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February 24, 2022

Tumor Coverage vs Healthy Tissue Sparing—What Is the Balance When Palliation Is the Goal?

Author Affiliations
  • 1UNC/Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill
JAMA Oncol. 2022;8(4):569-570. doi:10.1001/jamaoncol.2021.7604

Symptom palliation is a fundamental indication for radiotherapy in patients with metastatic cancer. The goal of palliative radiation is to mitigate symptoms caused by tumor burden, while minimizing treatment-associated toxic effects. Palliative thoracic radiotherapy can alleviate a variety of symptoms in patients with metastatic non–small cell lung cancer (NSCLC) including chest pain, dyspnea, cough, hemoptysis, dysphagia, and superior vena cava syndrome. These symptoms are often caused by central tumors and/or bulky mediastinal adenopathy, and as a result, standard radiotherapy fields typically encompass a significant length of esophagus. The high dose per fraction typically used for palliative radiation (3-4 Gy per fraction) can produce improvement in tumor-related symptoms and survival, at the potential cost of increased toxic effects.1

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