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Emergency radiation therapy in modern-day practice: Now or never, or never again ?

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Abstract

Radiation therapy plays a fundamental role in oncological emergencies such as superior vena cava syndrome (SVCS) and metastatic epidural spinal cord compression (MESCC). These are two examples of critical complications of metastatic cancer in terms of pain and functional impact (respiratory and/or neurological). The aim of this review is to explore the current indications, treatment options and outcomes for emergency radiotherapy regarding to these complications.

Regarding SVCS, studies are mostly retrospective and unanimously demonstrated a beneficial effect of radiotherapy on symptom relief. Spinal cord compression remains an indication for urgent radiotherapy, and should be combined with surgery when possible. The innovative stereotactic body radiotherapy (SBRT) showed promising results, however this technique requires small volumes and more time preparation and therefore is often unsuitable for SVCS and MESCC emergencies.

This review concluded that radiotherapy has a central role to play within a multimodal approach for SVCS and MESCC treatment. Further prospective studies are needed to confirm the effectiveness of radiation and establish the criteria for selecting patients to benefit from this treatment option.

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Funding

This review was not funded.

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Author notes

  1. Margaux Yaouanq and Nyere Gibson contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Institut Bergonié, Bordeaux, France

    Margaux Yaouanq, Nyere Gibson, Augustin Boudoussier, Lucas Edouard, Pierre Pouvreau, Imed Taleb, Paul Sargos, Nicolas Magné & Nicolas Benziane-Ouaritini

  2. Cancerology and Hematology Institute, Department of Medical Oncology, Saint-Etienne University Hospital, 42055, Saint-Etienne, France

    Wafa Bouleftour

  3. Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, Unité Mixte de Recherche CNRS5822/IP2I, University of Lyon, Lyon, France

    Nicolas Magné

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  1. Margaux Yaouanq
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NB. NM and PS had the idea for the article, MY and NG performed the literature search and data analysis, WB, IT, PP, LE and AB drafted, and all authors critically revised the work.

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Correspondence to Wafa Bouleftour.

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Yaouanq, M., Gibson, N., Boudoussier, A. et al. Emergency radiation therapy in modern-day practice: Now or never, or never again ?. Support Care Cancer 32, 114 (2024). https://doi.org/10.1007/s00520-024-08322-8

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