Short-course Palliative Radiotherapy Research Articles

Clinical Outcomes of Patients Treated with Short-course Palliative Radiotherapy in the First Year of the COVID-19 Pandemic: A Single Institution Experience

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.

Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Introduction: Choroidal metastases are infrequent in breast cancer, but if they present, they usually signify the disseminated disease and poor prognosis. The challenges in treating choroidal metastases are not only to prolong survival but also to preserve vision, improving the quality of life. Case Presentation: Our patient was firstly diagnosed with stage-three triple-negative breast cancer at the age of 32 years. She had surgery, adjuvant chemotherapy with anthracycline regime, as well as adjuvant radiotherapy. Her disease firstly recurred two years later with pleural effusion, but it was controlled with six cycles of docetaxel. She was in remission until ten years later when she presented with a worsening dry cough and progressive blurring of vision in both eyes. CT restaging showed multiple sub-centimeter bilateral lung nodules, singular pleural metastases, and multiple bone metastases. Choroidal metastases were also confirmed with the ophthalmological assessment which includes CT of the orbit. She received short-course palliative radiotherapy followed immediately by eribulin. Then, she started monthly bisphosphonates. She was able to read again four months after radiotherapy, and her vision remains normal to date. The latest PET scans showed no FDG avid disease in the lungs with pleural metastases significantly reduced in size. Bone metastases remain stable and asymptomatic. It has been nearly four years since the diagnosis of choroidal metastases. She is still on eribulin at an adjusted dose and interval. She remains asymptomatic from her bone, lung, and choroidal metastases. Conclusions: Short-course radiotherapy to the orbit, followed by continuous administration of eribulin, can lead to prolonged survival with a good quality of life in triple-negative breast cancer with choroidal metastases

Short-Course Palliative Radiotherapy Combined With Immunotherapy for Recurrent/Advanced/Metastatic Head and Neck Cancer

To evaluate tumor response rates in patients treated with a combination of palliative short-course radiotherapy (SCRT) and immune checkpoint inhibitor immunotherapy (IO) in patients with recurrent, advanced or metastatic (R/A/M) head and neck cancer (HNC).We reviewed the medical records of patients treated with short-course palliative intent radiation therapy (RT) (hypofractionated RT in 4-5 fractions) for R/A/M HNC between 2014-2020. Patient, disease, and treatment factors were abstracted from the medical record. Patients were categorized as having been treated with combined immunotherapy and radiotherapy (IO+RT) if the RT was given after at least 1 cycle of IO with at least 1 cycle of IO afterward. Treated gross tumor volume (GTV) was measured prior to and after RT and percent change in GTV volume from baseline to best overall response (BOR) was calculated. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.In total, 19 patients were treated with SCRT, 7 of whom were treated with combined IO+RT. Primary site included oral cavity (n = 6), larynx/hypopharynx (5), oropharynx (3), sinonasal (2), cutaneous (2), and thyroid (1). Squamous cell histology was most frequent (16/19) with the other 3 comprised of sinonasal intestinal-type adenocarcinoma, mucosal melanoma, and Hürthle cell carcinoma. Disease status included 6 patients with a recurrence, 6 were metastatic, 3 locally advanced/incurable, and 3 recurrent/metastatic. Prior treatments included RT (n = 9) and chemotherapy (6); ECOG performance status was 1-2 in 13 patients and 3-4 in 6 patients. Seventeen patients were treated with "quad-shot" radiotherapy (14.4-14.8 Gy in 4 fractions delivered twice daily) and 2 were treated with 20 Gy in 5 fractions. Median (range) number of IO cycles given pre- and post-RT were 7 (1-11) and 2 (1-21), respectively. Of the 17 evaluable patients for treatment response, 13 patients responded or were stable while 4 had progression. Median pre-RT target volume in the RT cohort was 37.2 (6.14-486.21) cc and 145.28 (24.21-219.51) cc in the IO+RT cohort. Median post-RT target volume in the RT cohort was 28.00 (17.23, 57.630 cc and 58.44 (0.00, 246.56) cc in the IO+RT cohort. Median change in target volume in RT cohort was -42% (range: -100, 259) cc and -54% (-100, 12) cc in the IO+RT cohort. 1-year PFS and OS were 5% and 21%, respectively. 1-year OS was numerically higher for IO+RT patients (43% v. 8%, P = 0.13).In this select cohort of patients with R/A/M HNC, combined IO+SCRT was feasible and showed an improved tumor response as evidenced by greater decrement in post-treatment tumor volume. An ongoing clinical trial (NCT04454489) aims to prospectively evaluate the potential benefit of combined quad-shot radiotherapy with Pembrolizumab to improve response rates to IO alone.

