Palliative Radiation Therapy
The best person to talk to about radiation therapy is a radiation oncologist.
A radiation oncologist is a specialist doctor who is part of the team that takes care of people having radiation therapy. You can ask your doctor for a referral to a radiation oncologist to learn if radiation therapy is an option for you.
Role of Palliative Radiation Therapy
Palliative radiotherapy helps people with advanced cancer by easing pain and other symptoms. It is used for many different reasons.
Palliative radiation therapy is a careful and focused treatment. It aims to boost people’s quality of life by helping them with pain and other symptoms.
Palliative radiotherapy does not aim to cure cancer and uses less radiation. This means fewer side effects.
Advanced cancers often cause pain by moving into bones and pressing on nerves. By targeting radiation in these areas, the radiation oncologist can shrink the cancer and reduce the pressure.
The Treatment Team
Radiation oncologists make a treatment plan for each person based on:
- the type of cancer
- area the cancer has spread to
- symptoms
- overall prognosis
- what other treatment options are available or have been tried
Sometimes treatments such as surgery, chemotherapy, immunotherapy or hormone therapy are also helpful. These are often offered with palliative radiotherapy.
A highly trained radiation oncology team takes care of people having radiation therapy. This includes radiation oncologists, radiation therapists, medical physicists and radiation oncology nurses.
When is Palliative Radiation Therapy Used?
Palliative radiation therapy is used for:
- relieving pain from bone metastases
- treating spinal cord and nerve compression
- reducing pain from brain metastases
- controlling an ulcerating cancer and reducing bleeding
- easing pressure or blockages
Treatment is usually short, with as few as 1 or 2 sessions or up to 10 sessions.
In urgent cases radiation oncologists can sometimes do treatments on the same day.
Types of Palliative Radiation Therapy
External beam radiation therapy
This is the most common type of palliative radiation therapy.
Radiation oncologists often use volumetric arc therapy (VMAT) or stereotactic radiotherapy which are advanced types of external beam radiation therapy, to carefully deliver radiation to the areas that need to be treated.
These advanced techniques allow the treating team to target the radiation on the cancer while limiting radiation to healthy parts of the body.
Before Palliative Radiation Therapy Starts
Radiation oncologists carefully plan palliative radiation therapy to best meet the needs of people being treated. This is how it works:
Initial clinical consultation
The radiation oncologist meets the person being treated and checks their overall health, cancer type, and symptoms. The radiation oncology team use this information to create a treatment plan.
During this meeting, there is plenty of time to ask questions and learn about the benefits and possible side effects of treatment. If everything sounds okay, the radiation oncologist will ask the person to sign a form agreeing to go ahead.
Planning session
This is when the treating team work out the best treatment for each person. They sometimes use a CT scan and permanent ink ‘tattoos’ on the skin to ensure the treatment area is carefully targeted.
For treatments involving the head or neck, people wear a special mask to help them stay still during treatment. The treatment team will offer medicine and relaxation techniques for people who struggle with the mask.
Number of palliative radiotherapy visits
These visits are called fractions and the number varies.
Some people receive a single fraction of radiotherapy, while others have many fractions spread over a few days or weeks.
The number of fractions depend on the aim of treatment, how far the person must travel and how long they are likely to live.
General Side Effects of Radiation Therapy
Radiation therapy is more effective with fewer side effects than ever before.
Recent advances mean radiation oncologists can effectively target the cancer while getting less radiation on healthy body parts. This means much fewer side effects.
Side effects from radiation therapy vary between people, even for those having the same treatment. Side effects are usually very mild with palliative radiation therapy as the dose given is lower.
While some people feel no side effects, some will feel some mild side effects (including tiredness or skin redness) during and/or just after treatment. These usually get better within a few weeks and the treatment team will offer advice and medication to help. People who feel unwell in the stomach during treatment may be offered an anti-nausea tablet.
Side effects starting later (months to years after the palliative radiation therapy) are uncommon.
The radiation oncologist will talk to you about side effects and answer any questions before treatment.
After treatment, radiation oncologists keep a close eye on people to see how they are doing and how well the treatment worked.
This may include follow-ups and imaging. The treating team may also check pain, brain function and how well someone is coping with daily life. They use this information to learn if the treatment helped.
Side Effects of Radiation Therapy in Palliative Treatment
Pain from bone metastases
Most people feel less pain after 1 treatment. Pain levels drop as quickly as a few days after treatment or may take a few weeks.
For many people the benefits last many months but if the pain does come back treatment can be done again.
