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The vertebral column is the most commonly affected site of metastatic cancer, occurring in approximately 5-10% of cancer patients. Palliative radiotherapy is given to alleviate symptoms and sustain quality of life for patients with advanced cancer. Acute adverse effects from the radiation therapy may however contribute to reducing quality of life, contradicting treatment intention.  

For patients receiving palliative irradiation for metastatic spinal cord compression, acute adverse effects commonly occur in the gastro-intestinal tract, causing symptoms such as pain or soreness in the throat, reduction or loss of taste sensation, abdominal discomfort and diarrhea.

Palliative radiotherapy is typically given with an AP/PA beam or a single arc and may or may not be assisted with image guidance.
Advanced radiotherapy techniques offer the possibility of personalising radiotherapy. Personalised radiotherapy is used extensively for curative patients. For palliative patients, who often are offered very standardised treatment options, there are options of treatment personalisation, which are easy to implement clinically.  
Options of personalising palliative treatment include (daily) image guidance, arc therapy, organs at risk delineation, fractionation adjustment according to primary diagnose and advanced disease and adjusting to patient wishes.

It is possible to significantly reduce dose to organs at risk. Research has shown effective dose reduction to the bowel through organ at risk delineation. Our research with reducing oesophageal dose for patients with metastatic spinal cord compression showed a mean dose reduction of 29,1% without PTV compromise and up to 50,4% dose reduction with a PTV compromise. Furthermore, modern delineation tools offer this possibility in less than 10 minutes pr patient, making this an inexpensive opportunity of offering personalised radiotherapy to reduce acute toxicity.