Zheng Alina, Zheng Alec, Zheng Alan, Wu Xiaodong, Amendola Beatriz
Radiation Oncology, Innovative Cancer Institute, South Miami, USA.
Neuroscience and Behavioral Biology, Emory University, Atlanta, USA.
Cureus. 2025 May 1;17(5):e83316. doi: 10.7759/cureus.83316. eCollection 2025 May.
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.
尽管在实施姑息性放射治疗（PRT）方面存在公认的挑战，但进展仍然缓慢，传统方法取得的成功有限。需要一种变革性策略来克服系统性障碍，并建立可持续的PRT基础设施。本提案提出了一种新颖的模式，通过解决培训、监管、设施开发和治疗方案中的关键障碍，提高可及性、可承受性，并融入姑息治疗。提议在放射肿瘤学住院医师培训项目中设立专门的认证轨道，使姑息治疗医生能够在完全持证的放射肿瘤学家的监督下获得有限的PRT执照。监管调整应促进这一框架，确保合规的同时扩大PRT劳动力队伍。与综合放射治疗中心（CRTC）相关联并融入临终关怀环境的专用PRT设施，将通过减轻后勤和财务负担来提高可及性。这些设施将采用具有成本效益的基础设施，包括翻新的直线加速器、模块化建设以及远程物理和剂量测定支持，确保运营成本显著低于传统放疗中心。优化PRT的实施需要将临床策略转向以单次分割治疗为主要方法，必要时采用低分割治疗。以PRT为导向的系统研究应制定PRT特定的治疗建议，摒弃传统放疗方案。通过解决教育、监管、基础设施和临床策略方面的关键障碍，该模式为可持续实施PRT提供了一条途径。虽然需要初始投资和监管调整，但它有可能改善晚期癌症患者的临终护理，确保更大的尊严和舒适度，同时为未来的报销模式奠定坚实基础。
