Symptoms management
Transcript of Symptoms management
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Symptomsmanagement
Radiotherapysymptomscontrol
inlungmet
MarcoTrovòAz.SanitariaUniversitariaIntegratadiUdine
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Thoracicsymptoms:Dependingontumorsizeandlocation
-Cough75%- Severecough40%- Hemptysis50-60%- Dyspnea40%- Thoracicpain40%- Systemicsymptoms(weightloss,weakness,anorexia,malaise)10%
%indicateprimarylungcancerpresentationaccordingto“Perez”
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Thoracicsymptoms:Dependingoninfiltrationofspecific
thoracicstructuresLungApex:- Pancoast’stumor:shoulderpainirradiatingtothearm- Horner’ssyndrome:enophthalmos,ptosis,meiosis,ipsilateraldecreaseinsweating.
Leftmediastinum:- involvementoftherecurrentlaryngealnerve:àhoarsenessRightmediastinum:-SuperiorVenaCavaSyndromSuperiormediastinum:-Thoracicinletobstruction:àsevererespiratorydistressPericardium:pericardialtamponadeandheartfailureEsophagus:disfagiaPhrenicnerve:dyspnea
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Treatmentrecommendations:1. Treatingsymptomaticdisease-symptomspalliationonlyvs.maintainingthetumor/symptomsresponse.
2.Treatingasympomaticdisease-preventingfuturesymptoms-deferringchemotherapy-increasingsurvival?
àlocalcontrol
SBRTforoligometastaticpatients
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• ShortEBRTschedules(e.i.20Gyin5fr)providegoodsymptomaticreliefwithfewersideeffects• PatientswithgoodPSmaybenefitfromhigherdosesà(modest)survivalbenefit
• Theintegrationofconcurrentchemotherapywithpalliativeintentisnotsupportedbytheliterature
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• Palliativemanagementoflungcancer
• Durationofsymptomreliefisnotassessed
• Integrationofnewtechnologies(IMRT,IGRTandPET)isnotstudiedyet.
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Theonlypublisheddataquantifyingtheeffectivenessofpalliative-intentRTforsecundarylungtumors
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CFRT:maximumdose50Gy- 80courses:opposedfields(2D-CRT)- 6courses:3D-CRT- 13courses:IMRT
à78coursesforpalliativeanalysis
SBRT:-91coursesin88patients
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Resultsonconventionalfractionation(1)
Symptomimprovement:74%- Hemoptysis:86%- Cough:70%- Airwayobstruction:65%- Pain:64%
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Resultsonconventionalfractionation(2)
Symptomsrecurrence:6mo:54%12mo:65%
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• Patientswhosurvivelongerthan6monthshadagreaterthan50%chanceofdevelopinglocalprogressionafterCFRT• Leadingtoalimiteddurationofpalliativeeffect
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1. Treatingsymptomaticdisease-symptomspalliationonlyvs.maintainingthetumor/symptomsresponse.
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Myconsiderations:TheroleofpalliativeRTforthoracictumorsiswelldefined:UseshortRTschedulestopalliatesymptoms.ThinkaboutdurationofpalliationwhendeliveringpalliativeRTConsidertheimportanceofpreventingtumorsymptomsWereallyneedtostudythepossiblevalueaddedbythenewtechnologies