The reirradiation of recurrent bronchogenic carcinoma with external beam irradiation

Symptomatic local failure following thoracic irradiation for bronchogenic carcinoma presents a clinical challenge to the Radiation Oncologist. We retrospectively evaluated the efficiency of reirradiation with external beam radiation of 30 patients. The median dose of initial irradiation was 6,000 cGy in 6 weeks. The median time following initial irradiation to recurrence was 12 months. The median dose of retreatment was 3,030 cGy in 3 weeks. Of the symptomatic patients, 88% and 70% subjectively responded to initial irradiation and to reirradiation, respectively. Retreatment toxicity included radiation esophagitis (6 patients), dry desquamation (4 patients), and symptomatic radiation pneumonitis (1 patient). Based on this study, doses of external beam radiation in the range of 2,000-3,000 cGy in 2 to 3 weeks appear safe and effective in reirradiating recurrent bronchogenic carcinoma.

Management of chronic cancer pain using a computerized ambulatory patient-controlled analgesia pump

Chronic pain associated with neoplastic disease can be difficult to treat. The development of a computerized ambulatory, patient-controlled analgesia (PCA) pump may provide the patient and clinician with an alternate approach in management of chronic cancer pain. The pump delivers a constant infusion of analgesic and allows for additional on-command doses for breakthrough pain. Patients with chronic cancer pain poorly controlled with conventional narcotic regimens were eligible for this trial. Four patients were included in this trial. Upon admission, each patient was started on a morphine infusion via a peripheral site and titrated to an effective dose. Once the optimal dose was achieved, the patients were converted to the ambulatory pump. The pump was programmed to deliver identical morphine infusions and any PCA doses. Infusion access was provided by a long-term central venous catheter or subcutaneous infusion set. Final maintenance infusions ranged from 0.8 to 60 mg morphine per hour. Three patients required PCA doses. Patients and family members were trained on catheter care and operation of the infusion pump. At home, patients reported acceptable pain relief while engaging in many activities of daily living. Complications included constipation, possible drug tolerance, and accidental catheter removal. Overall, patient acceptance of the pump was good with improved pain control, minimal adverse reactions, and ease of use at home.