Clinical trials that will change practices: News in palliative radiotherapy

Palliative radiotherapy is used to alleviate cancer-related symptoms. Symptomatic responses to palliative radiotherapy may however take several weeks, meaning that patients need to survive long enough to derive a real benefit. Oncologists can be optimistic when estimating survival for patients with advanced cancer and as a consequence some patients receiving palliative radiotherapy die before experiencing any gain. Models of patient survival have limited accuracy, particularly for predicting whether patients will die within the next 30 days. Dedicated rapid access palliative radiotherapy clinics, in which patients are assessed, simulated and treated on the same day, reduce the number of patient visits to the radiation oncology department and hence the burden on the patient as well as costs. Teleconsultation and advanced practice nurses can play a crucial role in providing rapid access to palliative radiotherapy in a dedicated palliative radiotherapy service. Single-fraction palliative radiotherapy should be offered to eligible patients if they are able to attend treatment and could potentially benefit from symptom palliation, irrespective of predicted life expectancy. Technical and organizational innovations have been proposed in order to dispense with the computed tomography scanner by carrying out the dosimetry on a recent diagnostic scanner or a magnetic resonance imaging scanner with integrated linear acceleration system. Stereotactic body radiation therapy makes it possible to envisage greater and more lasting analgesic benefits in patients with painful bone metastasis and good prognosis. Flash radiotherapy remains at the preclinical stage.