during EP-CT). Among patients receiving palliative RT before or during EP-CT enrollment, there were fewer ED visits or hospitalizations versus patients who received palliative RT after EP-CT completion (30.1% vs 50.0%, P = 0.042). Conclusion:In a cohort of advanced cancer patients enrolled in EP-CTs, palliative RT was utilized in one-third of patients at some point during their care. Those who received palliative RT prior to or during EP-CT enrollment experienced fewer ED visits and hospitalizations compared to those who received it after EP-CT. While rare, those patients who received palliative RT while on EP-CT experienced a markedly longer time on trial, highlighting the potential benefits of EP-CT trial designs that allow for palliative RT while remaining on study. Additional research is warranted to characterize the impact of palliative RT on the EP-CT trial experience.