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Practice Clinical updates

Palliative radiotherapy

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k821 (Published 23 March 2018) Cite this as: BMJ 2018;360:k821
  1. Katie Spencer, MRC clinical fellow in clinical oncology1,
  2. Rhona Parrish, salaried general practitioner and hospice doctor2,
  3. Rachael Barton, consultant clinical oncologist3,
  4. Ann Henry, associate professor in clinical oncology1
  1. 1Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
  2. 2Garforth Medical Centre, Garforth, Leeds LS25 1HB, UK
  3. 3Queen’s Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham HU16 5JQ, UK
  1. Correspondence to: K Spencer katie.spencer1{at}nhs.net

What you need to know

  • Palliative radiotherapy offers effective symptom control for focal disease due to cancer

  • Increased analgesia, anti-emetics, and in some cases corticosteroids can help to reduce discomfort and side effects

  • Acute side effects of radiotherapy usually resolve within 4-6 weeks of completing treatment

  • Symptoms of cancer may deteriorate before improvement

  • For patients in the final weeks of life, the side effects and disruption of palliative radiotherapy may outweigh the benefits, and holistic palliative care may be more appropriate

Palliative radiotherapy offers a quick, inexpensive, and effective way of reducing many of the focal symptoms of advanced, incurable cancer, whether these arise from the primary tumour or from metastatic deposits. It can improve quality of life while being associated with limited treatment burden in terms of both hospital attendances and side effects.1 The average UK general practice oversees care for around 20 patients with terminal cancer each year with higher numbers seen in secondary care,23 while a Canadian survey of general practitioners found that 85% had provided care for patients with advanced cancer within the previous month.4 This article aims to update non-specialists on the benefits, practicalities, and side effects of palliative radiotherapy to ensure that patients are considered and referred for these treatments when appropriate.

Sources and selection criteria

In developing this article, we used multiple sources. For each of the sites treated, we carried out a search of the Cochrane database to identify systematic reviews. Search terms used included “palliative AND radiotherapy AND bone metastases,” “spinal cord compression AND radiotherapy,” and “palliative radiotherapy AND lung cancer.” Where no Cochrane reviews were identified, we used Medline searches to identify other relevant systematic reviews and individual studies. We also searched our existing collections of relevant references and consulted appropriate experts where relevant studies could not be identified. In all cases we used the …

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