Abstract
Pain is a frequent and serious symptom of cancer and should be treated with comprehensive supportive and palliative care in cancer patients. The decisions about treatment modalities should be set in the multidisciplinary team.
Radiotherapy is an effective method in various indications in the treatment of both, cancer pain and non-cancer pain. In the field of non-cancer indications, these include radiosurgical procedures for functional pain syndromes or the application of X-ray therapy in painful degenerative diseases of joints and tendons.
Within the advanced oncological disease, several localities are commonly indicated to palliative radiotherapy because of the tumor infiltration: bones, lungs, brain, pelvis, lymph nodes areas, skin and subcutaneous tissue. Depending on the location, the metastatic lesion can cause, in addition to pain, other symptoms, which could be well-controlled by radiotherapy - thoracic or pelvic symptoms, symptoms in bone metastases.
In palliative radiotherapy, accelerated fractionation regimens of higher doses per fraction are often applied with the intention of rapid symptom relief with minimal side effects. In comparison of different fractionation regimens, the equivalence of the analgesic effect was confirmed.
Longer schemes (10 fractions) produce longer lasting effect with less need of re-irradiation and single irradiation is more comfortable for both patient and caregiver, but the analgesic effect may be shorter. A retrospective analysis of the effect and toxicity of palliative radiotherapy in our own groups of patients was performed: Overall, 91 patients received radiation therapy for bone metastases and pain relief was achieved in 72 (79,2%) cases.
Two groups of patients were irradiated for lung cancer with palliative intent (29 and 59 patients) and symptoms were well palliated in 22 (75,9%) and 38 (64,4%) patients respectively. Palliative radiotherapy is beneficial in the treatment of pain and other symptoms in patients with advanced cancer.
This method provided very good symptom control in our groups of patients, with minimal toxicity.