Palliative Radiation Therapy: Utilization of Advanced Technologies. Volume 1


Alysa M. Fairchild (Editor)
Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada

Series: Cancer Etiology, Diagnosis and Treatments
BISAC: MED062000, ANT054000

As the definition of palliative-intent radiation therapy (RT) continues to evolve, the application of advanced radiotherapeutic technologies, such as intensity-modulated RT, and techniques, such as image-guidance, are no longer the provision solely of the curative realm. Treatment options previously considered strictly palliative are expanding, with conventional RT being delivered in conjunction with other modalities such as highly conformal radiation, surgery or systemic therapy, or being bypassed entirely. Additionally, as the median survival rate for many primary cancer histologies improve, more and more patients are outliving the palliative benefit of their first course of RT, making reirradiation a commonly encountered scenario.

Many factors should be taken into account when making RT treatment decisions, including those incorporating advanced technologies, such as individualized considerations of symptom burden, extent of disease, life expectancy, performance status, comorbidities, toxicity, prior treatment, and patient wishes. However, while palliative RT should be appropriately customized for each patient, it should also have a convincing evidence base. To date, research investigating the optimal use of palliative RT has been strikingly underrepresented, especially considering it comprises up to 50% of a department’s workload.

This book reviews state of the art in palliative radiation therapy across all disease sites, discussing available evidence supporting the use of advanced technologies and related clinical and dosimetric outcomes. Areas in which practice diverges from available evidence, as well as those in which no supporting evidence exists, are described. Many chapters include a historical overview highlighting lessons learned from past experience and techniques. Additionally, where specific palliative literature does not exist, generalizable excerpts from the curative setting are examined as well. Also, key practice points pertinent to management approaches and decisions, treatment planning and other clinical pearls are summarized by more than 60 international experts from three continents, often incorporating a multinational and/or multi-institutional perspective. A foundational chapter reviewing these technologies is complimented by sections on their use in each primary cancer site, along with chapters focusing on emerging techniques such as stereotactic radiation, clinical settings such as oligometastases, and patient-reported outcomes including quality of life and toxicity. Clinical trial methodology applicable to palliative RT, prognostication, health services research, and the interface of radiation oncology with palliative care in the 21st century are highlighted. Finally, a concluding chapter provides an overview of clinical contexts in which conventional radiation therapy or best supportive care may be favoured. (Imprint: Nova Biomedical)

Table of Contents

Table of Contents


Section 1 – Clinical Applications of Advanced Technologies

Chapter 1 – Palliative Radiotherapy Delivery Technologies
(Akos Gulyban, Marc Mackenzie, Michel Mathot, N Barthelemy, F Lakosi, Department of Radiation Therapy, Liege University Hospital, Liege, Belgium, Department of Medical Physics, Community Oncology, Alberta Health Services, Edmonton, AB, Canada)

Chapter 2 – The Treatment of Extracranial Oligometastases with Advanced Therapeutic Technologies
(Shaakir Hasan, Christian Okoye, Ravi Patel, Tithi Biswas, Min Yao, Rodney J Ellis, Mitchell Machtay, Simon S Lo, Nova Southeastern University College of Osteopathic Medicine Fort Lauderale, FL, USA, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA)

Chapter 3 – Use of Advanced Technologies in Dedicated Palliative Radiotherapy Clinics
(Kristopher Dennis, Kelly Linden, Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada, Radiation Medicine Program, The Ottawa Hospital, Ottawa, ON, Canada)

Section 2 – Special Topics in Palliative Radiotherapy

Chapter 4 – The Interface of Radiation Oncology and Palliative Care in the 21st Century
(Amanda Brisebois, Sarah Burton-Macleod, Ana Hermosa Garcia, Yoko Tarumi, Sharon Watanabe, University of Alberta Hospital and Grey Nuns Community Hospital, Alberta Health Services, Edmonton, AB, Canada, Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada, and others)

Chapter 5 – Life Expectancy and its Role in Palliative Radiotherapy Fractionation
(Candice Johnstone, Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA)

Chapter 6 – Methodological Issues and Challenges in Performing Clinical Trials in Palliative Radiotherapy
(Jackson Wu, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada)
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Chapter 7 – Quality Assurance for Clinical Trials of Palliative Radiotherapy Incorporating Advanced Radiotherapeutic Technologies
(Melissa Christiaens, Christos Melidis, Coen Hurkmans, Damien Weber, EORTC Headquarters, Brussels, Belgium, RTQA Office, EORTC Headquarters, Brussels, Belgium, and others)

Chapter 8 – The Impact of Health Policy on the use of Advanced Technologies for Palliative Radiotherapy
(Nora Janjan, National Centre for Policy Analysis, Dallas, TX, USA)

Section 3: Bone & Skin

Chapter 9 – Palliation of Bone Metastases using Advanced Radiotherapeutic Technologies
(Erin Wong, Simon S Lo, Danielle Rodin, Edward Chow, Hany Soliman, Karen P. Chu, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, US, and Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada)

Chapter 10 – Stereotactic Radiation for Spinal Metastases
(Rachit Kumar, Sara R Alcorn, Arjun Sahgal, Kristin J Redmond, Banner MD Anderson Cancer Center, Division of Radiation Oncology, Gilbert, AZ, USA, and others)

Chapter 11 – Quality of Life in Radiation Treatment of Bone Metastases
(Paul Cheon, Marko Popovic, Hany Soliman, Gillian Bedard, Liang Zeng, Erin Wong, Andrew Bottomley, Edward Chow, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, and European Organization for Research and Treatment of Cancer, Brussels, Belgium)

Chapter 12 – Palliation of Skin Malignancies using Advanced Radiotherapeutic Technologies
(Elizabeth A Barnes, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada)


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