Palliative and pain medicine: radiation oncology

Radiation therapy is an effective palliative treatment for incurable cancer. Radiation can be used to palliate pain, bleeding, or obstruction. Pain resulting from bone metastases can be controlled with external localized or wide field radiotherapy. Healing of bone fracture can be influenced by the use of radiation therapy. Radiopharmaceuticals such as 89Sr and 153Sm are considered forms of systemic radiation therapy that can be used in the presence of generalized osteoblastic bone metastases. Spinal cord compression can be fatal if not diagnosed and treated in a timely fashion. Radiation therapy plays a role in the management of brain metastases using traditional whole brain radiation therapy or stereotactic radiosurgery, offering a faster and easier way of palliation. Visceral metastases can be treated with external beam, brachytherapy, or radionuclides. Brachytherapy allows the safe delivery of high doses over short time intervals with minimal doses to the surrounding structures. The use of yttrium-90 microspheres is a new intraarterial therapy consisting of beta-irradiating microspheres that can be delivered directly to the tumors. 90Y microspheres, which carry the radiation, are selectively taken up by the tumors, thus preserving normal liver. Radiation therapy is part of a multimodality approach to deal with cancer patients with serious conditions.