{"entity":{"id":"palliative-radiotherapy","kind":"technology","name":"Palliative radiotherapy","aka":[],"tldr":"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.","status":"standard-of-care","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Radiation_therapy","links":[{"label":"ASTRO bone metastases guideline 2017","url":"https://doi.org/10.1016/j.prro.2016.08.001"},{"label":"SCORAD III (JAMA 2019)","url":"https://doi.org/10.1001/jama.2019.17913"},{"label":"NICE NG122: lung cancer, palliative interventions and supportive and palliative care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"}],"tags":["gap-fill","supportive"],"related":[],"cancers":["prostate","breast-hr-positive","nsclc","multiple-myeloma","lung-cancer","sclc"],"sections":["radiation","supportive-care"],"technologies":["sbrt","imrt-igrt","pain-management"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-hoskin-jama","paper-lutz-pract-radiat-oncol"],"journals":[],"dependsOn":[],"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."],"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.","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"],"since":1900},"route":"/technologies/palliative-radiotherapy/","neighbours":{"cancer":[{"id":"anaplastic-thyroid-cancer","kind":"cancer","name":"Anaplastic thyroid cancer","route":"/cancers/anaplastic-thyroid-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"follicular-thyroid-cancer","kind":"cancer","name":"Follicular thyroid cancer","route":"/cancers/follicular-thyroid-cancer/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","route":"/cancers/metastatic-cancer/"},{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"mycosis-fungoides","kind":"cancer","name":"Mycosis fungoides","route":"/cancers/mycosis-fungoides/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"ocular-adnexal-malt-lymphoma","kind":"cancer","name":"Ocular adnexal MALT lymphoma","route":"/cancers/ocular-adnexal-malt-lymphoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"primary-cutaneous-anaplastic-large-cell-lymphoma","kind":"cancer","name":"Primary cutaneous anaplastic large cell lymphoma","route":"/cancers/primary-cutaneous-anaplastic-large-cell-lymphoma/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"recurrent-metastatic-hnscc","kind":"cancer","name":"Recurrent or metastatic head and neck squamous cell carcinoma","route":"/cancers/recurrent-metastatic-hnscc/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"bone-modifying-agents","kind":"technology","name":"Bone-modifying agents (bisphosphonates, denosumab)","route":"/technologies/bone-modifying-agents/"},{"id":"pain-management","kind":"technology","name":"Cancer pain management","route":"/technologies/pain-management/"},{"id":"hyperbaric-oxygen-radiation-injury","kind":"technology","name":"Hyperbaric oxygen for late radiation injury","route":"/technologies/hyperbaric-oxygen-radiation-injury/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"radiotherapy-access-gap","kind":"technology","name":"Radiotherapy access and the global machine gap","route":"/technologies/radiotherapy-access-gap/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"paper":[{"id":"paper-hoskin-jama","kind":"paper","name":"Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer: The SCORAD Randomized Clinical Trial","route":"/key-papers/paper-hoskin-jama/"},{"id":"paper-lutz-pract-radiat-oncol","kind":"paper","name":"Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline","route":"/key-papers/paper-lutz-pract-radiat-oncol/"}],"term":[{"id":"bone-metastases","kind":"term","name":"Bone metastases and skeletal-related events","route":"/terms/bone-metastases/"},{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"},{"id":"pain-with-biliary-cancer","kind":"term","name":"Pain with gallbladder and bile duct cancer","route":"/terms/pain-with-biliary-cancer/"},{"id":"colorectal-palliation-obstruction-pain","kind":"term","name":"Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain","route":"/terms/colorectal-palliation-obstruction-pain/"},{"id":"lung-palliation-breathlessness-effusion-obstruction","kind":"term","name":"Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain","route":"/terms/lung-palliation-breathlessness-effusion-obstruction/"},{"id":"palliative-treatment","kind":"term","name":"Palliative","route":"/terms/palliative-treatment/"},{"id":"lymphoma-tx-radiotherapy","kind":"term","name":"Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy","route":"/terms/lymphoma-tx-radiotherapy/"},{"id":"lymphoma-tx-skin-directed-therapy","kind":"term","name":"Skin-directed therapy in mycosis fungoides: creams, light and small radiotherapy fields","route":"/terms/lymphoma-tx-skin-directed-therapy/"}],"trial":[{"id":"dutch-bone-metastasis-study","kind":"trial","name":"Dutch Bone Metastasis Study","route":"/trials/dutch-bone-metastasis-study/"},{"id":"fort","kind":"trial","name":"FoRT","route":"/trials/fort/"},{"id":"jrosg-99-1","kind":"trial","name":"JROSG 99-1 (Aoyama): stereotactic radiosurgery with or without whole-brain radiotherapy","route":"/trials/jrosg-99-1/"},{"id":"quartz","kind":"trial","name":"QUARTZ","route":"/trials/quartz/"}],"roadmap":[{"id":"global-access-roadmap","kind":"roadmap","name":"Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation","route":"/roadmaps/global-access-roadmap/"},{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"}]}}