OC-0406 Short-course palliative radiotherapy of advanced solid cancer (sharon project): a pooled analysis.

OC-0406 Short-course palliative radiotherapy of advanced solid cancer (sharon project): a pooled analysis.

Palliative radiation therapy for patients with orbital and ocular metastases.

Patients with cancer may develop metastases to the orbit causing distressing symptoms. External beam radiation therapy (RT) is an effective palliative treatment for patients with orbital and ocular metastases. The aim of treatment is to preserve vision and to reduce pain. Delivery of 30 to 40 Gy in 2 Fr fractions is a practice in many oncology centres. The aim of this study is to evaluate the outcome of shortcourse palliative radiotherapy in the management of orbital and ocular metastases. A retrospective study to review all patients with orbital metastases treated in 2016 to 2018 were performed. The primary outcomes were a change in visual acuity and tumor response. Secondary outcomes included toxicities of radiotherapy, symptomatic response and survival. Fifteen patients with 19 eyes were included. The most common presenting symptoms were decreased vision, periorbital swelling, and pain. The median follow-up period was 8 months. Visual acuity improved in 11 out of 13 (84.6%) of patients and remained stable in the remaining 2 patients. Partial and complete response (CR) of tumor was observed in 14 out of 15 (93.3%) of patients while one (6.6%) patient had stable disease. The overall response rate (ORR) was 100%. Two (13.3%) patients had grade 2 conjunctivitis. There were no grade 3-4 toxicities and no long-term toxicities observed. The median survival was 9.1 months from diagnosis of choroidal metastases. Short course palliative RT is effective and well tolerated in patients with orbital and ocular metastases. The current review showed that it effectively preserves vision and improves orbital symptoms with minimal radiation-induced toxicity. Short course radiotherapy will help to minimize the traveling time to the hospital and relieve the burden of a long treatment course in this palliative patient population.

Split-Course radiotherapy: A nonideal treatment in a nonideal patient

Background: Radical chemoradiation is the standard of care for locally advanced head-and-neck cancer. However, patients with pretreatment poor risk features exhibit a poor tolerance to these rigorous regimens and are then usually prescribed short-course palliative radiotherapy which provides symptomatic relief; however, survival outcomes are poor. However, a proportion of these patients may tolerate higher dose of radiation with planned treatment break which in turn may translate into improved locoregional control. Materials and Methods: Patients with histologically confirmed nonmetastatic locally advanced squamous cell carcinoma of oropharynx with poor risk features, treated with split-course radiotherapy were included in this retrospective study. A dose of 35 Gy in 15# 3 weeks was initially prescribed. After planned treatment break of 2 weeks, an additional dose of 25 Gy in 10# 2 weeks was delivered. A weekly assessment of radiation reactions was performed during the treatment course, and response to the treatment was assessed clinically at 8 weeks after treatment completion and on subsequent follow-up. Survival analysis was done at median follow-up. Results: Of the 117 eligible patients, 14 (11.9%) had Stage III (with poor Karnofsky Performance Score) and 103 (88.1%) had Stage IV disease. Toxicity was observed as Grade I 80/117 (68.4%), Grade II 20/117 (17.1%), and Grade III as 17/117 (14.5%). A complete clinical response was observed in 45.3% patients at first follow-up. Patients had a median follow-up of 20 months (range 0–62 months). Median progression-free survival and overall survival were 12 and 16 months, respectively. Conclusions: This regimen can be delivered effectively and has an acceptable toxicity profile. It can be used as a treatment option in patients with poor risk pretreatment features.

