A Practice Model for Palliative Radiotherapy.

Despite well-recognized challenges in implementing palliative radiation therapy (PRT), progress remains slow, and conventional approaches have yielded limited success. A transformative strategy is required to overcome systemic barriers and establish a sustainable PRT infrastructure. This proposal presents a novel model to improve accessibility, affordability, and integration into palliative care by addressing key obstacles in training, regulation, facility development, and treatment protocols. A specialized certification track within radiation oncology residency programs is proposed, enabling palliative care physicians to obtain limited PRT licenses under the supervision of fully licensed radiation oncologists. Regulatory adjustments should facilitate this framework, ensuring compliance while expanding the PRT workforce. Dedicated PRT facilities-affiliated with comprehensive radiation therapy centers (CRTCs) and integrated into hospice settings-will enhance accessibility by reducing logistical and financial burdens. These facilities will utilize cost-effective infrastructure, including refurbished linear accelerators, modular construction, and remote physics and dosimetry support, ensuring operational costs remain significantly lower than those of conventional radiotherapy centers. Optimizing PRT delivery requires shifting clinical strategies toward single-fraction treatment as the primary approach, followed by hypofractionation treatment when necessary. Systematic studies with a PRT-oriented mindset should establish PRT-specific treatment recommendations and recommendations, moving away from conventional radiation therapy protocols. By addressing key barriers in education, regulation, infrastructure, and clinical strategy, this model offers a path toward sustainable PRT implementation. While requiring initial investment and regulatory adjustments, it has the potential to improve end-of-life care for terminally ill cancer patients, ensuring greater dignity and comfort while establishing a robust foundation for future reimbursement models.