Radiation Oncology/Palliation/Palliation Overview

General review

• Hoegler - PMID 9202888 — "Radiotherapy for palliation of symptoms in incurable cancer." Hoegler D. Curr Probl Cancer. 1997 May-Jun;21(3):129-83.
  • Nice abstract. Discusses hemi-body radiotherapy.

Palliative Prognostic (PaP) Score

• Best validated and most widely used predictive scoring system
• Endorsed by European Association for Palliative Care

• Milan; 1999 (Italy) PMID 10203875 -- "A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care." (Pirovano M, J Pain Symptom Manage. 1999 Apr;17(4):231-9.)
  • Model developed for survival in terminally ill cancer patients
  • Variables (total tally)
    • Dyspnea: no (0) vs yes (1)
    • Anorexia: no (0) vs yes (1.5)
    • KPS: >=30 (0) vs. 10-20 (2.5)
    • CPS (clinical prediction of survival, in weeks): 11-12 (2.0) vs. 7-10 (2.5) vs. 5-6 (4.5) vs 3-4 (6.0) vs. 1-2 (8.5)
    • WBC: <8.5K (0) vs. 8.5-11K (0.5) vs. >11K (1.5)
    • Lymphocyte percentage: 20-40% (0) vs. 12-20% (1.0) vs. <12% (2.5)
  • Risk groups (30-day survival probability):
    • Score 0-5.5: >70%
    • Score 5.6-11: 30-70%
    • Score 11-17.5: <30%

Hemibody Irradiation

• RTOG 8206 -- Local RT + hemibody RT vs Local RT + observation
  • Randomized. 499 patients with painful body metastases, treated with standard palliative RT 30/10 to symptomatic site, then Arm 1) hemibody irradiation 8/1 (local site shielded, lungs max 7 Gy) vs Arm 2) no further treatment
  • 1992 PMID 1374061 -- "A report of RTOG 8206: a phase III study of whether the addition of single dose hemibody irradiation to standard fractionated local field irradiation is more effective than local field irradiation alone in the treatment of symptomatic osseous metastases." (Poulter CA, Int J Radiat Oncol Biol Phys. 1992;23(1):207-14.)
    • Outcome: 1-year retreatment rate HBI 60% vs OBS 76%; 1-year disease progression HBI 35% vs OBS 46%
    • Toxicity: 5-15%
    • Conclusion: Hemibody irradiation can treat systemic and occult mets

• RTOG 78-10; 1981 (1978-1980) PMID 6169699 -- "Single-dose half-body irradiation for the palliation of multiple bone metastases from solid tumors: a preliminary report." (Salazar OM, Int J Radiat Oncol Biol Phys. 1981 Jun;7(6):773-81.)
  • Prospective, dose-escalation. 91 patients (mostly breast, prostate, lung), significant cancer pain. Treated with upper hemibody irradiation (UHBI: above head to bottom of L4), midbody irradiation (MBI: top of diaphgram to bottom of obturator foramina), or lower hemibody irradiation (bottom of L4 to mid-ankles). Doses UHBI 6/1 -> 7/1 -> 8/1, and MBI/LHBI 8/1 -> 9/1 -> 10/1. Dose-rate 15-45 rad/min. Protection for eyes, mouth, parotids and lungs.
  • Outcome: Pain relief 77% (complete 21%); within 48 hours in 50%
  • Toxicity: Grade 3-4 nausea/vomiting/diarrhea in 12%, minimal with 8/1 more significant with 10/1
  • Conclusion: 6/1 insufficient, 8/1 effective, no benefit for further increase. Results comparable to conventional 30/1