Experience of Low-Dose, Short-Course Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer.

The optimal regimen of radiotherapy (RT) for bleeding from gastric cancer (GC) has not yet been established. The aim of this study was to evaluate the usefulness of low-dose, short-course palliative RT (LSP-RT) for bleeding from GC. We reviewed the clinical data of 18 patients (26 courses) who received palliative RT for bleeding from GC between 2004 and 2014. The radiation dose was 6 Gy in three fractions. The total courses of RT for each patient were 1-4 (median, 1). The treatment success rate of the first and the additional RT at two weeks after RT was 55% and 75%, respectively. Regarding first RT, there was a statistically significant increase in the mean hemoglobin level for one month (p = 0.009) and a significant decrease in the mean number of transfused red blood cell units for one month (p = 0.012). Toxicities were observed in two patients: one patient who received chemotherapy developed grade 3 afebrile leukocytopenia and another who had a malignant stricture suffered from a gastric obstruction. The performance status was improved in 3 of the 12 evaluable patients (25%) and dietary intake became possible one month after RT in three of the four patients who had not been able to eat before RT. LSP-RT is expected to be not only an effective and safe treatment option for bleeding from GC, but also repeatable in cases of rebleeding. Furthermore, this treatment modality may be able to improve the patient's quality of life.

The International Atomic Energy Agency (IAEA) randomized trial of palliative treatment of incurable locally advanced non small cell lung cancer (NSCLC) using radiotherapy (RT) and chemotherapy (CHT) in limited resource setting

BackgroundTo optimize palliation in incurable locally advanced non-small cell lung cancer (NSCLC), the International Atomic Energy Agency conducted a prospective randomized study (NCT00864331) comparing protracted palliative radiotherapy (RT) course with chemotherapy (CHT) followed by short-course palliative RT. Methods and materialsTreatment-naive patients with histologically confirmed NSCLC, stage IIIA/IIIB, received either 39Gy in 13 fractions as RT alone (arm A, n=31) or 2–3 platinum-based CHT cycles followed by 10Gy in a single fraction or 16Gy in 2 fractions separated by one week (arm B, n=34). Primary outcome was overall survival. ResultsTreatment groups were balanced with respect to various variables. Median survival for all 65 patients was 8months, while median survival was 7.1 and 8.1months for the two arms, respectively (log-rank p=0.4 by study arm, and p=0.6 by Cox regression and stratified by country and sub-stage). One and three year survival rates for the two arms were 29%, and 9% and 41%, and 6%, respectively. There were no differences in any of the following endpoints: any failure, local failure, regional failure, contralateral thoracic failure, and distant failure between the two arms. High-grade (⩾3) toxicity was similar between the two arms. Symptoms, adverse events of any kind, KPS and body-mass index, were not different during treatment and during follow-up. There was no grade 5 toxicity. ConclusionsThis incomplete and underpowered trial only hinted similar outcome between the treatment arms. Therefore, combined CHT-RT can perhaps be considered, in limited resource setting, where access to RT remains inadequate.

PP134: Case report of palliative radiotherapy for anaplastic carcinoma of ectopic thyroid tissue

Purpose Ectopic thyroid tissue is found in 7% of the adult population. The most common site of growth is along the course of thyroglossal duct or around the two lobes of the gland. Other sites of possible growth are the larynx, trachea, esophagus, mediastinum, pericardium or the diaphragm. Most reports deal with papillary carcinoma of ectopic thyroid tissue. The first report of anaplastic carcinoma of ectopic thyroid tissue was in 1981 and concerned a tumor growing at a thyroglossal duct remnant. Materials and methods We present the case of a 70 year old man with a preexisting lesion of the right submandibular triangle with a progressive increase in size the last 6 months. The imaging studies revealed a tumor in close proximity to the salivary gland and few enlarged lymph nodes. The lesion was characterized as a mixed salivary gland tumor. After surgical excision the histologic report revealed a malignant tumor with necrosis, fibrosis and immunohistochemical characteristics of an anaplastic carcinoma of ectopic thyroid tissue. After 3 cycles of chemotherapy (CDDP/Paclitaxel) the patient had local tumor progression and was referred for radiation therapy. The patient was offered a short course of palliative radiotherapy due to metastatic lung lesions. He was treated with hypofractionated radiation therapy to a total dose of 39 Gy in 13 fractions. Results At the end of radiotherapy course the patient had a remarkable clinical and radiological response with a significant decrease of preexisting dyspnea. However, one month later the patient was diagnosed with multiple brain metastasis and was offered a short course of whole brain radiotherapy. Conclusion Short-course palliative radiotherapy is effective in controlling obstructive symptoms of patients with anaplastic thyroid carcinoma.

