to reduce toxicity and improve quality of life in the palliative setting , and it is reasonable to assume that most of the side effects among our patients were mild to moderate since the expectation would be that severe side effects would be more likely to be documented in the patient records. However, this is purely conjecture basis on assumptions related to routine practice of patient documentation. One could assume that with IMRT there could in fact be less severe side effects due to reduced radiotherapy doses to adjacent normal structures but we were unable to demonstrate this. More consistent use of symptom assessment scales such as The Edmonton Symptom Assessment System (ESAS) could help in the future to document changes in patients’ symptoms between visits. Better documentation and quantification of toxicities would also be useful to assess side effects. This could be considered for future studies since symptom improvement as well as side effect treatment contribute to patient’s quality of life.
Palliative radiation therapy forms a large proportion of the work load of many radiotherapy departments and delivering IG-IMRT using TomoTherapy® provides an efficient alternative to traditional palliative radiotherapy techniques. The ability to scan, plan, and treat patients all on a single unit in a single appointment is very convenient for patients, and this retrospective study suggests that response rates compare vary favourably (over 80% within one month) with those in the published literature with more traditional approaches. There was also no difference in response rates related to the site or symptom being treated or the dose fractionation regimen used. However due to the small sample size and lack of adequate documentation is not possible to make a definitive conclusion regarding the side effects related to this approach.
Then authors would like to thank the Ottawa Cancer Foundation for financial support of this study and Ms. Betty McAndrew for her administrative assistance.
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