Palliative Radiotherapy for End-of-Life Oncology Care

Authors

DOI:

https://doi.org/10.24950/Revisao/103/19/1/2020

Keywords:

Neoplasms/radiotherapy, Palliative Care, Radiation Oncology, Terminal Care

Abstract

Palliative radiotherapy can help to alleviate a multitude of symptoms related to advanced cancer. Time to symptom relief is measured in 24-48 hours or weeks to months after the completion of radiotherapy. The optimal rate of radiotherapy use in the final months of life is unclear; therefore, its use must be judicious. But would incorporate anticipated efficacy in patients whose survival allows it and minimize overuse among patients with expected short survival. Studies have shown that oncologists overestimate patient survival times of patients with advanced cancer and expose terminally ill patients to the burden of longer fractionated courses of radiotherapy with no further benefits. Prognostic indices can help with estimations of survival length and may assist to guide treatment decisions regarding palliative radiotherapy in patients with potentially short survival times. This review intends to highlight the advantages and role for palliative radiotherapy in end-of-life oncology care.

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References

Lopes AC, Martins JC. A Radioterapia Nos Cuidados Paliativos: perspectiva do radioterapeuta. [Tese de mestrado em Cuidados Paliativos- 6o curso]. Porto: Faculdade de Medicina da Universidade do Porto;2016.

Lutz S, Chow E. Palliative radiotherapy: past, present and future- where do we go from here? Ann Palliat Med. 2014;3:286-290. Doi: 10.3978/ j.issn 2224-5820.2014.10.04

Joshua A , Lutz ST, Chow E, Johnstone PA. Paliative Radiothepy at the End of Life: A Critical Review. CA Cancer J Clin. 2014;64:296-310. doi: 10.3322/caac.21242.

Hayman JA, Abrahamse PH, Lakhani I, Earle CC, Katz SJ. Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer. Int J Radiation Oncology Biol Phys. 2007;69:1001–7. doi: 10.1016/j.ijro- bp.2007.04.059.[PubMed][Cross Ref]

Huang J, Wai ES, Lau F, Blood PA. Palliative radiotherapy utilization for cancer patients at end of life in British Columbia: retrospective cohort study. BMC Palliative Care. 2014; 13:49. doi:10.1186/1472-684X-13-49.

Quintino VL. Avaliação da eficácia da radioterapia paliativa no controlo da dor em doentes com metástases ósseas. [Trabalho para a obtenção de título de especialista em radioterapia]. Lisboa: Instituto Politécnico de Lisboa; 2015.

Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P,et al. Palliative ra- diotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiation Oncol Biol Phys. 2011; 79:965–76. doi:10.1016/j.ijro- bp.2010.11.026.

Fine P. Palliative radiation therapy in end-of-life care: evidence-based utilization. Am J Hosp Palliative Med. 2002;19:166– 70. doi: 10.1177/104990910201900307.

Roa W, Brasher PM, Bauman G, Anthes M, Bruera E, Chan A, et al. Abbreviated course of radiation therapy in older patients with glio- blastoma multiforme: A prospective randomized clinical trial J Clin Oncol.2004;22:1583–88.

Chen AM, Vaughan A, Narayan S, Vijayakumar S. Palliative radiotion therapy for head and neck cancer:Towards an optimal fractionation scheme. Head Neck. 2008; 30:1586-91. doi: 10.1002/hed.20894.

Bedwinek JM, Lee J, Fineberg B, Ocwieza M. Prognostic indicatiors in patients with isolated local-regional recurrence of breast cancer. Cancer. 1981; 47:2232-5

Rodrigues G, Videtic GM, Sur R, Bezjak A, Bradley J, Hahn CA, et al. Palliative thoracic radiotherapyin lung cancer: An American Society for Ra- diation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol. 2011;1:60-71.doi:10.1016/j.prro.2011.01.005.

Fairchild A, Harris K, Barnes E, Wong R, Lutz S, Bezjak A, et al. Palliative thoracic radiotherapy for lung cancer. A systematic review. J Clin Oncol. 2008; 26:4001-11. doi: 10.1200/JCO.2007.15.3312.

