简介：Therehasbeenaparadigmshiftinmedicineawayfromtradition,anecdoteandtheoreticalreasoningfromthebasicsciencestowardsevidence-basedmedicine(EBM).Inpalliativecarehowever,statisticallysignificantbenefitsmaybemarginalandmaynotberelatedtoclinicalmeaningfulness.Thetypicaltreatmentvs.placebocomparisonnecessitatedby‘goldstandard'randomisedcontrolledtrials(RCTs)isnotnecessarilyapplicable.Thecomplexmultimorbidityofendoflifecareinvolvesconsiderationsofthepatient'sphysical,psychological,socialandspiritualneeds.Inaddition,thefieldofpalliativecarecoversaheterogeneousgroupofchronicandincurablediseasesnolongerlimitedtocancer.Adequatesamplesizescanbedifficulttoachieve,reducingthepowerofstudiesandhighattritionratescanresultininadequatefollowupperiods.Thisreviewusesexamplesofthemanagementofcancer-relatedfatigueanddeathrattle(noisybreathing)todemonstratethecurrentstateofEBMinpalliativecare.ThefutureofEBMinpalliativecareneedstobeasdiverseasthepatientswhoultimatelyderivebenefit.Non-RCTmethodologiesofequivalentquality,validityandsizeconductedbycollaborativeresearchnetworksusinga‘mixedmethodsapproach'arelikelytoposethecorrectclinicalquestionsandderiveevidencebasedyetclinicallyrelevantoutcomes.

简介：Palliativeradiotherapy(pRT)isprimarilyemployedforpalliationofbonepaininpatientswithcastrate-resistantprostatecancer(CRPC).However,evidencethatpRTinfluencesprostate-specificantigenresponseinpatientswithCRPConsystemictherapyislacking.WedescribethreecasesofCRPCprogressingaftertreatmentwithdocetaxel(n=2)andabiraterone(n=1),whorespondedunusuallyafterpRTforbonepainwiththedevelopmentofasignificantbiochemicalresponseandrestorationofresponsetosystemictherapy.ThepossibilityofpRTinfluencingmetastaticdiseaseinCRPChasnotbeenpreviouslyreported,andraisesthepossibilityofradiation-inducedmodulationofanti-tumorimmuneresponsemechanismsthatmayplayaroleintherestorationofresponsetosystemictreatment.