title: Early palliative radiation therapy in patients with newly diagnosed cancer: Reasons, clinical practice, and survival.
abstract: OBJECTIVE
  To analyze indications for early palliative radiation therapy (RT) (ie, start within 1 month from cancer diagnosis), regimens used in clinical practice, rate of treatment completion and treatment in the last 30 days of life, and overall survival.
  
  
  METHODS
  Retrospective uni- and multivariate analyses covering a 4.5-year inclusion period.
  
  
  RESULTS
  Seventeen percent of all palliative RT courses were administered in the specified time frame (n = 100 patients, 30 Gy in 10 fractions in 49%). Common indications were bone and brain metastases, whereas metastatic spinal cord compression or other emergencies comprised a minority. Only 14% of patients had no distant metastases. Most patients had non-small cell lung cancer (51%), whereas other high-incidence primary tumors such as breast, prostate, and colorectal cancer combined comprised 10%. Failure to complete RT occurred in 6%. Median survival was 3.6 months. A startling high rate of RT in the last 30 days of life was observed (19%). Risk correlated significantly with performance status and extent of metastatic disease.
  
  
  CONCLUSIONS
  The study population of patients who received early palliative RT is not identical to the general population described in previous studies, which covered the entire disease trajectory. Median survival was relatively short and rate of RT in the last 30 days of life higher than expected. Need for early palliative RT might be caused by large symptom burden and/or contraindication(s) for other management options, and might in many cases also be associated with adverse prognostic features and aggressive disease.
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. Electronic address: carsten.nieder@nlsh.no.
authors.forename: Carsten
authors.initials: C
authors.lastname: Nieder
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
authors.forename: Ellinor
authors.initials: E
authors.lastname: Haukland
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
authors.forename: Bård
authors.initials: B
authors.lastname: Mannsåker
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
authors.forename: Adam
authors.initials: A
authors.lastname: Pawinski
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Dalhaug
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis