ESTRO 2025 - Abstract Book

S107

Invited Speaker

ESTRO 2025

4822

Speaker Abstracts Relevant endpoints & follow-up towards end-of-life Carsten Nieder Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway. Dept. of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

Abstract:

Palliative radiotherapy has evolved into a complex, individually tailored treatment concept, in response to needs such as symptom alleviation, temporary tumor control or prolonged survival. Fractionation concepts and treatment techniques range from single fraction to 3-week schedules, and from simple and robust 3-D to sophisticated stereotactic plans. In many cases, systemic therapy is also a component of care. A mismatch between prognosis and resource utilization should be avoided. Overly aggressive management in the final phase of cancer progression close to the end of life often results in more harm than benefit. Also, regarding follow-up intensity, numerous studies have had difficulties in providing patient-reported outcomes, such as pain scores and quality of life questionnaires, e.g., after treatment of painful bone metastases. Electronic solutions may contribute to better adherence than in-person follow-up at the treating hospital. Patient-centered care in a world of advanced technologies and potentially disconnected care is not a trivial task. We can easily design a clinical trial of palliative radiotherapy for painful bone metastases with the endpoint of complete pain response. However, we can not be sure that all patients define their clinical goal or expectation from such treatment as complete pain response. A highly active younger patients may have other goals than a multimorbid older patient. Maybe our hypothetical trial should have each patient define their goal (or magnitude of symptom improvement, e.g. on a visual analogue scale) and than look at level of satisfaction and decision regret. Secondary endpoints such as quality of life questionnaire outcomes, quality-adjusted life years, toxicity and response duration, to name a few, would still remain relevant. Close to the end-of-life, attention should be given to aspects such as number of days at home, place of death or hospice care, all of whom adjusted to patients' wishes, at least in an ideal scenario. This invited lecture is focussing on all these challenges with examples from the bone and brain metastases trial landscape, their endpoints and follow-up schedules.

4823

Speaker Abstracts Advanced technology solutions in palliative radiotherapy: Is it worth the hassle? Aisling Barry Cancer Research@UCC, University College Cork, Cork, Ireland

Abstract:

Providing patients with an effective and efficient treatment option for symptomatic metastatic disease is front and centre in radiation oncology clinics. Palliative radiotherapy is historically underutilised, accounting for approximately 50% of radiation treatments. The scope of palliative intent radiotherapy has changed with patients living longer, and the traditional aim of palliation for short term symptomatic control is evolving for many into longer more durable control. Thus, the management of patients with metastatic cancer, in particular those with symptomatic metastatic disease, is complex and varies based on a number of additional considerations. In tandem, radiotherapy has evolved, and the integration of advanced technological solutions such as imaging, motion management, volumetric modulated arc therapy and advanced image guidance techniques has enhanced the delivery of treatment, and for some clinical outcomes, for patients. However, the integration of such technological solutions impose a different, and perhaps additional, set of