Radiation Therapy in the Management of Distant Breast Cancer Metastases.
Dose-time-volume relationships are probably the most heatedly debated single item in radiation oncology, with virtually no clinical or radiobiologic aspect of this subject that is not contentious in some way. There is even less agreement among oncologists about the treatment of patients with metastatic breast cancer. The goal of radiation therapy should be to relieve pain or restore function as quickly as possible, and treatments should be as short as possible to attain that goal. A summary of pertinent literature is given in this article. In addition to the decisions regarding dose, time, and field placement, the palliative treatment patients requires a value judgment, balancing quality of life against quantity of life. The effective clinician intuitively acts in favor of prolonging life, not prolonging death. Clinical judgement, comment sense, and a little humility for what we can accomplish with radiation therapy are probably more important than dose-time-volume relationships in the successful treatment of the dying patient with metastatic disease. Some of the important questions that must be asked to decide the appropriateness of a particular course of therapy are discussed.
Kagan
AR
Department of Radiation Oncology, Kaiser Permanente Medical Center, Los Angeles, CA, USA