Massive-Dose Rapid Palliative Radiotherapy

Abstract

The radiotherapist is often faced with the problem of attempting to alleviate symptoms in situations which are hopeless in respect to long-term survival. When life expectancy is short, a course of palliative radiotherapy may involve a large portion of the patient's remaining life. Under these conditions it is often desirable to reduce the period of hospitalization and to return the patient to his home environment as soon as possible. An opportunity to treat patients with rather unconventional fractionation was created in the Radiotherapy Department of Columbia-Presbyterian Medical Center in 1959 in conjunction with a planned project for irradiation under conditions of increased oxygen tension. We were interested in determining response to massive doses of radiation delivered at weekly intervals. Patients with far advanced malignant disease were selected for this preliminary evaluation prior to institution of a similar dosage schedule in the oxygen study. It was realized from the outset that the majority of the patients were in a near terminal stage of their disease and that only immediate effects could be evaluated. Method The supervoltage facility available for this study was the x-ray beam from a 22.5 Mev betatron. Advantages inherent in this unit are: (a) relatively low integral dose, thus increasing general systemic tolerance; (b) high percentage depth dose, thus shortening the time required to deliver an adequate tumor dose; (c) low surface dose, resulting in virtually no skin reaction (surface dose usually 55 to 60 per cent of tumor dose). Various dosage schedules were used within a general pattern. A tumor dose of 800 to 1,250 r was administered at weekly intervals. The total tumor dose was in the range of 1,600 r in eight days (two treatments) to 4,000 r in twenty-two days (four treatments). Treatment time varied according to the field size. At short distances for small fields approximately fifteen minutes are required to deliver 1,200 to 1,400 r. At longer distances the duration of a treatment was sometimes thirty to forty-five minutes. The largest field employed was 12 × 15 cm. In most cases, two opposing fields were used. Patients with inoperable breast lesions were treated twice a week because two separate tumor volumes were included, being irradiated through tangential breast and chest wall fields, and supraclavicular and axillary fields. Water or Lucite bolus was used where required to increase the surface or immediate subsurface dose. Results A total of 63 patients were treated by this method from July 1959 to January 1961; 2 had a second course of therapy. Almost all patients had incurable advanced or widespread malignant disease. A number were preterminal and would not have been considered for palliative irradiation with conventional fractionation.