Future directions in palliative thoracic radiotherapy

Recent systematic review, practice guidelines, and consensus statements have summarized the known clinical trial information with regards to the appropriate use of external-beam radiation, brachytherapy, and concurrent chemotherapy (with external-beam radiotherapy) in the palliation of chest symptoms with thoracic radiotherapy. The purpose of this review is to describe our present knowledge with regards to palliative thoracic radiotherapeutic maneuvers and to identify potential areas for future research inquiry consistent with current knowledge gaps.

Two systematic reviews, one practice guideline, and one consensus statement based on published prospective clinical trials have demonstrated that palliative thoracic radiotherapy is an effective modality both in terms of symptom palliation and other important cancer outcomes. Evolving areas for future scientific inquiry include the role of advanced technologies such as intensity-modulated radiation therapy and image-guided radiation therapy, economic analyses as well as the creation of a common palliative endpoint that can be used for future clinical trials.

Robust clinical trial information and high-level knowledge-translation documents currently exist to guide radiotherapy practitioners to provide standard-of-care treatment for thoracic palliative scenarios.