Palliative radiotherapy at the end of life: A critical review

Ca-A Cancer Journal for Clinicians - Tập 64 Số 5 - Trang 295-310 - 2014
Joshua Jones1, Stephen Lutz2, Edward Chow3, Peter A.S. Johnstone4
1Assistant Professor, Department of Radiation Oncology Hospital of the University of Pennsylvania Philadelphia PA
2Medical Director, Department of Radiation Oncology Blanchard Valley Regional Cancer Center Findlay OH
3Professor, Department of Radiation Oncology University of Toronto Toronto Ontario Canada
4Professor, Department of Radiation Oncology University of Indiana Indianapolis IN

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Abstract

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When delivered with palliative intent, radiotherapy can help to alleviate a multitude of symptoms related to advanced cancer. In general, time to symptom relief is measured in weeks to months after the completion of radiotherapy. Over the past several years, an increasing number of studies have explored rates of radiotherapy use in the final months of life and have found variable rates of radiotherapy use. The optimal rate is unclear, but would incorporate anticipated efficacy in patients whose survival allows it and minimize overuse among patients with expected short survival. Clinician prediction has been shown to overestimate the length of survival in repeated studies. Prognostic indices can provide assistance with estimations of survival length and may help to guide treatment decisions regarding palliative radiotherapy in patients with potentially short survival times. This review explores the recent studies of radiotherapy near the end of life, examines general prognostic models for patients with advanced cancer, describes specific clinical circumstances when radiotherapy may and may not be beneficial, and addresses open questions for future research to help clarify when palliative radiotherapy may be effective near the end of life. CA Cancer J Clin 2014;64:295–310. © 2014 American Cancer Society.

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Ca-A Cancer Journal for Clinicians

Tập 64 Số 5

295-310

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