Single-institution analysis of the prevalence, indications and outcomes of end-of-life radiotherapy

Abstract

Highlights Survival prognostication and patient selection remain challenging tasks. End-of-life radiotherapy until one week before death showed a patient benefit. Treatment prescribed within one week of death often had to be discontinued. Therapy needs to take into account patient preferences for the last phase of life.

Validation and extension of the METSSS score in a metastatic cancer patient cohort after palliative radiotherapy within the last phase of life

“…Two patients (1%) each received RT to the breast and pelvis region. RT intent was palliative for all patients and treatment indication included pain, dyspnea, bleeding, amongst others [10] . For an overview of patient characteristics according to the METSSS nomenclature, see Table 1 .…”

“…Here, we aimed to extend its use to a cohort of metastatic cancer patients having received palliative RT in the last phase of life. We had previously reported on the prevalence, indications and outcomes of palliative RT in this patient cohort in a single-institution analysis [10] .…”

Shortened Palliative Radiotherapy Results in a Lower Rate of Treatment During the Last Month of Life

“…There is still debate about the complete avoidance of palliative radiotherapy in the last month of life. Recently, Christ et al reported that radiotherapy achieved high completion and success rates until one week before death, and suggested that treatment within one week of death should be restricted to carefully selected patients or avoided altogether [ 21 ]. In a different study, treatment was discontinued in 41% of the patients irradiated during the last two weeks of life, and worsening of the general condition was the prevailing reason for discontinuation (70%) [ 22 ].…”

Mortality during or shortly after curative-intent radio-(chemo-) therapy over the last decade at a large comprehensive cancer center

“…The institutional treatment database was screened for patients who had received curative-intent R(C)T between January 2011 and December 2021 at our center and deceased during or within 30 days after radiotherapy completion/end. This cut-off was chosen, as it was reported in the two quoted ASTRO abstracts [3] , [4] , and also because it is commonly used in the palliative RT literature when assessing therapy close to end-of-life [6] , [7] . While it is an open question of whether 30-, 90- or even 180-day mortality after RCT should be regarded as quality measure, the contrast between a high potential for cure after a weeks-long therapy regimen versus death during or shortly after therapy seems most pronounced [2] , [8] .…”