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