Palliative Radiotherapy for Malignant Neuropathic Pain, Adrenal, Choroidal, and Skin Metastases

This chapter discusses palliative radiotherapy for malignant neuropathic pain, adrenal, choroidal, and skin metastases. There are very little data in the literature on the use of RT for malignant neuropathic pain. One randomized trial on neuropathic pain due to bone metastases showed similar response rates to those observed for localized bone pain but leaves the question of optimal fractionation open. Both external beam radiation therapy (EBRT) and stereotactic body radiation therapy (SBRT) are effective for palliation of painful adrenal metastases, with response rates of about 85%, although the latter technique is primarily used for local control and disease-free survival benefit. EBRT has been used to treat symptomatic cutaneous metastases from a wide variety of carcinomas and for recurrent/metastatic primary skin malignancies including cutaneous malignant melanoma (CMM), Merkel cell carcinoma (MCC), and primary cutaneous lymphoma (PCL).