Palliative Radiotherapy

• Indications
  • Bone pain that does not respond to pain medication (including opioids): at least partial palliation is achieved in about two thirds of patients and total relief on pain in about half. The onset of pain relief varies from a few days to four weeks, and palliation lasts on average 3 to 6 months; most patients benefit from repeated treatment.
  • Prevention of fractures of the weight-bearing bones. If the risk of fracture is already present (more than half of the cortex is destroyed or there is a larger than 2 to 3 cm lytic metastasis in the diaphysis), consult a surgeon first.
  • Treatment of spinal cord compression; Note: if the patient is developing paraparesis, tetraparesis, or the cauda equina syndrome (i.e., he/she has progressive neurological symptoms), radiotherapy (or surgical therapy) should be given as an emergency treatment. The neurological status of the patient at the time the therapy is started determines the outcome. Start the patient on steroids: see instructions below.
  • Managing pressure symptoms (e.g., brain metastases, brain tumour, nerve compression)
  • Haemorrhage: haemoptysis, haematuria
  • Treatment of skin metastases
  • Reducing obstructions (bronchus, vena cava superior, ureter)
• If pressure symptoms occur in the beginning of the treatment, or if they are to be expected during therapy, start the patient on a steroid (e.g., dexamethasone 3 to 10 mg x 1 to 3 p.o. or parenterally [some centres use doses up to 100 mg per day in medulla compression]) (Loblaw & Laperriere, 1998) [A].
• The aim of palliative radiotherapy is to relieve symptoms quickly with as few adverse effects as possible.
• On the average, palliative radiotherapy is administered in 1 to 10 fractions; at times, longer courses of radiotherapy are needed.