Role Of Palliative Radiotherapy Research Articles

Role of palliative radiotherapy (PRT) in patients with malignant airway obstruction (MAO) in the intensive care unit (ICU).

143 Background: MAO is a challenging sequela of advanced cancer, leading to significant morbidity and mortality. A number of patients with MAO present with significant airway compromise necessitating intubation and mechanical ventilation. PRT for MAO patients in the ICU is complex, requiring high levels of coordination and support. The role and efficacy of PRT in intubated patients is not well defined. We performed a retrospective review of intubated patients with MAO receiving PRT to understand efficacy of treatment and patient outcomes. Methods: After obtaining IRB approval, a retrospective query was performed to identify all patients who received PRT and required mechanical ventilation at some point during the course of RT at the Hospital of the University of Pennsylvania from 2008 to 2016. Data was analyzed looking at demographics, reason for intubation, PRT dose and fractionation, length of intubation, extubation success and overall survival. Data was subsequently entered into a database using the secure online application, REDCap. Results: 22 (M:13; F:9) patients with different histologies (most common: lung (11) and lymphoma (3)) were studied. 14 patients had stage IV and 8 had stage II-III disease. All patients had KPS ≤ 50 (ECOG ≤3) at the time PRT initiation. Two patients received PRT and then completed definitive course when became medically stable. The median RT dose was 2000cGy (300 - 7000cGy) given over 1 – 35 (median: 6) fractions. 13 (59%) patients received a full course of initially planned RT. Successful extubation was achieved in 13 (59%) cases but only 11 (50%) patients were survived to hospital discharge. 11 (50%) patients died despite PRT. The average ICU stay was 41.4 days (1 – 75 days). The median overall survival measured from the time of intubation to death or the last follow-up was 23.5 days (1 day - 5.3 year). Favorable histology and lower stage were associated with better outcome following PRT. Conclusions: We found that, in carefully selected patients, PRT can yield successful extubation and potentially improve survival in patients with MAO intubated in ICU. PRT should be considered early in the management of these patients, particularly when it is the treatment of last resort.

The role of palliative radiotherapy in esophageal cancer

The role of palliative radiotherapy in esophageal cancer

Role of palliative radiotherapy, chemotherapy and stents for dysphagia and quality of life improvement in advanced esophageal cancer. The optimal management?

Role of palliative radiotherapy, chemotherapy and stents for dysphagia and quality of life improvement in advanced esophageal cancer. The optimal management?

Research progress in palliative radiotherapy for advanced gastric cancer

According to the medical history, imaging and pathological diagnosis, the advanced gastric cancer patients able to tolerate radiotherapy can be divided into the following three groups: (1) unresectable locally advanced or locally recurrent disease; (2) metastatic disease at primary diagnosis with stage Ⅳ; (3) patients experiencing severe tumor-related clinical symptoms. The role of palliative radiotherapy in patients with advanced gastric cancer would be discussed by reviewing 33 articles (8 in last five years, 13 in ten years). Key words: Gastric neoplasms/radiotherapy; Advanced stage; Palliative

Palliative radiotherapy may improve outcomes in metastatic esophageal and gastric (OG) cancer treated with palliative chemotherapy: A single center retrospective experience.

e15066 Background: The role of palliative radiotherapy (pRT) in patients with metastatic OG cancer remains poorly defined. We report on the outcomes of patients treated with pRT to primary tumor in...

Role of Palliative Radiotherapy for Bone Metastasis

With approximately 50-70% of patients with advanced cancer developing bone metastases during the course of their disease, treatment of bone metastases depends on many factors including performance status, pathology, site of disease, and neurologic status [1]. Radiotherapy has become highly precise, improving local control and facilitating minimally invasive treatment, and has attracted attention as a curative treatment method comparable to surgery. On the other hand, radiotherapy also plays an extremely important role in palliative treatment for advanced cancer patients [2]. Palliative care and treatment is aimed at providing relief from pain and other symptoms. Curative and palliative radiotherapies differ in the radiation field size, dose fraction, and treatment schedule. We review the role of radiotherapy in palliative treatment for patients with symptomatic bone metastases.

9220 POSTER The Role of Palliative Radiotherapy in Patients With Myeloma Bone Disease in the Era of the Novel Agents

9220 POSTER The Role of Palliative Radiotherapy in Patients With Myeloma Bone Disease in the Era of the Novel Agents

Role of Palliative Radiotherapy in the Management of Metastatic Pediatric Neuroblastoma: A Retrospective Single-Institution Study

Neuroblastoma is the most common extracranial solid tumor of childhood, and metastatic disease occurs in a majority of patients. Although radiotherapy (RT) plays an important role in the management of metastatic disease, data on the effectiveness of palliative RT, in this setting, is scarce. A retrospective review of the outcome of palliative RT in children with metastatic neuroblastoma was conducted at the Institut Curie. Thirty-four children with 69 metastatic sites received palliative RT between 2000 and 2009. Sites of disease were grouped according to location, and there were 19 soft tissue, 38 bone, 9 central nervous system (CNS), and 3 hepatic metastases. Mean RT doses for the four groups were 19.6 Gy, 17.6 Gy, 17 Gy, and 5 Gy, respectively. Median survivals after RT were 27 days, 43 days, 29 days, and 27 days, respectively, for an overall median survival of 29.5 days. For the soft tissue metastases, good response was defined as a decrease >25% in the tumor mass or any decrease in pain; the response rate was 84.2%. Furthermore, a dose 15 Gy or more significantly increased response rate (100% vs. 57%; p = 0.038), compared with a dose smaller than 15 Gy. For the bone group and CNS metastases group, the overall response rates were 63.2% and 44%, respectively. A trend toward dose-response relationship was seen for the bone but not the CNS group. Good response rates are achieved with palliative RT for symptomatic metastatic pediatric neuroblastoma, but survival is dismal.

Role of palliative radiotherapy in brain metastases

Background:Brain metastases are a common manifestation of systemic cancer and exceed primary brain tumors in number and are a significant cause of neurologic problems. They affect 20-40% of all cancer patients. Aggressive management of brain metastases is effective in both symptom palliation and prolonging the life. Radiotherapy has a major role to play in the management of brain metastases.AIM:The aim of the study was to know the outcome of palliative radiotherapy in symptomatic brain metastases in terms of improvement in their performance status.Materials and Methods:This is a retrospective study of 63 patients diagnosed to have brain metastases and treated with palliative whole brain radiotherapy to a dose of 30 Gy in 10 fractions over two weeks between June 1998 and June 2007. Diagnosis was done in most of the cases with computed tomography scan and in a few with magnetic resonance imaging. Improvement in presenting symptoms has been assessed in terms of improvement in their performance status by using the ECOG scale.Results:Fifty-four patients completed the planned treatment. Eight patients received concurrent Temozolamide; 88% of patients had symptom relief at one month follow-up; 39/54 patients had a follow-up of just one to three months. Hence survival could not be assessed in this study.Conclusion:External beam radiotherapy in the dose of 30 Gy over two weeks achieved good palliation in terms improvement in their performance status in 88% of patients. Addition of concurrent and adjuvant Timozolamide may improve the results.

The important role of radiotherapy in patients with non‐melanoma skin cancer and other cutaneous entities

Non-melanoma skin cancer is the commonest malignancy worldwide and a significant public health issue. Although most non-melanoma skin cancers are small and easily excised or ablated, a recommendation of definitive radiotherapy is often made in patients where the outcome (cosmetic and/or functional) will probably be better with radiotherapy compared to surgery. The aim of adjuvant radiotherapy is to reduce the risk of loco-regional recurrence and the role of palliative radiotherapy is important in improving the quality of life in patients with advanced and/or incurable disease. The aim of this review article is to broadly discuss the various clinical settings in which a recommendation of radiotherapy may be made and also includes a discussion on less frequently encountered cutaneous entities (e.g. in situ squamous cell carcinoma, keratocanthoma, lentigo maligna, cutaneous lymphomas and malignant fibrous tumours).

Palliative radiotherapy in pediatric malignancies

9050 Background: To evaluate the role of palliative radiotherapy in the management of incurable pediatric malignancies. Methods: Records of 40 pediatric patients treated between Jan’ 2003 and Nov’ 2005 were reviewed and analyzed retrospectively. All of theses 40 children received palliative external beam radiotherapy for symptom control. Palliative radiotherapy was given either as single modality or in addition to surgery, chemotherapy and symptom relief drugs. Information recorded for each patient included age, sex, and extent of disease, histological types, symptomatology, treatment methods and symptom relief. Results: There were 28 boys and 12 girls in the age group of 1 to 18 years, with a median age of 14 years (range of 1–18 years). Predominant symptoms were swelling with or without pain, bleeding, and weakness of limbs. The median duration of symptoms was 90 days (range of 4–50 days). The diagnosis of these children varied with different histologies, most in the group of malignant round cell tumors (11), retinoblastoma (4), neuroblastoma (4), AML with chloromas (3), Ewing’s sarcoma (4). All patients presented with advanced stages of disease. Out of 40 patients 18 (45%) had disseminated disease at presentation. Nine patients underwent surgery while 32 patients received chemotherapy and all but two patients received symptom relief drugs in addition to palliative radiotherapy. The various dose schedules were either 5 Gy or 8 Gy for single fraction treatment while the dose schedules for fractionated radiotherapy ranged from 20 Gy in 5 fractions to 30 Gy in 10 fractions. Four patients showed complete resolution, 20 patients showed good, while 15 patients had little, 1did not have any relief in their symptoms. At the completion of multimodality treatment, 18 patients had partial response, 8 patients had progressive disease, 8 had stable disease and two patients had complete response. The disease status of 4 patients could not be known. Conclusions: The role of radiotherapy as palliative modality in children with locally advanced lesions provides better symptom relief in combination with other modalities of treatment. No significant financial relationships to disclose.