Short-course palliative radiotherapy for uterine cervical cancer

PurposeThe purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer.Materials and MethodsSeventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions.ResultsThe median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity.ConclusionShort-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.

Palliative prostate radiotherapy for symptomatic advanced prostate cancer

Background and purpose To report the results for the use of short-course palliative radiotherapy to the prostate for localised symptoms. Materials and methods Fifty-eight patients were identified from radiotherapy records between 2003 and 2007. Data were collected retrospectively on patients’ demographics, radiotherapy details and response. Symptoms and toxicity were scored, retrospectively, according to the following scale: 0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms, and 3 = severe symptoms. Results All the 58 patients had advanced prostate carcinoma. The median age at radiotherapy was 76.6 years (range 54–91). Fifty-six patients (97%) had hormone refractory disease. Twenty-seven patients (47%) had evidence of metastatic disease. 20Gy in 5 fractions was the most commonly used fractionation. The most frequent baseline symptom was haematuria (54%). Eighty-nine percent (31/35) of the patients had a complete or partial resolution of symptoms at 4 months. Response rates for individual symptoms (including unknown responses) were: rectal symptoms (75%), pelvic pain (69%), urinary obstruction (54%) and haematuria (42%). A >50% reduction in PSA occurred in five patients. Toxicity was mild to moderate only and was self-limiting. Conclusion Palliative radiotherapy to the prostate gland for local symptoms appears to be an effective means of palliation with minimal toxic side effects. Prospective studies are now required to assess its benefits in more detail.

The Emerging Role of IG-IMRT for Palliative Radiotherapy: A Single-Institution Experience

Many modern radiotherapy centers now have image-guided intensity-modulated radiotherapy (IG-IMRT) tools available for clinical use, and the technique offers many options for patients requiring palliative radiotherapy. We describe a single-institution experience with IG-IMRT for short-course palliative radiotherapy, highlighting the unique situations in which the technique can be most effectively used.

Short-course palliative radiotherapy for airway stenosis in non-small cell lung cancer.

The majority of patients with non-small cell lung cancer have inoperable disease that is already too advanced for radical treatment at the initial diagnosis. But patients who suffer from symptoms caused by intrathoracic tumor often require palliative treatment to relieve the symptoms. We investigated, retrospectively, the outcome of short-course palliative radiotherapy for airway stenosis in non-small cell lung cancer. Between October 1997 and June 2001, 24 patients were treated by palliative radiotherapy to relieve airway stenosis caused by intrathoracic tumor. The short-course radiotherapy consisted of a total dose of 30 Gy given in ten fractions over 2 weeks. The effect of treatment was assessed by improvement of radiographic findings. The duration of palliation and this duration as a percentage of the remaining survival time were also investigated. Palliation of airway stenosis was achieved in 13 (54.2%) patients. The time until palliation was achieved ranged from 11 to 44 days (median, 24 days). The duration of palliation ranged from 44 to 351 days (median, 116 days). In the palliated patients, the median survival time was 192 days, while that of the non-responders was 43 days. The duration of palliation as a percentage of the remaining lifetime ranged from 41% to 96% (median, 66%). Short-course palliative radiotherapy of 30 Gy in ten fractions over 2 weeks achieved good palliation without severe acute toxicities in over half of the patients. It is suggested that, in the palliated patient, the airway can be, potentially, maintained over the long term.