From Guidelines to Real-World Practice in Palliative Radiation Oncology

Palliative radiotherapy is a core component of modern cancer care and represents a substantial proportion of day-to-day radiation oncology activity. Across disease sites and clinical scenarios, such as painful bone metastases, symptomatic primary tumors, bleeding, neurologic compromise, and other urgent indications, palliative RT can rapidly improve symptoms, preserve function, and support patient-centered goals of care. Over the past decade, clinical practice guidelines and consensus recommendations have increasingly emphasized value-based, patient-centered approaches, including appropriate fractionation, timely access, and thoughtful selection of technique to minimize treatment burden. However, real-world delivery remains heterogeneous across institutions and health systems, influenced by workflows, referral pathways, reimbursement structures, resource availability, and local culture of practice.Despite a mature evidence base, meaningful gaps persist between “what we know” and “what we do” in palliative radiation oncology. Variation in fractionation and technique selection, uneven uptake of evidence-supported approaches, and challenges in decision-making near end of life can lead to undertreatment, overtreatment, or avoidable patient burden. At the same time, the increasing availability of real-world data sources, pragmatic study designs, and implementation science methods creates an opportunity to better understand barriers, test scalable solutions, and align everyday practice with guideline-informed, patient-centered care. This Research Topic aims to bring together clinically grounded contributions that evaluate current practice patterns, measure outcomes that matter to patients, and propose actionable strategies to close the implementation gap, while recognizing that “real-world” care must remain adaptable to prognosis, symptom trajectory, comorbidities, and patient preferences.To translate evidence into consistent, high-quality practice, this Research Topic welcomes submissions addressing (but not limited to) the following themes:• Guideline concordance and practice variation in palliative RT (e.g., fractionation choices, retreatment patterns, care pathways across settings).• Real-world outcomes in palliative RT, including symptom response, toxicity burden, treatment burden, and patient-reported outcomes.• Decision-making frameworks and prognostic tools supporting appropriate use of RT near end of life.• Implementation studies and quality improvement initiatives (e.g., rapid-access palliative RT clinics, standardized triage/referral pathways, equity-focused interventions).• Pragmatic trials, registry-based research, and multicenter audits in palliative radiation oncology.• Patient-centered and supportive-care integration (shared decision-making, goals-of-care alignment, coordination with palliative care teams).• Responsible use of advanced techniques in the palliative setting when linked to patient-centered endpoints and real-world feasibility.We particularly encourage Original Research, Brief Research Reports, Systematic Reviews, Narrative/Practice-Oriented Reviews, Methods/Implementation papers, and Policy or Health Services Research manuscripts with clear clinical applicability.Please note: manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal. Topic editors: Alessio G. Morganti, Federica Medici, Costanza Maria Donati, Francesco Cellini, AFM Kamal Uddin Source: https://www.frontiersin.org/research-topics/81342/from-guidelines-to-real-world-practice-in-palliative-radiation-oncology