. 2020 Apr 8;5(4):589–594. doi: 10.1016/j.adro.2020.04.001

Table 2.

Hypofractionated palliative regimens

Indication	Treatment	References
Brain metastases requiring whole brain RT	4 Gy × 5 daily fractions steroids alone	Rades et al²⁴: 20 Gy/5 fx well tolerated QUARTZ²⁶: Steroids alone for patients with poor performance status
Cord compression	8 Gy × 1 daily fraction	Maranzano et al, SCORAD III, ICORG 05-0330, 31, 32, 33: Similar effect on OS and post-RT motor functions. Retreatment is safe.
Tumor bleeding	3.7 Gy × 4 twice daily fractions 4 Gy × 5 daily fractions	RTOG 8502, RTOG 7905³⁴^,³⁵^,⁴³: “Quad Shot” is safe and effective. Avoid bid fractionation for COVID + patients.
SVC syndrome airway obstruction	8.5 Gy × 2 weekly fractions 4 Gy × 5 daily fractions	Sundstrom et al³⁶^,³⁷: Equivalent symptom relief and no difference in survival compared with standard fractionation Exercise caution with COVID + patients
Bone metastases	8 Gy × 1 daily fraction	RTOG 9714¹³^,38, 39, 40: 8 Gy × 1 similar efficacy in pain relief with less acute toxicity. Retreatment is safe.

Abbreviations: COVID = coronavirus disease; ICORG = Cancer Trials Ireland (formerly All Ireland Cooperative Oncology Research Group); OS = overall survival; RT = radiation therapy; QUARTZ = Quality of Life after Treatment for Brain Metastases; RTOG = Radiation Therapy Oncology Group; SCORAD = Single-fraction Radiotherapy Compared to Multifraction Radiotherapy; SVC = superior vena cava.