Leading to debilitation and impaired quality of life External beam radiation provides significant relief in 50-80% of patients and complete pain relief in 30 % of patients (ASTRO)
Factors affecting choice of fractionation regimen
Performance status Prognosis Risk for fracture or cord compression Site to be treated A literature review confirms similar
rates of pain control using a single fraction versus a multiple fractions (5085%). There are however higher retreatment rates for single fraction regimens. Fractionation regimens
8 Gy in 1 fraction 20 Gy in 5 fractions
30 Gy in 10 fractions 24 Gy in 6 fractions Endpoints using pain relief, narcotic relief and quality of life measures show consistent similarity in the regimens The frequency and severity of side effects especially mucosal are a
more of a function of radiation planning than radiotherapy dose BRAIN METASTASES Comparison of median survival in 7 studies using the recursive partitioning analyses (RPA) classes (treatment was WBRT with or without local measures, none of the studies is limited to one particular cancer type).
Clinical Recommendations of DEGRO Breast Care (Basel). 2010; 5(6): 401407. Published online 2010 December 8. doi: 10.1159/000322661
Analysis of all included patients, SRS plus WBRT, did not show a survival benefit over WBRT alone. However, performance status and local control were significantly better in the SRS plus WBRT group. Furthermore, significantly longer OS was reported in the combined treatment group for RPA Class I patients as well as patients with single metastasis. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD006121.
Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases
conventional fractionation can be used to avoid late neurotoxicity dexamethasone is the corticosteroid of choice for cerebral edema anticonvulsants should not be prescribed prophylactically
Spinal cord compression Inform patients at high risk of developing bone metastases, patients with diagnosed bone metastases, or patients with cancer
who present with spinal pain about the symptoms of MSCC (NICE) Patients with cancer and any of the following symptoms suggestive of spinal metastases should seek medical attention immediately for
assessment: pain in the middle (thoracic) or upper (cervical) spine progressive lower (lumbar) spinal pain severe unremitting lower spinal pain spinal pain aggravated by straining (for example, at stool, or when coughing or sneezing)
localized spinal tenderness nocturnal spinal pain preventing sleep Patient should be nursed flat with neutral spine alignment (including log rolling with use of a bed pan for toilet) until bony and neurological stability are ensured
and cautious remobilisation may begin For patients with MSCC, once any spinal shock has settled and neurology is stable, carry out close monitoring and interval assessment during gradual sitting
from supine to 60 degrees over a period of 34 hours Offer conventional analgesia (including NSAIDs, non-opiate and opiate medication) as required to patients with painful spinal metastases in escalating doses as
described by the WHO three-step pain relief ladder Offer patients with vertebral involvement from myeloma or breast cancer bisphosphonates to reduce pain and the risk of vertebral fracture/collapse
Unless contraindicated (including a significant suspicion of lymphoma) offer all patients with MSCC a loading dose of at least 16 mg of dexamethasone as soon as possible after assessment, followed by a short course of 16 mg dexamethasone daily
while treatment is being planned If surgery is appropriate in patients with MSCC, attempt to achieve both spinal cord decompression and durable spinal column stability
Patients with MSCC who have been completely paraplegic or tetraplegic for more than 24 hours should only be offered surgery if spinal stabilisation is required for pain relief
There should be urgent (within 24 hours) access to and availability of radiotherapy and simulator facilities in daytime sessions, 7 days a week for patients with MSCC requiring definitive treatment or who are unsuitable
for surgery Fractionation regimens
8 Gy in 1 fraction 20 Gy in 5 fractions 30 Gy in 10 fractions 24 Gy in 6 fractions Palliative radiotherapy a slice
of the palliative pie Palliative radiotherapy should be aimed as a one stop approach Factors affecting utilization of palliative
Poor performance status Short predicted life expectancy Access to radiotherapy centres Limited oncology training of attending physicians Waiting time for radiotherapy
Strategies for Working in Secondary Subject Classrooms SATEAL March 2013 Schools with 10% or more School Department Classroom Teacher EAL / Teacher collaboration School EAL Policy Class allocation Access previous reports Timetable Pupil Induction Pupil EAL profiles accessible to all...
The Act did not change the tax treatment for the owners, individuals and corporations, of insurance and annuity contracts. These contracts include: life insurance, annuities, disability income insurance and long term care insurance . The Act also did not change...
Crust is made of two main parts. ... Asthenosphere- solid rock that flows slowly (like hot asphalt) Mesosphere- middle layer. Outer Core- liquid layer. Inner Core- solid, very dense. Physical Structure of the Earth (5 Layers) Earth's Interior Structure.
Readers Workshop by Lucy Calkins. Good Habits, Great Readers. Words Their Way. Units of Study in Opinion, Information and Narrative Writing by Lucy Calkins. Comprehension Toolkit. District 157c created curriculum. Writing Workshop. Method of writing instruction.
Process for Local District Goal Setting 2018-19 Process for Local District Goal Setting Plan to Involve Board of Trustees Review Baseline Data and Report Goals Development Process Review Existing Plans and Priorities Set Local Goals Adopt and Report Local Goals...
Set up a student-centered seating arrangement; be at eye level with the students. 2. Select an appropriate text. 3. Be prepared with a few kick-off questions. 4. Keep the dialogue going with follow-up questions. 5. Remind all students to refer...
Everything is an Argument. ... Stasis . Another way to categorize arguments is to look at the issues they address. This system, developed in ancient Greece and Rome, is called stasis theory. The questions were posed in sequence because each...
Ready to download the document? Go ahead and hit continue!