title: Patterns of care and course of symptoms in palliative radiotherapy: a multicenter pilot study analysis.
abstract: OBJECTIVE
  To evaluate patterns of care as well as effectiveness and side effects of palliative treatment in four German radiation oncology departments.
  
  
  METHODS
  All referrals in four German radiation oncology departments (two university hospitals, one academic hospital, one private practice) were prospective documented for 1 month in 2008 (2 months at one of the university hospitals). In palliatively irradiated patients, treatment aims and indications as well as treated sites and fractionation schedules were recorded. In addition, symptoms and side effects were analyzed with standardized questionnaires before and at the end of radiotherapy.
  
  
  RESULTS
  During the observation period, 603 patients underwent radiation therapy in the four centers and 153 (24%, study population) were treated with palliative intent. Within the study, patients were most frequently treated for bone (34%) or brain (27%) metastases. 62 patients reported severe or very severe pain, 12 patients reported severe or very severe dyspnea, 27 patients reported neurological deficits or signs of cranial pressure, and 43 patients reported a poor or very poor sense of well-being. The most frequent goals were symptom relief (53%) or prevention of symptoms (46%). Life prolongation was intended in 37% of cases. A wide range of fractionation schedules was applied with total doses ranging from 3-61.2 Gy. Of the patients, 73% received a slightly hypofractionated treatment schedule with doses of > 2.0 Gy to ≤ 3.0 Gy per fraction and 12% received moderate to highly hypofractionated therapy with doses of > 3.0 Gy to 8.0 Gy. Radiation therapy led to a significant improvement of well-being (35% of patients) and reduction of symptoms, especially with regard to pain (66%), dyspnea (61%), and neurological deficits (60%). Therapy was very well tolerated with only 4.5% grade I or II acute toxicities being observed. Unscheduled termination was observed in 19 patients (12%).
  
  
  CONCLUSIONS
  Palliative radiation therapy is effective in reducing symptoms, increases subjective well-being, and has minimal side effects. More studies are necessary for subgroup analyses and for clarifying the different goals in palliative radiotherapy.
authors.affiliation: Department of Radiation Oncology, University of Würzburg, Würzburg, Germany. Oorschot_b@klinik.uni-wuerzburg.de
authors.forename: Birgitt
authors.initials: B
authors.lastname: van Oorschot
authors.forename: Michael
authors.initials: M
authors.lastname: Schuler
authors.forename: Anke
authors.initials: A
authors.lastname: Simon
authors.forename: Ursula
authors.initials: U
authors.lastname: Schleicher
authors.forename: Hans
authors.initials: H
authors.lastname: Geinitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D010166:Palliative Care / Q000379:methods*; D010352:Patient Dropouts / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome