Palliative radiotherapy in the breast and chest wall

Introduction

The definition of palliative care by the World Health Organization (WHO) is centered around “an approach that improves the quality of life of patients ... through the prevention and relief of suffering ....” One of the most important and straightforward goals of palliation for locally advanced breast cancer is therefore to provide in their words “relief from pain and other distressing symptoms.” This approach to radiation for palliation is very different from one of accepting a short-term risk of treatment-related time and side effects for a long-term expectation of cure. Palliative radiation needs to offer its clinical benefit with a minimum risk of treatment-related inconvenience or side effects. The WHO definition of palliative care also includes that while a palliative treatment “intends neither to hasten or postpone death ... palliative care may positively influence the course of illness.” Positive influences on the illness of breast cancer that includes locally advanced cancer in the breast or chest wall may include a durable local control and freedom from local progression, reduced pain and other symptoms, reduced wound care needs or risk for infection, and improved quality of life. Prolongation of survival is not a main goal of palliative radiation, but in some cases of limited metastatic disease it may be possible. These important elements of palliation—improving pain and distressing symptoms, improving quality of life, and positively influencing the course of illness—are all applicable to palliative radiation for locally advanced, recurrent, or otherwise uncontrolled cancers of the breast, chest wall, or skin.