Palliative Radiotherapy—New Approaches

Oorschot, Birgitt van; Rades, Dirk; Schulze, Wolfgang; Beckmann, Gabriele; Feyer, Petra

doi:10.1053/j.seminoncol.2011.03.015

Cited by 54 publications

(31 citation statements)

References 39 publications

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“…Considering that short-course regimens with no or low-grade side effects exist, which often improve symptoms such as pain, dyspnea and hemoptysis, clinicians are wary of withholding a meaningful therapeutic measure for patients with terminal cancer (15)(16)(17)(18). Therefore, prediction tools must not predict short survival times in patients who survive long enough to experience a reduced burden of symptoms, and must also identify the majority of patients will succumb to the disease too early to benefit from the treatment.…”

Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

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Abstract.Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.

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Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

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“…Along with the development of a plan of pharmacologic treatment, disease-modifying therapy such as radiation should always be considered, especially in pain caused by bone metastases or other somatic nociceptive pain syndromes [16]. If bone pain is localized, as for example due to tissue destruction by a metastasis, radiotherapy can be extremely effective [17].…”

Section: Disease-modifying Therapymentioning

confidence: 99%

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider

Voltz²,

Gaertner³

2012

Breast Care

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Breast cancer patients with bone metastases often suffer from cancer pain. In general, cancer pain treatment is far from being optimal for many patients. To date, morphine remains the gold standard as first-line therapy, but other pure µ agonists such as hydromorphone, fentanyl, or oxycodone can be considered. Transdermal opioids are an important option if the oral route is impossible. Due to its complex pharmacology, methadone should be restricted to patients with difficult pain syndromes. The availability of a fixed combination of oxycodone and naloxone is a promising development for the reduction of opioid induced constipation. Especially bone metastases often result in breakthrough pain episodes. Thus, the provision of an on-demand opioid (e.g., immediate-release morphine or rapid-onset fentanyl) in addition to the baseline (regular) opioid therapy (e.g., sustained-release morphine tablets) is mandatory. Recently, rapid onset fentanyls (buccal or nasal) have been strongly recommended for breakthrough cancer pain due to their fast onset and their shorter duration of action. If available, metamizole is an alternative non-steroid-anti-inflammatory-drug. The indication for bisphosphonates should always be checked early in the disease. In advanced cancer stages, glucocorticoids are an important treatment option. If bone metastases lead to neuropathic pain, coanalgetics (e.g., pregabalin) should be initiated. In localized bone pain, radiotherapy is the gold standard for pain reduction in addition to pharmacologic pain management. In diffuse bone pain radionuclids (such as samarium) can be beneficial. Invasive measures (e.g., neuroaxial blockage) are rarely necessary but are an important option if patients with cancer pain syndromes are refractory to pharmacologic management and radiotherapy as described above. Clinical guidelines agree that cancer pain management in incurable cancer is best provided as part of a multiprofessional palliative care approach and all other domains of suffering (psychosocial, spiritual, and existential) need to be carefully addressed (‘total pain’).

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“…In these patients, the question whether to offer radiotherapy or not should be considered rather than the issue of fractionation schedule. The main factors that influence this decision are: performance status, estimated prognosis, symptom severity and patient's choice [1,3,10,13,14,18,19,27,28].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies suggest that schedules of longer fractionation and higher doses should be considered for patients with good performance status (PS) and longer of life expectancy [1,2,6,[15][16][17][18][19]. To the contrary, in patients with a poor PS and short expected survival time, hypofractionated short-course PTR is used most frequently [1,[3][4][5][6]11,[14][15][16][17][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%