Shades of gray: a personal view of palliation by radiotherapy

Palliation is a significant part of the work of a radiation oncologist and yet is discussed infrequently. All too often it is considered simple when in many cases the contrary is the case. The philosophy of palliation is discussed and is defined as non-curative treatment. Further sub-division into symptom control, growth restraint/local control is helpful. The aim of palliation must be clearly defined if it is to be achieved, taking into account not only the lesion causing the problem but also many other factors including the patient's general condition, the clinical evolution of the tumour, previous treatment and social factors. The aim should be communicated to the patient and relatives. Doses for effective palliation vary from low to high and require different fractionation regimens. Examples are given from clinical practice with emphasis on difficult and controversial areas. There are as many diseases as patients and the need to individualise treatment is stressed.