Radiation Therapy with 3 Gy per Fraction over 10 Fractions (30 Gy Total)
A regimen of 30 Gy in 10 fractions (3 Gy per fraction) is a well-established palliative radiation therapy schedule that provides effective symptom control for multiple cancer-related conditions including bone metastases, spinal cord compression, hemoptysis, and moderate-risk radiation fields, with acceptable toxicity and the advantage of shortened treatment duration. 1
Clinical Applications and Efficacy
Bone Metastases
- 30 Gy in 10 fractions is the standard of care for palliative treatment of bone metastases, demonstrating equivalent pain relief compared to single-fraction regimens but with lower retreatment rates. 1
- In the RTOG 97-14 trial, 30 Gy in 10 fractions achieved 66% overall response rate (18% complete response, 48% partial response) with 33% of patients discontinuing narcotics at 3 months. 1
- Grade 2-4 acute toxicity occurred in 17% of patients, which was higher than single-fraction treatment (10%), but retreatment rates were significantly lower (9% vs 18%). 1
- This fractionation is preferred over shorter schedules for newly diagnosed patients who are chemotherapy-naïve or in postoperative settings. 1
Spinal Cord Compression
- 30 Gy in 10 fractions is the standard radiotherapy dose for epidural spinal cord compression, used in both surgical and non-surgical management. 1
- In the Bluegrass Neuro-Oncology Consortium trial, this regimen was effective for patients with metastatic spinal cord compression, though outcomes were optimized when combined with surgical decompression in appropriate candidates. 1
Hemoptysis Control
- For non-massive hemoptysis in unresectable lung cancer, 30 Gy in 10 fractions provides symptom relief in approximately 60% of patients, with hemoptysis being the best palliated symptom (81-86% response rate). 1
- This regimen demonstrated equivalent efficacy to 40 Gy in 20 fractions with no significant survival differences and median survival of 6 months. 1
Antiemetic Prophylaxis Requirements
High Emetic Risk Scenarios
- For total body irradiation or upper abdominal fields at this dose, administer a 5-HT3 receptor antagonist plus dexamethasone before each fraction and for 24 hours after each fraction. 1
Moderate Emetic Risk Scenarios
- For hemibody, mantle, craniospinal, or abdominal-pelvic irradiation, administer a 5-HT3 receptor antagonist before each fraction. 1
- Consider adding dexamethasone for the first five fractions in moderate-risk fields. 1
Low Emetic Risk Scenarios
- For lower thorax or cranial radiation, offer 5-HT3 receptor antagonist prophylaxis before each fraction. 1
- For brain radiation specifically, offer rescue dexamethasone therapy. 1
Biologically Effective Dose Considerations
- The BED (Biologically Effective Dose) for 30 Gy in 10 fractions is 39 Gy₁₀ using the linear-quadratic model with α/β = 10 Gy for tumor tissue. This represents moderate biological intensity suitable for palliative intent.
- For late-responding normal tissues (α/β = 3 Gy), the BED₃ is 60 Gy₃, which remains within safe tolerance limits for most organs when treating limited volumes. 1
Treatment Planning Specifications
Dose Delivery Parameters
- Deliver 3 Gy per fraction once daily, five fractions per week, over 2 consecutive weeks. 1
- Standard dose rate is 9-10 Gy per week. 1
- Never exceed 2 Gy per fraction for extended-field treatments to avoid excessive late toxicity, but 3 Gy fractions are acceptable for palliative limited-field treatments. 1
Quality Assurance
- Obtain control films at least twice during the treatment course (minimum requirement) or weekly (preferred). 1
- Ensure maximum dose homogeneity within the treated volume to avoid hot spots exceeding 3 Gy per fraction. 1
Common Pitfalls and Caveats
Avoid in These Scenarios
- Do not use 30 Gy in 10 fractions for whole brain re-irradiation after previous whole brain radiation due to neurotoxicity concerns; consider focal techniques instead. 2
- Avoid this regimen for curative-intent treatments where higher total doses with conventional fractionation (1.8-2 Gy) are required. 1
- Do not use for severe symptomatic cord compression requiring urgent decompression; consider higher doses (e.g., 40 Gy) or surgical intervention first. 1
Special Populations
- For patients with poor performance status or progressive disease refractory to chemotherapy, consider shorter regimens (20 Gy in 5 fractions or 8 Gy in 1 fraction) to minimize treatment burden. 1
- In concurrent chemoradiation settings, antiemetic prophylaxis should match the higher emetic risk between the chemotherapy and radiation therapy. 1
Monitoring Requirements
- Monitor for radiation pneumonitis if treating thoracic fields; treat with corticosteroids if symptomatic. 1
- Assess for radiation esophagitis when treating mediastinal or upper thoracic fields, which typically manifests during the second week of treatment. 3
- Monitor renal function when using bisphosphonates concurrently for bone metastases management. 1
Concurrent Systemic Therapy Considerations
- Systemic chemotherapy can be administered concurrently with this radiation regimen, though toxicity monitoring is essential. 1, 3
- Do not delay initiation of systemic therapy for radiation; these can often be given together with careful toxicity surveillance. 1
- For bone metastases, continue bisphosphonates or denosumab during radiation therapy to optimize skeletal-related event prevention. 1