Ebook Radiation oncology in palliative cancer care: Part 2
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Ebook Radiation oncology in palliative cancer care: Part 2
CHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2t, Mount Vernon I lospital, Northwood, I.ondon, UKIntroductionThe aims of palliative radiation therapy (RT) are to alleviate symptoms, restore function, diminish suffering, and improve quality of life. Palliative RT has been shown to be an effective and simple method of providing relatively rapid re Ebook Radiation oncology in palliative cancer care: Part 2lief in both locally advanced and metastatic cancer [1,2] for symptoms of pain, bleeding, ulceration, compression, or obstruction. It is accepted thatEbook Radiation oncology in palliative cancer care: Part 2
the majority of patients will have a limited life span, and the duration of symptom relief may be short. Box 15.1 lists the indications for use of paCHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2though larger fraction sizes may lead to increased late effects, this toxicity will take months or years to develop and is unlikely to prove problematic in a population with a short life span. Current palliative radiotherapy regimens for colorectal and gastrointestinal cancer commonly deliver doses Ebook Radiation oncology in palliative cancer care: Part 2ranging from 8Gy as a single fraction, 20-25 Gy in 5 fractions, 30Gy in 10 fractions, to 27-30 Gy in 6 fractions over 3 weeks (figure 15.1). We oftenEbook Radiation oncology in palliative cancer care: Part 2
have insufficient information to choose the optimal regimen. Very few studies have used validated endpoints for symptom relief or have included formalCHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2stimated survival time, although, due to their close patient contact, oncologists tend to be overly optimistic and unrealistic.This chapter reviews the role of palliative radiation therapy in gastrointestinal and colorectal cancer as well as the selection of patients who are appropriate for radiothe Ebook Radiation oncology in palliative cancer care: Part 2rapy Patients with advanced gastrointestinal and colorectalRadiation Oncology in Palliative Cancer Care, First Edition. Edited by Stephen Ĩ Utz, EdwarEbook Radiation oncology in palliative cancer care: Part 2
d Chow, and Peter i Ioskin.© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.177178 Radiation oncology in palliative cancer careCHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2wel obstruction•Fungating or ulcerative masscancers suffer from a range of symptoms which include bleeding, pain, and obstruction, but there are a number of challenges somewhat distinct from other malignancies. Though the management of bone, cerebral, and painful metastases parallels other cancers, Ebook Radiation oncology in palliative cancer care: Part 2a significant amount of palliative treatment is aimed at preserving luminal patency. Dysphagia is a uniquely distressing symptom since immediate conseEbook Radiation oncology in palliative cancer care: Part 2
quences are obvious and, for those with some luminal patency, there is an obvious discomfort evident to the patient and their carers. We describe the CHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2formal techniques such as stereotactic ablative radiotherapy (SART), CyberKnife, and brachytherapy are also described. Finally we recommend specific studies to accumulate evidence for decisionmaking and define the optimal way to utilize radiotherapy for palliation of colorectal cancer.Treatment of d Ebook Radiation oncology in palliative cancer care: Part 2ysphagiaEsophageal cancer generally presents at a late stage, with severe dysphagia. An inability to swallow solid foods progresses to difficulty in sEbook Radiation oncology in palliative cancer care: Part 2
wallowing even liquids. In general, radical treatments for cure are only possible in the minority of patients, with the remainder requiring optimal paCHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2tions for management of dysphagia include stenting, laser ablation, and possibly chemotherapy, though radiotherapy has been shown to offer the best dysphagia-free survival |3|.Endoscopic dilatation can be useful in the short term, but requires serial endoscopy, with a consequent risk of perforation. Ebook Radiation oncology in palliative cancer care: Part 2 Laser ablation using the Nd:YAC laser can be used if the tumor is exophytic and projects into the esophagus, but it is less effective for circumferenEbook Radiation oncology in palliative cancer care: Part 2
tial tumors, where perforation is a risk, especially in stenosing lesions where the direction of the lumen is not obvious [4]. Argon plasma coagulatioCHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2erapy for patients with esophageal cancer.Chapter 15: Gastrointestinal and colorectal cancer 179180 Radiation oncology in palliative cancer careEarly complication rates from stent placement are low, and 95% of patients enjoy significant improvement in their dysphagia. Currently, stent migration occu Ebook Radiation oncology in palliative cancer care: Part 2rs in only 5-10%, and obstructive episodes require intervention in 3-5% of patients. However, the stent may eventually be bypassed by continuing tumorEbook Radiation oncology in palliative cancer care: Part 2
growth through or around the lattice of the stent in up to 36%, which may limit the effectiveness of the technique [4,5]. One-third of patients with CHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2therapy, laser ablation therapy, and argon beam coagulation (APC) therapy with self-expanding metal stents for the palliation of dysphagia in esophageal cancer. One study [11] examined external beam radiation therapy (EBRT).Several different radiotherapy fractionation schema have improved dysphagia Ebook Radiation oncology in palliative cancer care: Part 2in up to 70% of treated patients. In Mount Vernon, our standard is the delivery of 27Gy in 6 fractions over 3 weeks usually delivered with parallel opEbook Radiation oncology in palliative cancer care: Part 2
posed fields but occasionally to a planned volume [12]. Symptom palliation may persist for several months or years. The median survival of this group CHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2range 0-208 weeks) and was maintained until death in 40% [13]. The radiotherapy can be delivered with concurrent continuous infusion 5-fluorouracil or oral capecitabine chemotherapy.Some studies reported the benefit of palliative radiation with concurrent 5-FU chemotherapy (CRT) for dysphagia in adv Ebook Radiation oncology in palliative cancer care: Part 2anced esophageal cancer [14,15]. A phase I/II trial from Canada [15] prospectively treated 22 patients with dysphagia from advanced incurable esophageEbook Radiation oncology in palliative cancer care: Part 2
al cancer with palliative RT (30Gy /10 fractions) and a concurrent single course of chemotherapy (5-FU and mitomycin-C). Treatment was generally well-CHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2ients (50%) remained dysphagia-free until death. They concluded that a short course of radiotherapy plus chemotherapy might produce complete relief of swallowing difficulties in a substantial proportion of patients with acceptable toxicity. An ongoing Norwegian randomized clinical study compares pri Ebook Radiation oncology in palliative cancer care: Part 2mary stenting followed by brachytherapy 8Gy X 3, with standard brachytherapy 8Gy X 3 alone (NCT00653107). 'Our recommendation is that patients with anEbook Radiation oncology in palliative cancer care: Part 2
estimated survival of greater than 2 months receive 27Gy/6 fractions of EBRT and those with a more limited survival or very low performance status reCHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer Treatment Ebook Radiation oncology in palliative cancer care: Part 2astric outlet or biliary obstruction, pain, and bleeding [16]. ExophyticChapter 15: Gastrointestinal and colorectal cancer 181CHAPTER 15Palliative radiotherapy for gastrointestinal and colorectal cancerRobert Glynne-Jones, Mark HarrisonMount Vernon Centre for Cancer TreatmentGọi ngay
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