Table 3.
Palliative Radiotherapy Treatments where fractionation may be reduced.
| Cohort/Eligibility | Dose/fraction (Gy) | # fractions | Interval between fractions | Technique | Other | OS benefit vs Observation | Evidence level | Group/Trial | |
|---|---|---|---|---|---|---|---|---|---|
| Bone metastasis, no fracture, +/− cord compression | Palliation | 6–10 | 1 | N/A | 3D | Risk of pain flare 25% with single fraction plus dexamethasone. Meta-analysis of 25 RCTs show difference between symptom relief single vs multifraction RT. Large studies show no difference in pain flare with single fraction compared to multifraction | 1 – non-inferior | University of Toronto TROG 96.05, SCORAD III ICORG 05-03 [15], [18], [56], [57] | |
| Bone metastasis, fracture/surgery | 4 | 5 | Daily | 3D | 1 – non-inferior | ||||
| Brain metastasis | 1–3 mets, good KPS, no extracranial disease | 15–20 | 1 | N/A | SRS | ||||
| Palliation | 4 | 5 | Daily | 3D WBRT | A routine option in UK, UK, Europe, Asia, Canada, and Australia. Established in RTOG dose esclation studies | Generally no, but benefit in some groups in QUARTZ | 1 – not different | RTOG QUARTZ [19], [58] | |
| Palliation, poor prognosis | 6 | 2 | Daily | 3D | On subanalysis seemed reasonable for poor prognosis; good prognosis benefited from longer fractionation | Generally no, but benefit in some groups in QUARTZ | 1 – refer to abstract | Royal College of Radiologists [59] | |
| Esophageal bleeding/dysphagia | 3 | 4 | BID | 3D | Alternate = 5 Gy × 3 | Sharon Project [60] | |||
| 6 | 3 | Day 0, 7, 21 | 3D | Adapted from other sites | |||||
| GBM, poor KPS | Age ≥ 50, KPS 50–70, or age ≥ 65 KPS 50–100 | 5 | 5 | Daily | 3D, CTV was 2 cm margin as per EORTC | No Temozolamide | Yes but likely not curable Palliation benefit | 1 – noninferior | IAEA [61] |
| Head & Neck | Palliation | 6 | 5–6 | 2 fxs/week | None, palliation only | Prospective | HYPO trial [62] | ||
| Head & Neck | 6–8 | 3 | Day 0, 7, 21 | 3D/IMRT | [63] | ||||
| SCV Syndrome/Lung cancer | Palliation | 8–10 | 1 | N/A | 3D | 1 | IAEA [64], [65], [66] | ||
| 8.5 | 2 | 1 Week | 3D | 1 | MRC [67] | ||||
| Lymphoma, low grade | 4 | 1 | N/A | 3D | |||||
| Pelvic/GI bleeding | Palliation | 4 | 5–6 | Daily | 3D | Reasonable BED equivalent for tolerance = 5.5 Gy × 4 | |||
| 4.5 | 4 | BID | 3D | Phase II | SHARON trial [68] | ||||
| 3.7 | 4 | BID | 3D | Repeat q2-4 wks to total 44.4 Gy in 3 courses, QUAD SHOT | Phase II, III | RTOG 8502 [49], [69], [70] | |||
| 6–8 | 3 | Day 0, 7, 21 | 3D | Retrospective | [71] |