# Palliative radiotherapy

Source: https://onco.cc/technologies/palliative-radiotherapy/  
OnCo record `palliative-radiotherapy` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Short courses of radiation, often a single treatment, to relieve pain from bone metastases, stop bleeding, open blocked airways or protect the spinal cord. Among the most cost-effective treatments in cancer.

## Summary

About 40% of radiotherapy courses are palliative. Trials established that a single 8 Gy fraction equals multi-fraction regimens for uncomplicated bone metastases (RTOG 9701, Dutch Bone Metastasis Study; ~60% pain response), that 8 Gy ×1 or 20 Gy ×5 suffices for spinal cord compression in poor-prognosis patients (SCORAD III, ICORG), and that whole-brain radiotherapy adds little for poor-performance NSCLC brain metastases (QUARTZ) while SRS replaces it for limited metastases. Other indications: haemostasis (bladder, gynaecologic, lung), airway and oesophageal obstruction, SVC syndrome, hepatic pain, skin fungation. Underuse of single fractions persists in fee-for-service systems; rapid-access palliative clinics shorten time to treatment.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Deliver a biologically sufficient dose for symptom control with minimum visits and toxicity, using simple techniques (parallel-opposed or 3D) or SBRT where oligometastatic ablation is intended.
- Since: 1900
- Strengths: Single fraction as good as multiple for bone pain; Fast, cheap, widely available; Effective for bleeding, obstruction, cord compression
- Limitations: Underuse of single fractions and overuse of long courses; Pain flare in ~30%; Retreatment limits with prior high doses

## Notes

- Lung cancer: NICE NG122 (1.13.1) says to provide palliative radiotherapy, either as symptoms arise or immediately, for people who are eligible and cannot have curative treatment; (1.14.2) to offer external beam radiotherapy and/or endobronchial debulking or stenting to people with impending endobronchial obstruction; (1.15.7) for people who present with superior vena cava obstruction, to offer chemotherapy and radiotherapy based on the stage of disease and performance status; and (1.12.5) to offer radiotherapy for palliation of local symptoms in small-cell lung cancer that has relapsed.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Radiation_therapy
- ASTRO bone metastases guideline 2017: https://doi.org/10.1016/j.prro.2016.08.001
- SCORAD III (JAMA 2019): https://doi.org/10.1001/jama.2019.17913
- NICE NG122: lung cancer, palliative interventions and supportive and palliative care: https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care

## Connected records

- cancers: [Anaplastic thyroid cancer](https://onco.cc/cancers/anaplastic-thyroid-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Follicular thyroid cancer](https://onco.cc/cancers/follicular-thyroid-cancer/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Metastatic cancer (cancer that has spread)](https://onco.cc/cancers/metastatic-cancer/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Mycosis fungoides](https://onco.cc/cancers/mycosis-fungoides/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Ocular adnexal MALT lymphoma](https://onco.cc/cancers/ocular-adnexal-malt-lymphoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Primary cutaneous anaplastic large cell lymphoma](https://onco.cc/cancers/primary-cutaneous-anaplastic-large-cell-lymphoma/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Recurrent or metastatic head and neck squamous cell carcinoma](https://onco.cc/cancers/recurrent-metastatic-hnscc/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Bone-modifying agents (bisphosphonates, denosumab)](https://onco.cc/technologies/bone-modifying-agents/), [Cancer pain management](https://onco.cc/technologies/pain-management/), [Hyperbaric oxygen for late radiation injury](https://onco.cc/technologies/hyperbaric-oxygen-radiation-injury/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Radiotherapy access and the global machine gap](https://onco.cc/technologies/radiotherapy-access-gap/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- key papers: [Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer: The SCORAD Randomized Clinical Trial](https://onco.cc/key-papers/paper-hoskin-jama/), [Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline](https://onco.cc/key-papers/paper-lutz-pract-radiat-oncol/)
- terms: [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Pain with gallbladder and bile duct cancer](https://onco.cc/terms/pain-with-biliary-cancer/), [Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain](https://onco.cc/terms/colorectal-palliation-obstruction-pain/), [Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain](https://onco.cc/terms/lung-palliation-breathlessness-effusion-obstruction/), [Palliative](https://onco.cc/terms/palliative-treatment/), [Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy](https://onco.cc/terms/lymphoma-tx-radiotherapy/), [Skin-directed therapy in mycosis fungoides: creams, light and small radiotherapy fields](https://onco.cc/terms/lymphoma-tx-skin-directed-therapy/)
- trials: [Dutch Bone Metastasis Study](https://onco.cc/trials/dutch-bone-metastasis-study/), [FoRT](https://onco.cc/trials/fort/), [JROSG 99-1 (Aoyama): stereotactic radiosurgery with or without whole-brain radiotherapy](https://onco.cc/trials/jrosg-99-1/), [QUARTZ](https://onco.cc/trials/quartz/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)

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