Patterns of symptom control and palliative care-focused original research articles in the International Journal of Radiation Oncology *Biology* Physics and the Radiotherapy and Oncology Journal, 2005-2014.

BACKGROUND: A significant portion of radiation treatment (30-40%) is delivered with palliative intent. Given the frequency of palliative care (PC) in radiation oncology, we determined the patterns of research focusing on symptom control and palliative care (SCPC) in two prominent radiation oncology journals from 2005-2014. METHODS: Original research manuscripts published from 2005-2014 in the International Journal of Radiation Oncology *Biology* Physics (Red Journal) and the Radiotherapy and Oncology Journal (Green Journal) were reviewed to categorize articles as PC and/or SCPC. Articles were categorized as PC if it pertained to any aspect of treatment of metastatic cancer, and as SCPC if symptom control in the metastatic cancer setting was the goal of the research inquiry and/or any domain of palliative clinical practice guidelines was the goal of research inquiry. RESULTS: From 2005-2014, 4.9% (312/6,386) of original research articles published in the Red Journal and 3.5% (84/2,406) published in the Green Journal pertained to metastatic cancer, and were categorized as PC. In the Red Journal, 1.3% (84/6,386) of original research articles were categorized as SCPC; 1.3% (32/2,406) of articles in the Green Journal were categorized as SCPC. There was no trend observed in the proportion of SCPC articles published over time in the Red Journal (P=0.76), the Green Journal (P=0.48), or both journals in aggregate (P=0.38). CONCLUSIONS: Despite the fact that palliative radiotherapy is a critical part of radiation oncology practice, PC and SCPC-focused original research is poorly represented in the Red Journal and the Green Journal.

Radiotherapeutic and surgical management of iris melanoma: A review.

We compare outcomes following radiotherapeutic and surgical management of iris melanoma. End points included local tumor recurrence, metastases, and common complications. From an initial search that yielded 231 articles, we found 17 relevant studies with 761 eyes. The gender distribution was balanced with a mean age of 52 years. Most studies focused on either proton beam (49.4%) or plaque (31.4%) radiotherapy. Rates of local recurrence (range: 0%-8%) and metastatic development (0%-5%) were favorable following radiotherapy; however, common complications included cataract (36%-73%), glaucoma (3%-92%), and corneal conditions (0%-33%). A unique complication of proton beam radiotherapy was limbal stem cell deficiency (2%-33%). In contrast, iridectomy and comparable procedures showed similar rates of recurrence (0%-8%) and metastases (0% in one study), lower rates of postoperative cataract (0%-33%) and corneal conditions (2.3% in one study), and a greater incidence of photophobia (9%-25%). Following enucleation, one study of mostly advanced eyes demonstrated a higher rate of metastases (14%). Overall, despite a paucity of research in this setting, efficacy and safety outcomes remain favorable. Decision-making for management should be based on tumor size, location, angle seeding, secondary glaucoma, visual potential, and patient preference.

The accuracy of clinicians' predictions of survival in advanced cancer: a review.

The process of formulating an accurate survival prediction is often difficult but important, as it influences the decisions of clinicians, patients, and their families. The current article aims to review the accuracy of clinicians' predictions of survival (CPS) in advanced cancer patients. A literature search of Cochrane CENTRAL, EMBASE, and MEDLINE was conducted to identify studies that reported clinicians' prediction of survival in advanced cancer patients. Studies were included if the subjects consisted of advanced cancer patients and the data reported on the ability of clinicians to predict survival, with both estimated and observed survival data present. Studies reporting on the ability of biological and molecular markers to predict survival were excluded. Fifteen studies that met the inclusion and exclusion criteria were identified. Clinicians in five studies underestimated patients' survival (estimated to observed survival ratio between 0.5 and 0.92). In contrast, 12 studies reported clinicians' overestimation of survival (ratio between 1.06 and 6). CPS in advanced cancer patients is often inaccurate and overestimated. Given these findings, clinicians should be aware of their tendency to be overoptimistic. Further investigation of predictive patient and clinician characteristics is warranted to improve clinicians' ability to predict survival.

EORTC QLQ-BR23 and FACT-B for the assessment of quality of life in patients with breast cancer: a literature review.

BACKGROUND: This study aims to compare the development, characteristics and validity of two widely used tools in the breast cancer population, the EORTC QLQ-BR23 and the FACT-B. METHODS: A literature search was conducted using Ovid MEDLINE, OLDMEDLINE, Embase, Embase Classic and the Cochrane Central Register of Controlled Trials to identify relevant studies. RESULTS: Both tools were found to be reliable and valid. The QLQ-BR23 focuses on physical function, whereas the FACT-B emphasizes emotional well-being. Scoring, item format, organization and response options differ between questionnaires. CONCLUSION: Overall, both questionnaires are effective in assessing breast cancer-specific quality of life. Clear similarities and differences between the two tools exist. Decision-making between the questionnaires should be based on the purpose and design of the study.

Comparing prognostic factors in patients with spinal metastases: a literature review.

For cancer patients with spinal metastases, palliative treatments are directed toward improving the patient's symptoms and quality of life. The expected prognosis of patients plays a large role in guiding treatment decisions, particularly when deciding between surgical management and conservative treatments, such as radiotherapy. This study aims to review the factors that can accurately predict the survival of patients with spinal metastases. The authors conducted a literature search on studies identifying prognostic factors using PubMed (1966­2011), Ovid MEDLINE (1948 to July 2011) and EMBASE (1947­2011) databases. Articles in English were included if they conducted retrospective or prospective analyses on predictors of survival for patients with spinal metastases; articles validating or examining the accuracy of existing scoring systems using prognostic factors were also included. A total of 29 studies were identified. A general consensus of the literature was found with respect to three prognostic factors: the patient's primary cancer site, the extent of the metastases and the general condition or performance score. Further research is recommended to assess the prognostic value of other factors identified by several studies, including age, neurological deficit and previous treatments. For future studies, the authors encourage the development of models capable of inclusion of all patients with spinal metastases.

New Considerations in the Design of Clinical Trials for Bone Metastases.

Palliative radiotherapy (RT) is prescribed to patients with bone metastases to alleviate symptoms and improve quality of life. The lack of consistent endpoints for such trials has made cross study comparison difficult and has led to contradictory conclusions. The International Bone Metastases Consensus Working Party was established to create a standard set of endpoints and recommendations for future clinical trials. Recommendations were included regarding eligibility criteria, pain assessments, follow-up assessments, timing, as well as radiation techniques. Suggestions were also made to facilitate the ease with which different studies could be compared as well as to encourage widespread consistency in certain aspects of trial design. Investigators conducting clinical trials in bone metastases should continue to adopt these recommendations to ensure consistent guidelines based on the most recent literature.