Adult Palliative Oncology and Radiotherapy of Locally Advanced and Metastatic Cancers

End of life care is perhaps the most challenging in oncology but a learnable skill. Treating patients with advanced and metastatic disease could provide palliation and sometimes may prolong survival. Palliative care is often complex. This paper does not attempt to be comprehensive but attempts to make choices on the best practices in palliative radiotherapy, and will also discuss other palliative modalities. It discusses how to adapt each step of the radiation oncology clinic flow to meet the needs of palliative patients, pain control and the most appropriate techniques in treatment planning and delivery. This paper discusses the most effective and efficient dose fractions for palliative patients. It also discusses some specific challenging scenarios in palliative oncology in selected details hopefully will enlighten. The radiotherapy in palliative cases is different than the curative cases in the intent of cure versus palliation. When active intervention is futile, palliating the pain and suffering of the cancer patient should be the primary treatment goal.