Article

Future directions in palliative thoracic radiotherapy.

Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Current opinion in supportive and palliative care 12/2011; 6(1):91-6. DOI:10.1097/SPC.0b013e32834de6bd
Source: PubMed

ABSTRACT Recent systematic review, practice guidelines, and consensus statements have summarized the known clinical trial information with regards to the appropriate use of external-beam radiation, brachytherapy, and concurrent chemotherapy (with external-beam radiotherapy) in the palliation of chest symptoms with thoracic radiotherapy. The purpose of this review is to describe our present knowledge with regards to palliative thoracic radiotherapeutic maneuvers and to identify potential areas for future research inquiry consistent with current knowledge gaps.
Two systematic reviews, one practice guideline, and one consensus statement based on published prospective clinical trials have demonstrated that palliative thoracic radiotherapy is an effective modality both in terms of symptom palliation and other important cancer outcomes. Evolving areas for future scientific inquiry include the role of advanced technologies such as intensity-modulated radiation therapy and image-guided radiation therapy, economic analyses as well as the creation of a common palliative endpoint that can be used for future clinical trials.
Robust clinical trial information and high-level knowledge-translation documents currently exist to guide radiotherapy practitioners to provide standard-of-care treatment for thoracic palliative scenarios.

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    ABSTRACT: Introduction Treatment of thoracic symptoms related to lung cancer with palliative radiotherapy is routinely performed in conjunction with radiation oncology practice. Various clinical trials, meta-analyses, practice guidelines, consensus statements, and Cochrane reviews have been conducted on different questions related to palliative thoracic radiotherapy considerations including: patient selection, external-beam radiotherapy dose fractionation, endobronchial brachytherapy, and chemotherapy. Discussion Novel radiotherapy technologies such as stereotactic ablative radiotherapy may allow new populations to benefit from radiotherapy. These new populations include: early stage lung cancer patients not fit for surgery that previously would be treated with best supportive care or palliative approaches and the treatment of oligometastatic lung metastases. Conclusion The goal of this narrative review is: (1) to review the foundations of what has already been established in palliative thoracic radiotherapy, with a focus on published clinical trials, (2) to review and discuss emerging data and trends in radiotherapeutic options for patients with advanced thoracic malignancies, with a focus on both clinical trials and other forms comparative-effectiveness research, and (3) to discuss active areas of research and future directions for research in this challenging patient population.
    Journal of Radiation Oncology. 1(3).