Estimating need for palliative external beam radiotherapy in adult cancer patients

Older surveys and benchmark data from different sources have suggested that 46-53% of all radiotherapy courses were administered with palliative intent. In Sweden, 87 annual palliative treatment courses per 100,000 inhabitants were registered in 2001, mainly for the treatment of bone and brain metastases (95% confidence interval [CI] 85-89). The corresponding number for Norway was 95 (95% CI 93-98) in 2004. New data are lacking, although new systemic treatment options might alter this number.

We collected prospective data on the use of palliative external beam radiotherapy for adult cancer patients during a 12-month period between 2007 and 2008. All patients (median age 69 years) were treated in one Norwegian county and had unlimited, rapid access to treatment. Efforts were made to account for potential overuse.

Most irradiated patients had skeletal target volumes, followed by nonbony thoracic targets and brain metastases. In the present population, 133 annual treatments per 100,000 inhabitants were registered (after correction for overuse, but not accounting for radiosurgery of brain metastases and emerging treatment options; e.g., stereotactic radiotherapy for lung and liver metastases; 95% CI 119-149). Because some patients received simultaneous treatment to different target volumes, the annual number of target volumes amounted to 175 per 100,000 inhabitants (95% CI 161-191).

The need for palliative radiotherapy has not decreased and might be greater than previously estimated. In regions with a significantly different cancer incidence, age structure, and other socioeconomic factors than northern Europe, separate analyses should be conducted.