The role of palliative radiotherapy and or chemotherapy in-patients diagnosed with recurrence after surgery with curative intent for oesophago-gastric cancers in a tertiary referral centre

The role of palliative radiotherapy and or chemotherapy in-patients diagnosed with recurrence after surgery with curative intent for oesophago-gastric cancers in a tertiary referral centre

954 Role of palliative radiotherapy in pediatric solid tumours

954 Role of palliative radiotherapy in pediatric solid tumours

Communication between primary care physicians and radiation oncologists regarding patients with cancer treated with palliative radiotherapy.

The purpose of this study was to assess the satisfaction and information needs of primary care physicians (PCPs) regarding communication with radiation oncologists (ROs), with respect to patients who receive palliative radiotherapy (RT). A selected objective was to evaluate the agreement between PCPs' expectations and the content of the RO letter sent after completion of RT. PCPs' knowledge of the role of palliative RT and their awareness of available patient support services were also determined. The PCPs of patients discharged from the Cross Cancer Institute after receiving palliative RT were surveyed using a mail-out questionnaire. Questions regarding communication, RT knowledge, and awareness of support services were asked. The corresponding RO letter was reviewed. A total of 148 PCPs were identified and were mailed questionnaires, with 114 (77%) responding. Overall, 80% (87 of 109) of PCPs found the RO letter to be useful in patient management. However, there was poor (< 53%) agreement between PCPs' expectations and the actual content of the RO letter. Knowledge of the indications and effectiveness of palliative RT was limited, with PCPs obtaining a median score of 4 of a possible 8. Only 27% (31 of 114) of PCPs were aware of all five of the patient support services listed. Results show that although the majority of PCPs found the RO letter useful, they believed that the letter lacked important information while containing unnecessary details. Communication between PCPs and ROs needs improvement, especially considering that PCPs seem to have limited knowledge of palliative RT.

Beyin Metastazlarında Palyatif Radyoterapinin Rolü

The Role of Palliative Radiotherapy in Brain Metastases In this study, patients with brain metastases who were applied palliative cranial radiotherapy have been analysed for objective and clinic response; correlation between these and factors which effect objective response. Between January 1993-February 1994, 33 patients with brain metastases were treated with palliative cranial radiotherapy and 7 patients were out of this study because of the death before evaluation of response. Dose schedules applied to whole brain were 3 GyxlO for fifteen patients, and 2 Gyx20 for 11 patients. Clinic response has been evaluated one month after completion of radiotherapy. Complete, partial and stationary response rates were 58% (15 patients), 23% (6 patients) and 15% (4 patients) respectively. Objective response has been evaluated with computerized tomography at the same time with clinic response. Complete, partial and stationary response rates were 42% (11 patients), 39% (10 patients) and 15% (4 patients) respectively and also in one patient, progression has been established (4%). Though, in 14 patients there was an exact conelation between objective and clinic response, in 7 patients clinic response was better than objective response, and 5 patients had Ure opposite. When the correlations between primary tumor location, histopathologic diagnosis, diameter of lesion, dose per fraction, boost and objective response were analyzed, only primer tumor location and histopathologic diagnosis was found significant statistically. Patients with squamous cell lung cancer had higher objective response rates than others Bu calismada, palyatif kraniyal radyoterapi uygulanan beyin metastazli hastalarda, ob¬jektif ve klinik yanit ile. bunlar arasindaki korelasyon ve objektif yaniti etkileyen faktorler arastirilmistir. Ocak 1993 ve Subat 1994 tarihleri arasinda bolumumuzde 33 beyin me¬tastazli hastaya palyatif kraniyal radyoterapi uygulanmis, 7 hasta yanitlan degerlendirecek kadar yasamadigindan calisma disi birakilmistir. Onbes hasta, tum beyin 10 fraksiyonda toplam 30 Gy ile tedavi edilirken. 11 hastaya 20 fraksiyonda toplam 40 Gy verilmistir. Klinik yanit, radyoterapinin tamamlanmasindan 1 ay sonra degerlendirilmistir. Buna gore; 26 hastanin 15 (%58)'inde tam. 6 (%23)'sinda parsiyel yanit, 4 (%15)'unde stabil hastalik ve 1 hastada (%4) ise progresyon gozlenmistir. Objektif yanit, radyoterapinin tamamlan¬masindan 4 hafta sonra alinan kraniyal bilgisayarli tomografi kesitlerinden belirlenmistir. Buna gore, hastalarin 11 (%42)'inde tam, 10 (%39)unda parsiyel yanit, 4 (%15)'unde sta¬bil hastalik ve 1 (%4) hastada ise progresif hastalik saptanmistir. Ondort hastada klinik ve objektif yanit arasinda tam bir uyum gozlenirken, 7 hastada klinik yanitin objektif yanittan, 5 hastada ise objektif yanitin klinik yanittan daha iyi oldugu saptanmistir. Ob¬jektif yanit oraninin, sadece primer tumor lokalizasyonu ve histopatolojik tanidan an¬lamli olarak etkilendigi saptanmistir. Primeri akcigerde bulunan ve histopatolojik tanisi epidermoid karsinom olan olgularda objektif yanit orani digerlerine gore daha yuksektir

