Short course accelerated radiation therapy in palliative care

Palliative radiotherapy is a key resource for symptoms control and improvement patient's life expectancy in advanced stage of illness. The most common symptoms that afflict this type of patients are pain, bleeding, dysphagia, obstruction, vomiting, nausea. Most of these can benefit from a hypo-fractionated radiation treatment with a good percentage of complete responses, variable depending on the symptom considered, but on average 56-70%. Normally a hypo-fractionated treatment, excluding uncomplicated bone metastases where the single fraction (800 cGy in 1 fraction) is the standard, provides for 30 Gy delivered in 10 fractions (1 fraction / day) or 20 Gy in 5 fractions (1 fraction / day). SHARON Project (Short Course Accelerated Radiation Therapy), based on dose-escalation Phase I-II studies that defined the MDT (maximum tolerated dose), is made up of 7 randomized Phase III trials (1:1 on Simon's design) that aim to compare the effectiveness on the symptom control of a conventional hypo-fractionationated radiotherapy compared with an accelerated hypofractionationated treatment. 4 Specifically, the fractionation we propose provides the delivery of 4.5-5 Gy twice a day at a distance of 6-8 hours for two consecutive days. GTV will be identified by macroscopic lesion (detailed in the single protocol), CTV by GTV + a margin of 2 cm and the PTV from CTV + 1 cm of isotropic margin. There will be described the results of the Sharon-Bone Phase I-II trial, Sharon Head and Neck Phase I-II trial and Sharone Elderly (pooled analysis phase I-II trials) and the seven randomized Phase III trials for all the described body regions (Abdomen RT 15-01, Brain RT 15-02, Thorax RT 15-03, Pelvis RT 15-04, H&N RT 15-05, Bone RT 15-06, Esophagus RT 15-07

Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review

Palliative radiotherapy (PRT) is known to be effective in relieving cancer related symptoms. However, many studies and clinical practice show several barriers hindering its use and worsening the quality of patient support during PRT. Various solutions were proposed to overcome these barriers: training on PRT for supportive and palliative care specialists and training on palliative care for radiation oncologists, and introduction of pathways and organizational models specifically dedicated to PRT. Evidence on innovative organizational models and mutual training experiences is few and sparse. Therefore, the aim of this literature review is to present a quick summary of the information available on improving the PRT quality through training, new pathways, and innovative organizational models. The majority of studies on the integration of PRT with other palliative and supportive therapies present low levels of evidence being mostly retrospective analyses. However, it should be emphasized that all reports uniformly showed advantages coming from the integration of PRT with supportive therapies. To actively participate in the integration of PRT and palliative care, providing comprehensive support to the needs of patients with advanced cancer, radiation oncologists should not only plan PRT but also: (i) assess and manage symptoms and stress, (ii) rapidly refer patients to specialists in management of more complex symptoms, and (iii) participate in multidisciplinary palliative care teams. To this end, improved education in palliative care both in residency schools and during professional life through continuous medical education is clearly needed. In particular, effective training is needed for radiotherapy residents to enable them to provide patients with comprehensive palliative care. Therefore, formal teaching of adequate duration, interactive teaching methods, attendance in palliative care services, and education in advanced palliative care should be planned in post-graduated schools of radiotherapy

Short course accelerated radiation therapy (SHARON) in palliative treatment of advanced solid cancer in older patients: A pooled analysis

Objectives: To evaluate the efficacy and safety of a conformal Short Course Accelerated Radiation therapy (SHARON) for symptomatic palliation of locally advanced or metastatic cancers in older patients. Materials and Methods: This is a pooled analysis on patients aged \ue2\u89\ua5. 80 years selected between subjects enrolled in 3 phase I-II studies on a short course palliative treatment of advanced or metastatic cancer. The primary endpoint was to evaluate the symptoms response rate produced by accelerated radiotherapy delivered in 4 total fractions in twice a day. Total dose ranged between 14 Gy and 20 Gy while dose/fraction between 3.5 and 5 Gy. Results: A total of 48 patients were included in this analysis. Twenty-six patients (54.2%) had advanced primary or metastatic head and neck tumors, 11 (22.9%) locally advanced or metastatic thoracic cancers, 11 (22.9%) complicated bone metastases. The majority of patients presented pain (60.4%). With a median follow-up time of 5.5 months, no G4 acute and late toxicities were recorded. The overall palliative response rate was 91.7% with a median duration of palliation of 4 months. Conclusion: Short course accelerated radiotherapy in locally advanced or metastatic cancers is effective in terms of symptom relief and well tolerated even in older patients