Palliative Radiation Oncology and Oncologic Emergencies
What to know
Palliative RT indications (bone pain, brain metastases, bleeding, obstruction, cord compression) and oncologic emergencies (malignant spinal cord compression, SVC syndrome, hypercalcemia, tumor lysis, febrile neutropenia, superior vena cava obstruction).
Concepts to master
- Bone metastases: single 8 Gy vs multifraction (e.g., 30 Gy/10) - similar pain relief; single fraction convenient.
- Brain metastases: whole-brain RT vs SRS; consider number/size and performance status.
- MSCC: steroids + urgent RT or surgery; timing is critical.
- SVC syndrome: RT ± stent; treat urgently.
Traps
- Delaying steroids in suspected MSCC while awaiting imaging.
- Assuming single-fraction is inferior for pain - evidence shows comparable palliation.
- Forgetting performance status drives palliative fractionation choice.
Rule of thumb
Palliative intent = symptom relief with minimal burden. For uncomplicated bone pain, single 8 Gy is reasonable; for MSCC, dexamethasone immediately, then imaging and definitive management.
Worked example
A patient with known prostate cancer presents with back pain, leg weakness, and urinary retention. Suspect MSCC → give dexamethasone, obtain urgent MRI, and arrange RT/surgery - do not wait for routine imaging.