Palliative radiotherapy: Evolving role and policy challenges

•New paradigms of care have been defined in palliative care through the integration of advanced radiation techniques.•Significant variation exists in the dose fractionation schedules utilised internationally for a number of tumour sites.•There is limited randomised controlled trial evidence available to define current standards of care.•Current reimbursement models disincentivise cost effective practices of care.•Study end-points need to be developed to capture the value of palliative radiotherapy.•Population based studies are required to define appropriate indications for radiotherapy utilisation in the palliative setting.