Haemangiopericytoma of the central nervous system

The records of four patients presenting with a histological diagnosis of haemangiopericytoma of the central nervous system, in Auckland, New Zealand, between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and response to various treatment modalities. Three out of the four patients reviewed presented with primary cerebral disease and the fourth with a primary spinal cord tumour. All three cerebral primary patients were initially treated with local surgical excision. All three patients received radical radiotherapy following local recurrence. The first two patients remained disease-free locally although one patient developed a solitary liver metastasis 5 years after radiotherapy. The third patient was referred with multiple cerebral metastases and failed to respond to radiotherapy. The patient with the primary lesion in the spinal cord was treated with local excision followed by post-operative radiotherapy and remains disease-free 17 years after treatment. One patient failed to respond to chemotherapy, prescribed to treat a local recurrence adjacent to the previous radiotherapy field. This was successfully excised subsequently. The patient presenting with multiple cerebral metastases was the only patient to die of this disease. Results suggest that local recurrence is avoidable with adequate wide excision of the primary tumour followed by local radical radiotherapy. The role of chemotherapy remains controversial and no conclusion could be drawn regarding the role of palliative radiotherapy from this study. Active treatment and long-term follow-up are necessary because of the relative aggressiveness of this disease and the propensity for late relapses.

The role of palliative radiotherapy in malignant mesothelioma

Chest pain is often a major problem in patients with malignant pleural mesothelioma but there are few data regarding the usefulness of radiotherapy (RT) in its palliation. Following a recent retrospective report which suggested that wide-field RT frequently affords pain relief in this disease, we prospectively assessed the effect of hemithorax irradiation on pain control. Twenty-two patients with chest pain due to mesothelioma received 30 Gy in 10 daily fractions to the involved hemithorax. The patients' symptoms were assessed before RT, 1 month after RT, and then 2 monthly. Symptoms were graded by the clinician and the patient, and analgesic requirements were noted at each assessment. Performance status and respiratory status were recorded by WHO and MRC criteria respectively. Nineteen assessable patients have been followed for at least 3 months after RT. The treatment was well tolerated, with nausea and vomiting in only 1 patient. Pain control improved in 13/19 patients at 1 month, but 9/12 patients had worsening chest pain at 3 months, and at 5 months pain control had deteriorated in 6/7 patients. Although partial regression of chest wall masses was seen in 5/9 patients, RT did not appear to delay the progression of respiratory symptoms or radiological changes. The median duration of survival after RT was 4 months. Radiotherapy can relieve pain due to malignant pleural mesothelioma but its effect at this dose is short-lived.

The role of palliative radiotherapy in malignant mesothelioma

Chest pain is often a major problem in patients with malignant pleural mesothelioma but there are few data regarding the usefulness of radiotherapy (RT) in its palliation. Following a recent retrospective report which suggested that wide-field RT frequently affords pain relief in this disease, we prospectively assessed the effect of hemithorax irradiation on pain control. Twenty-two patients with chest pain due to mesothelioma received 30 Gy in 10 daily fractions to the involved hemithorax. The patients' symptoms were assessed before RT, 1 month after RT, and then 2 monthly. Symptoms were graded by the clinician and the patient, and analgesic requirements were noted at each assessment. Performance status and respiratory status were recorded by WHO and MRC criteria respectively. Nineteen assessable patients have been followed for at least 3 months after RT. The treatment was well tolerated, with nausea and vomiting in only 1 patient. Pain control improved in 13/19 patients at 1 month, but 9/12 patients had worsening chest pain at 3 months, and at 5 months pain control had deteriorated in 6/7 patients. Although partial regression of chest wall masses was seen in 5/9 patients, RT did not appear to delay the progression of respiratory symptoms or radiological changes. The median duration of survival after RT was 4 months. Radiotherapy can relieve pain due to malignant pleural mesothelioma but its effect at this dose is short-lived.