Palliative Radiotherapy (XRT): Indications, Techniques, and Outcomes

Palliative Radiotherapy (XRT) uses ionizing radiation to relieve symptoms from incurable cancer—not to cure. Goal: quality of life, not tumor eradication.

Common Indications

Symptom / Site	Typical Dose/Fractionation	Response Rate
Bone metastases (pain)	8 Gy × 1 or 20 Gy / 5 fx	60–80% pain relief
Brain metastases	20 Gy / 5 fx (WBRT) or SRS	Neurologic improvement 60–70%
Spinal cord compression	8 Gy × 1 or 20 Gy / 5 fx (emergent)	Ambulation preserved if treated <48 hr
Superior vena cava syndrome	20–30 Gy / 10–15 fx	Symptom relief 70–90%
Hemoptysis (lung CA)	20–30 Gy / 10–15 fx	Bleeding control 60–80%
Dysphagia (esophageal CA)	20–30 Gy / 5–10 fx	Swallowing improvement 50–70%
Fungating breast/chest wall	20–30 Gy / 5–10 fx	Bleeding/odor control 70%

Advantages

• Localized: spares most normal tissue.
• Outpatient; 1–10 fractions (1–2 weeks).
• Minimal systemic side effects vs. chemotherapy.
• Can combine with systemic therapy.

Limitations

• Not curative; retreatment limited by tissue tolerance.
• Acute: fatigue, skin reaction, nausea (site-dependent).
• Late: fibrosis, second malignancy (rare, long latency).

Multidisciplinary discussion (radiation oncology, palliative care, medical oncology) optimizes patient-centered plans.