Javle M, Ailawadhi S, Yang GY, Nwogu CE, Schiff MD, Nava HR. Palliation of malignant dysphagia in esophageal cancer: A literature-based review. J Supot Oncol. 2006; 365-73

Kim MM, Rana V, Janjan NA, Das P, Phan AT, Delclos ME, et al. Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncol. 2008;47.421-7.

Mosconi C, Renzulli M, Giampalma E, Galuppi A, Balacchi C, Brandi G, et al. Unresectable perihilar cholangiocarcinoma: Multimodal palliative treatment. Anticancer Res. 2013;33:2747-53.

Janjan NA, Breslin T, Lenzi R, Rich TA, Skibber J. Avoidance of colostomy placement in advanced colorectal cancer with twice weekly hypofractionated radiation plus continuous infusion 5-fluorouracil. J Pain Symptom Manage. 2000; 20:266-72.

Duchesne GM, Bolger JJ, Griffiths GO, Trevor Roberts J, Graham JD, Hoskin PJ, et al. A randomized trial of hypofractionated schedules of palliative radiotherapy in the management of bladder carcinoma: Results of medical research council trial BA09. Int J Radiat Oncol Biol Phys. 2000; 47:379-88.

Mishra SK, Laskar S, Muckaden MA, Mohindra P, Shrivastava SK, Dinshaw KA.Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix. J Cancer Res Ther. 2005; 1:208-12

Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, et al. Palliative radiotherapy for bone metastases: An ASTRO evidence-based guideline. Int J Radiat Oncol BioLPhys. 2011; 79:965-76. doi: 10.1016/j.ijro- bp.2010.11.026.

Chow E, Harris K, Fan G, Tsao M, Sze WM.Palliative radiotherapy trials for bone metastases: A systematic review. J Clin Oncol 2007; 25:1423-36.

Chow E, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JS, et al. Single versus multiple fractions of repeat radiation for painful bone metastases: A randomised, controlled, non-inferiority trial. Lancet Oncol. 2014; 15:164-71. doi: 10.1016/S1470-2045(13)70556-4.

van der Linden YM, Steenland E, van Houwelingen HC, Post WJ, Oei B, Marijnen CA, et al. Patients with a favourable prognosis are equally palliated with single and multiple fraction radiotherapy: Results on survival in the Dutch Bone Metastasis Study. Radiother Oncol. 2006; 78:245-53.

Byrne TN. Spinal cord compression from epidural metastases. N Engl J Med. 1992; 327:614-9.

Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG. et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: A randomised controlled trial. Lancet Oncol. 2009; 10:1037-44. doi: 10.1016/S1470-2045(09)70263-3.

Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG, et al. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brainradiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resec- tion or radiosurgery: Quality-of-life results. J Clin Oncol. 2013; 31:65-72. doi: 10.1200/JCO.2011.41.0639.

Langley RE, Stephens RJ, Nankivell M, Pugh C, Moore B, Navani N, et al. Interim data from the Medical Research Council QUARTZ Trial: Does whole brain radiotherapy affect the survival and quality of life of patients with brain metastases from non-small cell lung cancer? Clin Oncol. 2013,25:e23-e30. doi: 10.1016/j.clon.2012.11.002.

Ashby M. The role of radiotherapy in palliative care. J Pain Symptom Ma- nage. 1991 6: 380-8.

Lutz S, Korytko T, Nguyen J, Khan L, Chow E, Corn B. Palliative radiotherapy: when is it worth it and when is it not? Cancer J. 2010;16:473-82. doi: 10.1097/PPO.0b013e3181f28b4d.

Chow E, Davis L, Panzarella T, Hayter C, Szumacher E, Loblaw A, et al. Accuracy of survival prediction by palliative radiation oncologists. Int J Ra- diat Oncol Biol Phys. 2005; 61: 870-3.

Spencer K, Morris E, Dugdale E, Newsham A, Sebag-montefiore D, Turner R, et al. 30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes. Radiother Oncol.

; 115: 264–71.

Lutz ST, Jones J, Chow E. Role of radiation therapy in palliative care of the patient with cancer. J Clin Oncol. 2014; 32: 2913-9. doi: 10.1200/JCO.2014.55.1143.

Kapadia NS, Mamet R, Zornosa C, Niland JC, DÂ ́Amico TA, Hayman JA. Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer. Cancer.2012;118:4339-45.