Some people may get a flare (or temporary worsening) of their bone pain 1-2 days after treatment. The radiation oncology can provide medicine to lessen the chance of this.
Treating spinal cord compression
When cancer spreads to the bones of the spine, it can lead to spinal cord compression.
The spinal cord is a large nerve that controls everything in the body. When cancer puts pressure on the spinal cord, it can cause problems like leg weakness, pain, and loss of bladder or bowel control. This needs urgent assessment and treatment.
Palliative radiation therapy is very good for treating spinal cord compression. If caught early it can also stop them getting worse. Treatment usually starts within 48 hours, sometimes on the same day.
If the person is fit and the cancer is limited to the spine, doctors may operate to reduce pressure on the nerve before radiation. This is done with the advice of a neurosurgeon.
People with spinal cord compression often take a medicine called dexamethasone, which works with the radiation therapy to lessen pressure on the nerve.
It is important to know the signs of spinal cord compression. Things to watch for include:
- back or neck pain that gets worse and makes it hard to sleep
- a band of pain around the body or down the arms or legs
- numbness in the arms or legs
- sensation changes such as pins and needles in the arms or legs
- weakness or difficult using arms or legs
- troubles controlling bladder or bowel.
It is important to contact your doctor if you notice any of these changes.
Reducing pain from brain metastases
Cancer cells sometimes spread to the brain through the bloodstream. This can cause secondary brain tumours or brain metastases. Sometimes 1 tumour forms and other times many grow at the same time.
As they grow, these tumours cause swelling and pressure inside the head, which can lead to headaches, nausea, and drowsiness.
Radiation therapy is a common treatment for secondary brain tumours. It aims to shrink the tumours and lessen pressure in the head. Surgery to take out the tumours may also be an option for some people before palliative radiation therapy.
Radiation treatment may be given to the whole brain or just the affected area.
Stereotactic radiation therapy is an advanced treatment that allows the radiation oncologist to safely give larger doses of radiation to a smaller area while sparing the healthy parts of the brain.
Whole brain radiation therapy is not used as much anymore due to better drug treatments and targeted stereotactic techniques, which have improved outcomes.
Short-term side effects can include headaches, nausea, red and itchy scalp, tiredness, and temporary hair loss.
Treating teams often give people dexamethasone to prevent headaches and nausea. Hair loss sometimes happens at the end or after treatment but usually starts to grow back within 2-4 months.
Somnolence syndrome, which is excessive drowsiness, is rare with stereotactic radiation therapy to the brain.
Controlling an ulcerating cancer and reducing bleeding
As some cancers grow, they cause bleeding, which can be very upsetting and lead to low blood counts. Radiation therapy is very helpful for stopping bleeding caused by cancer.
This treatment is often used for bleeding from skin cancers, bladder and prostate cancer, bowel/rectal cancer, lung cancer, and cancers of the cervix and uterus.
Often, the bleeding lessens before the radiation therapy is finished. Peak benefits from palliative radiotherapy usually occurs around 4-6 weeks after the treatment ends. If the bleeding comes back, extra rounds of radiotherapy may be done.
Relieve pressure or a blockage
As cancer grows, it can put pressure on various tubes in the body. These include the windpipe (trachea), food pipe (oesophagus), airways in the lungs, the bowel, and large blood vessels.
When a tube is blocked, radiation treatment can shrink the cancer and clear the blockage.
The tubes most affected by cancer blockages are those in the neck and chest. Blockages in the chest can lead to difficulty swallowing, shortness of breath, and pain. If large blood vessels are blocked, swelling in the arms and face may also occur.
Radiation is usually done from outside the body, but in some cases, internal radiation (brachytherapy) is used. This is when a small radioactive metal source is placed into the tube near the tumour for a few minutes before being taken out.
Side effects of chest radiation can occur after treatment ends and last 5-10 days. These may include coughing, pain while swallowing, tiredness, and redness of the skin in the treated area.
Other Useful Resources Palliative Radiation Therapy
Find additional information about cancer types, research groups, and support groups.
Radiation Oncologist
The best person to talk to is a radiation oncologist. You can ask your doctor for a referral to find out if radiation treatment is right for you.
GPs and Health Professionals
Information for any health professional involved in a patient's cancer care with a particular focus on primary care providers.
Talking to Your Doctor
Your GP or other doctors in the cancer team can organise a referral to a radiation oncologist.
Treatment Centres
Search and find your closest Radiation Oncology Treatment Centre.
