Radiotherapy in symptom management

Radiotherapy has a major role in symptom control and over 40% of all radiation treatments are given with palliative intent. In the palliative setting, radiotherapy will usually be delivered using high-energy external beam treatment from a linear accelerator. Bone metastases may be treated with intravenous systemic radioisotopes and dysphagia with endoluminal brachytherapy. A general principle of palliative radiotherapy is that it should be delivered in as few treatment visits as possible and be associated with minimal acute toxicity. The main indications for palliative radiotherapy are in the management of symptoms due to local tumour growth and infiltration. These include pain from bone metastases, visceral pain from soft tissue metastases, and neuropathic pain from spinal, pelvic, and axillary tumour. Local pressure symptoms are particularly onerous and potentially dangerous when they affect the nervous system; thus, spinal canal compression remains one of the few true emergency situations in which radiotherapy is indicated. Similarly, brain, meningeal, or skull base metastases require urgent assessment and can be helped with local radiotherapy. Obstruction of a hollow tube or drainage channels can lead to significant symptoms and again local radiotherapy can be valuable in addressing this scenario. Such indications would include dysphagia, bronchial obstruction, leg or arm oedema, vena cava obstruction, or hydrocephalus. Finally, haemorrhage can be distressing if rarely life-threatening. Local radiotherapy to bleeding tumours in the lung, bronchus, bowel, genitourinary tract, and skin is very effective at control of bleeding.