RADIOTHERAPY FOR PALLIATION

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RADIOTHERAPY FOR PALLIATION

• Bhadrasain Vikram, MD
• International Atomic Energy Agency of the United
  Nations

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RADIOTHERAPY

• Effectiveness
• Cost-effectiveness

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RADIOTHERAPYEFFECTIVE FOR PREVENTION/RELIEF OF

• Pain Localized or Widespread bone mets.
• Fractures Localized or Widespread bone mets.
• Paralysis Spinal cord compression, Cranial
  nerves compression, Brain mets.
• Blindness Choroid or Optic chiasm mets.
• Bleeding Cervix, Bladder, Hemoptysis.
• Esophageal obstruction.
• Airway obstruction.
• Intestinal obstruction CONTRAINDICATED.

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RADIOTHERAPY PAIN RELIEF PARADIGM

• Localized bone mets
• Single dose RT can decrease/eliminate need for
  opioids for several months.
• Widespread bone mets
• Hemi-body RT over 2 days is effective, with very
  few side effects.
• Single dose OK, if pre-medicated with IV
  Ondansetron and Dexamethasone.

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LOCALIZED METS(Hartsell et al. J Natl Cancer
Inst. 200597798-804)

• Prospective randomised trial of single-dose vs
  long-course RT.
• 3 mos after RT, 33 of patients no longer
  required narcotic meds.
• Longer treatment course caused toxicity but no
  added benefit.

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HEMI-BODY RADIOTHERAPY(Salazar et al. Int J
Radiat Oncol Biol Phys. 200150765-75)

• Prospective, randomised trial.
• Pain relief in 91 within 1 week.
• Median pain-relief duration 4 mos.
• Pain relief for remaining life in 71.
• Four doses over 2 days least toxic.
• Single dose requires pre-medication.

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INTRAVENOUS RADIOTHERAPY

• Similar effectiveness as external radiotherapy
  but far more expensive.
• No good evidence that external plus IV
  radiotherapy better than either one alone.
• IAEA is researching cheaper radionuclides.

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COST EFFECTIVENESS

• A cobalt-60 source (The Medicine) costs 80000
  USD.
• During its half life (5 yr) it can deliver
  200000 doses of RT.
• Cost 40 cents/dose.
• If adequately staffed.

• Pain relief Single dose.
• Curative treatment 20-40 doses.
• Priorities
• Replace old sources.
• Repair broken machines.
• Hire enough staff.

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IAEA ASSISTS MEMBER STATES IN

• Building the infrastructure.
• Acquiring appropriate technology.
• Improving QA.
• Preventing accidents.

• Training doctors, physicists, etc. (Fellowships,
  Expert visits, CME).
• Developing and evaluating resource-sparing
  protocols.

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B.Vikram_at_iaea.org