Palliative Radiation Therapy: Utilization of Advanced Technologies. Volume 2


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

Series: Cancer Etiology, Diagnosis and Treatments
BISAC: MED062000

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: Head and Neck and CNS

Chapter 1 – Palliative Radiation Therapy in Head and Neck Cancer: Utilization of Advanced Technologies
(Daan Nevens, Sandra Nuyts, Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium)

Chapter 2 – Palliation of Central Nervous System Malignancies using Advanced Radiotherapeutic Technologies
(John Amanie, Samir Patel, Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada)

Chapter 3 – Palliation of Brain Metastases using Advanced Radiotherapeutic Technologies
(Luluel Khan, May Tsao, Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada)

Section 2: Thorax and Breast

Chapter 4 – Lung Cancer Reirradiation with Advanced Radiotherapeutic Technologies: Current Status
(C Suzanne Drodge, Olexander Boychak, Dr H Bliss Murphy Cancer Centre, St John’s, NL, Canada, UPMC Whitfield Cancer Centre, Ireland)

Chapter 5 – Palliation of Breast Malignancies Using Advanced Radiotherapeutic Technologies
(Fleur Huang, Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada)

Section 3: Abdominopelvic Disease

Chapter 6 – Advanced Radiotherapeutic Technologies for the Palliation of Gastrointestinal Malignancies
(Kristopher Dennis, Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada)

Chapter 7 – Gastrointestinal Side Effects of Palliative Radiation Therapy Delivered via Advanced Technologies
(Bhagirath Dholaria, Shyam Dang, Konstantinos Arnaoutakis, Matthew Hardee, Department of Hematology-Oncology, Mayo Clinic, FL, USA, Department of Gastroenterology-Hepatology, University of Arkansas for Medical Sciences, AR, USA, and others)

Chapter 8 – Utilization of Advanced Radiotherapeutic Technologies for Palliation of Liver Metastases: Applications, Outcomes, and Health Services Implications
(Anand Swaminath, Joel Broomfield, Gunita Mitera, Department of Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada, BC Cancer Agency, Abbotsford Centre, Abbotsford, BC, Canada, and others)

Chapter 9 – Palliation of Gynecological Malignancies using Advanced Radiotherapeutic Technologies
(Jennifer Croke, Eric Leung, Eve-Lyne Marchand, Kathy Han, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, and others)

Chapter 10 – Palliation of Urological Malignancies Using Advanced Radiotherapy Technologies
(David I Pryor, H Margot Lehman, Tanya R Holt, Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia, School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia, and others)

Section 4: Conclusion

Chapter 11 – Advanced Radiotherapy Technologies Near the End of Life in Patients with Advanced Cancer: When is it Worth it and when is it not?
(Joshua A Jones, Stephen T Lutz, Alysa Fairchild, University of Pennsylvania Health System, Philadelphia, PA, USA, Blanchard Valley Cancer Centre, Findlay, OH, USA, and others)


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