Better be quick.

Top Line: Time to re-explore palliative radiation in pandemic times. 

The Study: Same song, different verse: avoid, delay, shorten. The palliative care team at MSKCC has followed suit with a clear and concise approach to limiting the number of palliative cases on-treatment, again with the dual goals of limiting patient and staff exposure and conserving PPE. In the era of oligomets, “palliative” radiation has taken on a vaguer meaning than ever, but this specifically addresses true palliative radiation for symptom relief. First, radiation should be avoided for those with short life expectancies with other effective supportive care measures. Second, symptomatic cases that do not portend an oncologic emergency (i.e, neurologic or airway compromise, major bleeding, or pain crises) can be delayed. Now, if we’re not all well-versed with abbreviated palliative regimens, Choosing Wisely needs a new marketing team. But if you need a refresher, Table 2 provides an excellent summary. It includes 8 Gy x 1 for painful bone mets including cord compression, 4 Gy x 5 for whole brain (SRS still favored when indicated), 4 Gy x 5 or QUAD SHOT for tumor bleeding, and 8.5 Gy x 2 for airway obstruction. Finally, Table 1 and Figure 1 propose a detailed approach to triaging cases.

TBL: Rethink how you will approach palliative cancer cases in the coming weeks to months. | Yerramilli, Adv Radiat Oncol 2020