Palliative Care Essentials includes the following sessions:

Palliative Radiation Therapy for Spine Metastases
 —Subha Perni, MD - University of Texas MD Anderson Cancer Center

With technological advances re-irradiation has rapidly become common and an important part of cancer management to new or recurrent tumors, yet is clinically challenging given risks of serious toxicity from cumulative doses. Institutional re-irradiation practices vary widely, though often involve a series of highly complex technical procedures coordinated by an interdisciplinary care team including across institutions. In the absence of evidence-based guidelines on re-irradiation best practices, an ESTRO-EORTC consensus paper has outlined technical aspects that must be accounted for in order to guide re-irradiation strategies. These include radiobiology and functional imaging to account for tissue recovery, and dosimetry aspects such as the use of deformable image registration to estimate cumulative doses in drastically different patient anatomy. Understanding the appropriateness and limitations of these processes is critical in their routine application in the clinic, and therefore re-irradiation necessitates interdisciplinary collaboration between oncologists, physicists, therapists and other team members. This session facilitates more consistent, safe and high-quality care for patients receiving re-irradiation to manage their cancer.

Learning Objectives

1. Develop a multidisciplinary and patient-centered approach to selection of treatment strategies for patients with spine metastases causing pain and/or neurologic compromise.
2. Understand evidence and potential indications for selection of spine metastasis-directed radiation techniques, including hypofractionation and stereotactic radiosurgery.

Radiation for Non-Spine Bone Metastases
—Divya Yerramilli, MD - Memorial Sloan Kettering Cancer Center

This session reviews the role of radiation therapy in the management of non-spine bone metastases, focusing on patient evaluation, treatment intent, dose selection and integration with systemic and surgical care. It emphasizes that prognosis and goals of care, ranging from immediate pain palliation to durable control in limited disease, should guide therapeutic decisions. Typical patient workup includes clinical history, musculoskeletal and neurologic examination, and multimodality imaging to assess fracture risk and lesion characteristics. The presenter discusses treatment scenarios such as postoperative irradiation after fixation, prophylactic palliation in high-risk asymptomatic lesions, oligometastatic disease and radioresistant histologies, where SBRT may improve response durability. Toxicities, including pain flare, fracture risk and long-term myositis, are reviewed, along with strategies for multidisciplinary management.

Learning Objectives

1. Identify appropriate treatment intent (pain palliation, prophylactic stabilization, or durable control in limited disease) for various clinical scenarios of patients with non-spine bone metastases.
2. Select dose, fractionation and technique for non-spine bone metastases, including when SBRT is preferred for ablation, radioresistant disease or re-irradiation.
3. Incorporate multidisciplinary care, including orthopedic input, systemic therapy, bone-modifying agents and supportive interventions in order to improve outcomes and patient quality of life.

Palliative Radiation for Head and Neck and Cutaneous Malignancies
—Jared Robbins, MD - Duke University Medical Center

This session provides an overview about palliative radiation for head and neck and skin malignancies. It focuses on a brief review of the available evidence supporting palliative radiation therapy for these diseases and assists participants in identifying resources to help guide them in application. Several cases are reviewed to solidify the principles and provide tips for success.

Learning Objectives

1. Appropriately identify patients who are “good” candidates for palliative radiation.
2. Be able to select the appropriate palliative RT doses and volumes.
3. Evaluate the available evidence and realize the limitations and strengths.
4. Become more familiar with and more comfortable using palliative regimens.

From Beam to Bedside: Benefits and Logistics of a Dedicated Palliative Radiation Therapy Service
—Anna W. LaVigne, MD - Johns Hopkins University School of Medicine

Palliative radiotherapy remains an unmet need, despite its efficacy. This session discusses how a dedicated palliative radiation service can address barriers to care and play an integral role in improving care access and receipt. The presenter provides helpful insights for those seeking to create such a service or strengthen an existing one. The session covers the current scope of palliative radiotherapy, the role of dedicated palliative radiation services in terms of both impacts and barrier to their success, and why such services are likely to become increasingly important within the evolving landscape of palliative radiation.

Learning Objectives

1. Illustrate why palliative radiotherapy remains an unmet need.
2. Convey the integral role that a dedicated palliative radiation service can play in improving access to and receipt of care.
3. Provide insights to support de novo development or further refinement of a dedicated palliative radiation service.

Pharmacologic Symptom Management in the Radiation Oncology Clinic
—Ethan Steele, MD, MSCR - University of North Carolina at Chapel Hill and Transitions Lifecare

Radiation oncologists see patients across a wide spectrum of oncologic diseases and clinical conditions. Whether as a result of disease burden, cancer-directed treatment, or other unrelated problems, many patients present to the radiation oncology clinic with significant symptom management needs. This session acts as a refresher of the pharmacology and best practices for outpatient pharmacologic symptom management. The primary focus of this presentation is opioid pain management and the treatment of nausea, vomiting and constipation.

Learning Objectives

1. Describe evidence-based practices in prescribing opioids.
2. Develop a structured approach to converting between different opioid agents and schedules.
3. Review pharmacologic strategies in the outpatient management of nausea, vomiting and constipation.

Navigating the Complexities of Brain Metastases and Leptomeningeal Disease Management
—H. Michael Yu, MD - Moffitt Cancer Center
The management of patients with brain metastases and leptomeningeal disease (LMD) presents complex clinical challenges requiring nuanced, evidence-based decision making. This session provides a focused review of contemporary treatment strategies for patients with brain metastases and LMD, with an emphasis on individualized care planning and multidisciplinary management. Participants will examine the evolving role of radiotherapy across clinical scenarios, including indications for stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT) and hippocampal-avoidance approaches.

Learning Objectives

1. Discuss treatment strategies for patients with multiple brain metastases and leptomeningeal disease (LMD).
2. Understand the role of radiotherapy for brain metastases and LMD.
3. Review radiotherapy techniques for brain metastases and LMD.
4. Appreciate the multidisciplinary management for patients with brain metastases.