The Palliative Uses of Radiation Therapy in Surgical Oncology Patients

Radiation Therapy without Surgery for Spinal Metastases: Clinical Outcome and Prognostic Factors Analysis for Pain Control

The purpose of radiation therapy (RT) for patients with spinal metastases is pain relief and control of paralysis. The aim of the present study was to assess pain relief using RT and to evaluate prognostic factors for pain control. We evaluated 97 consecutive patients, of mean age 62.7 years (range 28 to 86), with spinal metastases that had been treated by RT. We evaluated the effects of RT using pain level assessed using a drug grading scale based on the World Health Organization standards. The following potential prognostic factors for pain control of RT were evaluated using multivariate logistic regression analysis: age, gender, tumor type, performance status (PS), number of spinal metastases, and a history of chemotherapy. Among the 97 patients who underwent RT for pain relief, 68 patients (70.1%) presented with pain reduction. PS (odds ratio: 1.931; 95% confidence interval: 1.244 to 2.980) was revealed by multivariate logistic regression analysis to be the most important prognostic factor for pain control using RT. In conclusion, we found that RT was more effective for patients with spinal metastases while they maintained their PS.

Palliative radiation therapy for hemorrhage of unresectable gastric cancer: a single institute experience

PURPOSE

To clarify the toxicity of palliative radiotherapy (RT) and its efficacy against bleeding of unresectable gastric cancer.

METHODS

Clinical data of 19 patients received palliative RT for bleeding from unresectable gastric cancer were reviewed. The median total dose and dose per fraction were 40 Gy (range 2-50 Gy) and 2.5 Gy (range 1.8-3 Gy).

RESULTS

The treatment success rate was 68.4%. By using a tumor alpha/beta ratio of 10, biological effective dose of 50 Gy(10) or more was significantly correlated with treatment success (P = 0.040). The median event-free survival was 1.5 months after RT and the median overall survival from starting RT was 3.4 months. Grade 3 nausea and anorexia were recorded in 1 and 3 patients, respectively.

CONCLUSION

Palliative RT was effective for hemostasis in patients with gastric cancer bleeding with minor adverse events.

Radiotherapy and wound healing

Radiotherapy is an invaluable weapon when treating cancer. However, the deleterious effects of radiation, both immediate and long-term, may have a significant effect on local tissues. Problematic wound healing in radiation-damaged tissue constitutes a major problem that is frequently overlooked during the management of patients who require radiotherapy, or have had radiotherapy in the past. Poor wound healing may lead to chronic ulceration, pain, secondary infection and psychological distress and compromise the outcome of general or reconstructive surgery. We discuss the pathophysiology of poor wound healing following radiotherapy, specific problems for radiation-damaged tissue and potential treatments to improve wound healing of irradiated tissues.

Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma

OBJECTIVE

For patients with laparoscopic stage M1 gastric adenocarcinoma, no resection of the primary tumor, and systemic chemotherapy, this study investigated the incidence of subsequent palliative intervention and survival.

SUMMARY BACKGROUND DATA

Laparoscopy was performed for patients with computed tomography scan stage M0 disease and no significant obstruction or bleeding.

METHODS

A prospectively maintained database for 1993 to 2002 was used to identify 165 patients (median age, 63 years) with laparoscopic M1 disease in the peritoneum (P1, adjacent to stomach, 9%; P2, few distant sites, 35%; or P3, disseminated, 30%) or liver (10%) or both (16%). Functional performance status (FPS, Eastern Cooperative Oncology Group) was 0 to 1 (84%) or 2 (16%).

RESULTS

Subsequent intervention was performed on 50% of patients, at median interval of 4 months (range, 1-35 months) after laparoscopy. Intervention was performed on the stomach for obstruction (33%), bleeding (8%), or perforation (1%) or on a distant site for a metastasis-related complication (20%). More than one intervention (maximum, 4) was performed in 21%. Laparotomy was necessary in 12%; the remainder had endoscopic or radiologic procedures or radiation therapy only. There was one intervention-related death. Median survival was 10 months, with 1-year survival of 39%. On multivariate analysis, better FPS (0-1; odds ratio, 4; P=0.001) and limited peritoneal metastasis (P1 or P2; 2; P=0.01) were independently associated with improved survival.

CONCLUSIONS

The incidence of subsequent intervention was 50%, but few patients had laparotomy. Intervention-related mortality was minimal. The burden of metastatic disease and functional performance status were important prognostic factors.

Management of bleeding in patients with advanced cancer

Bleeding occurs in up to 10% of patients with advanced cancer. It can present in many different ways. This article provides a qualitative review of treatment options available to manage visible bleeding. Local modalities, such as hemostatic agents and dressings, radiotherapy, endoscopic ligation and coagulation, and transcutaneous arterial embolization, are reviewed in the context of advanced cancer, as are systemic treatments such as vitamin K, vasopressin/desmopressin, octreotide/somatostatin, antifibrinolytic agents (tranexamic acid and aminocaproic acid), and blood products. Considerations at the end of life are described.

Gastrectomy for gastric cancer: defining critical elements of patient selection and outcome assessment

In advanced gastric cancer, palliation of symptoms, rather than cure, is often the most appropriate goal of patient management. There are important differences among patients undergoing non-curative operations for gastric cancer. The literature to date is limited, in part, by imprecise use of the term palliative. In clinical decision-making, the potential benefits of proposed procedure must be balanced against the duration of hospitalization, treatment of complications, and requirements for additional palliation. Studies designed to measure palliative interventions would benefit from precise designations of palliative intent inpatients receiving non-curative operations.

Percutaneous arterial embolization and chemoembolization for treatment of benign and malignant tumors in three dogs and a goat

The term bland arterial embolization refers to catheter-directed delivery of particulate material for the purpose of embolizing selected arteries. This technique is used in humans to treat a number of conditions, including arteriovenous malformations, uterine fibroids, and epistaxis. The term chemoembolization refers to selective intra-arterial delivery of chemotherapeutic agents in conjunction with particulate material for the purpose of embolizing arteries supplying blood to a tumor. Compared with traditional modes of drug delivery, chemoembolization increases local concentration and dwell time of the chemotherapeutic agent, augments tumor ischemia, and minimizes systemic toxic effects. In humans, the technique has shown encouraging results in the treatment of a variety of nonresectable tumors. The present report describes techniques for percutaneous bland arterial embolization and chemoembolization in dogs and goats and results of these techniques in 3 dogs and a goat. Bland arterial embolization was performed in 2 dogs and the goat. The goals of treatment included pain palliation, reduction of tumor growth, and control of hemorrhage, and each animal was considered to have benefited from the procedure on the basis of the preprocedural goals. Chemoembolization was performed in 1 dog for treatment of a nonresectable hepatocellular carcinoma. Unfortunately, this dog did not live long enough to identify any response to treatment. Results for animals studied illustrate the feasibility of bland arterial embolization and chemoembolization in veterinary patients and suggest that embolization may provide an alternative method of treatment for animals with inoperable lesions.