Outcomes and Characteristics of Patients Treated with Emergent Palliative Radiation Therapy

Purpose: Emergent palliative radiation therapy (PRT) of symptomatic metastases can significantly increase the quality of life of patients with cancer. In some contexts, this treatment may be underused, but in others PRT may represent an excessively aggressive intervention. The characterization of the current use of emergent PRT is warranted for optimized value and patient-centered care. Methods and Materials: This study is a cross-sectional retrospective analysis of all emergent PRT courses at a single academic tertiary institution across 1 year. Results: A total of 214 patients received a total of 238 treatment courses. The most common indications were bone (39%) and brain (14%) metastases. Compared with outpatients, inpatients had lower mean survival rates (2 months vs 6 months; P <.001), higher rates of stopping treatment early (19.1% vs 9.0%; P =.034), and greater involvement of palliative care (44.8% vs 24.1%; P <.001), but the same mean planned fractions (9.10 vs 9.40 fractions; P =.669). In a multiple predictor survival analysis, palliative care involvement (P =.025), male sex (P =.001), ending treatment early (P =.011), and having 1 of 3 serious indications (airway compromise, leptomeningeal disease, and superior/inferior vena cava involvement; P =.007) were significantly associated with worse overall survival. Conclusions: Survival is particularly poor in patients who receive emergent PRT, and patient characteristics such as functional status and indication should be considered when determining fractionation schedule and dosing. A multi-institutional study of practice patterns and outcomes is warranted.