在晚期癌症患者中，放射疗法被认为是从诊断到死亡期间不同时间点上考虑的治疗方法。由于一些患者在新型治疗方案下的转移性癌症存活时间更长，放射肿瘤科医生越来越多地使用放射疗法作为适当选定患者的一种病灶消融疗法。然而，大多数转移性癌症患者最终还是会死于疾病。对于那些没有有效的靶向治疗选择或不适合免疫疗法的患者来说，从诊断到死亡的时间仍然相对较短。鉴于这种不断发展的局面，预后评估变得越来越具有挑战性。因此，放射肿瘤学家必须勤奋地定义治疗目标，并考虑从病灶消融放疗到医学管理和临终关怀等所有治疗选择。放射疗法的风险和益处因个体患者的预后、护理目标以及放射对于其癌症症状的帮助程度在其预期寿命期间而异。在考虑推荐放疗方案时，医生必须扩大对风险和益处的理解，包括身体症状以及各种心理社会负担。这些负担包括患者、其照料者和医疗保健系统的经济负担。必须考虑到在临终阶段接受放疗所耗费的时间负担。因此，在临终阶段考虑放疗可能是复杂的，需要仔细关注整个患者及其护理目标。版权所有© 2022 Elsevier Inc.。保留所有权利。

In patients with advanced cancer, radiation therapy is considered at various time points in the patient's clinical course from diagnosis to death. As some patients are living longer with metastatic cancer on novel therapeutics, radiation oncologists are increasingly using radiation therapy as an ablative therapy in appropriately selected patients. However, most patients with metastatic cancer still eventually die of their disease. For those without effective targeted therapy options or those who are not candidates for immunotherapy, the time frame from diagnosis to death is still relatively short. Given this evolving landscape, prognostication has become increasingly challenging. Thus, radiation oncologists must be diligent about defining the goals of therapy and considering all treatment options from ablative radiation to medical management and hospice care. The risks and benefits of radiation therapy vary based on an individual patient's prognosis, goals of care, and the ability of radiation to help with their cancer symptoms without undue toxicity over the course of their expected lifetime. When considering recommending a course of radiation, physicians must broaden their understanding of risks and benefits to include not only physical symptoms, but also various psychosocial burdens. These include financial burdens to the patient, to their caregiver and to the healthcare system. The burden of time spent at the end-of-life receiving radiation therapy must also be considered. Thus, the consideration of radiation therapy at the end-of-life can be complex and requires careful attention to the whole patient and their goals of care.Copyright © 2022 Elsevier Inc. All rights reserved.