Guadagnolo BA, Liao KP, Elting L, Giordano S, Buchholz TA ,Shih YC. Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States. J Clin Oncol.2013;31:80-7.

National Quality Measures Clearinghouse .External Beam Radiotherapy for Bone Metastases. [Accessed April 2,2014] Available from: http://www. qualitymeasures.ahrq.gov/content.aspx?id=47285.

Murphy JD, Nelson LM, Chang DT, Mell LK, Le QT. Patterns of care in palliative radiotherapy: a population-based study. J Oncol Pract.2013; 9:e220-e227.

Yeung H. Palliative Radiation Before Hospice: the Long and the Short of It. Presented at: American Academy of Hospice and Palliative Medicine Annual Assembly; March 12-15,2014; San Diego, CA.

Lavergne MR, Johnston GM, Gao J, Dummer TJ, Rheaume DE. Variation in the use of palliative radiotherapy at end of life: examining demographic, clinical, health service, and geographic factors in a population-based study. Palliat Med.2011; 25:101-10.

Gripp S, Moeller S, Boelke E, Schmitt G, Matuschek C, Asgari S, et al. Survival prediction in terminally ill cancer patients by clinical estimates, la- boratory tests, and self-rated anxiety and depression. J Clin Oncol.2007; 25:3313-20.

Gripp S, Mjartan S, Boelke E, Willers R. Palliative radiotherapy tailored to life expectancy in end-stage cancer patients: reality or myth? Can- cer.2010; 116:3251-6.

Berger B, Ankele H, Bamberg M, Zips D.Patients who die during palliative radiotherapy: status survey. Strahlenther Onkol. 2014;190:217-20.

AndersonF, Dowing GM, Hill J. Palliative Performance Scale (PPS): a new tool. J Palliat Care. 1996; 12:5-11.

Morita T, Tsunoda J, Inoue S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer. 1999; 7: 128-33.

Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, et al . A new Palliative Prognostic Score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage. 1999; 17: 231-9.

Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recomendations - a study by the steering committee of the European Associations for Palliative Care. J Clin Oncol 2005; 23: 6240-8.

Krishnan M, Temel JS, Wright AA, Bernacki R, Selvaggi K, Balboni T. Predicting life expectancy in patients with advanced incurable cancer. J Support Oncol. 2013; 11: 68-74

Chow E, Davis L, Panzarella T, Hayter C, Szumacher E, Loblaw A, et al. Accuracy of survival prediction by palliative radiation oncologists. Int J Radiat Oncol Biol Phys. 2005; 61 870-3.

Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, et al. A validation of a predictive model for survival in metastatic cancer patients attending na outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys. 2009 ̧73: 280-7. doi: 10.1016/j.ijrobp.2008.03.019.

Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, et al. Preditive model for survival in patients with advanced cancer. J Clin Oncol.2008; 26:5863-9. doi: 10.1200/JCO.2008.17.

Krishnan MS, Epstein-Peterson Z, Chen YH, Tseng YD, Wright AA, Temel JS, et al. Predicting life expectancy in patients with metastatic cancerre- ceiving palliative radiotherapy: The TEACHH model. Cancer. 2014; 120: 134-41. doi: 10.1002/cncr.28408.

Tseng YD, Krishnan MS, Sullivan AJ, Jones JA, Chow E, Balboni TA. How radiatiaon oncologists evaluate and incorporate life expectancy estimates into the treatment of palliative cancer patients: A survey-based study. Int J Radiant Oncol Biol Phys. 2013; 87:471-8. doi: 10.1016/j.ijro- bp.2013.06.2046.

Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assess- ment of palliative care patients. J Palliat Care. 1991;7:6-9.

Lutz S, Spencer C, Chow E, Janjan N, Connor S. Survey on use of radio- therapy in hospice care. J Clin Oncol. 2004; 22: 3581-6.

Published

2021-12-08

How to Cite

1.
Martins O, Azevedo I. Palliative Radiotherapy for End-of-Life Oncology Care. RPMI [Internet]. 2021 Dec. 8 [cited 2024 Nov. 23];27(1):49-54. Available from: https://revista.spmi.pt/index.php/rpmi/article/view/187

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Section

Review Articles