Symptoms management

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

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