ABSTRACT
Palliative radiation therapy (RT) is an important treatment to address symptoms from locally advanced or metastatic disease; mounting evidence supports the utility of single fraction schedules to treat pain from uncomplicated bone metastases. Acute RT toxicities are typically mild, well tolerated, and self-limiting. Late RT toxicities are lower risk given the limited life expectancy of patients treated with palliative RT. Predictable side effects of palliative RT should be prevented when possible to avoid deterioration in quality of life (QoL). The chance of treatment-related toxicity must be weighed against baseline symptoms and likelihood of benefit from palliative RT in terms of improvement of baseline symptoms and preservation of QoL. Worsening symptoms after RT cannot be assumed to be due to treatment-related toxicity until other etiologies, such as tumor progression, are ruled out. High precision stereotactic body radiotherapy for oligometastatic disease may not only change toxicity profiles, as lower doses to normal tissues can decrease certain side effects, but also may increase the likelihood of others due to higher dose delivery to the target.
