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
re-irradiation a commonly encountered scenario. Many factors should
be taken into account when making RT treatment decisions, including
those incorporating advanced technologies, such as individualised
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 customised 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, generalisable 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 summarised by over 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.
General
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