RESUMEN
Respiratory symptoms cause much of suffering in palliative care. Opioids are the first-line drugs in symptomatic treatment, and a therapeutic intervention with benzodiazepines may also be justified. If the patient does not have hypoxia, oxygen and air stream have similar effects on dyspnea. Cough reflex is attenuated with opioids, and symptoms due to respiratory secretions are alleviated with anticholinergic drugs and mucolytics. Physical therapy and methods of respiratory management are profitable in the treatment of respiratory symptoms. Radiation therapy relieves cancer-induced hemoptysis, cough, chest pain and dyspnea.
Asunto(s)
Disnea/terapia , Cuidados Paliativos/métodos , Terapia Respiratoria/métodos , Analgésicos Opioides/uso terapéutico , Benzodiazepinas/uso terapéutico , Dolor en el Pecho/radioterapia , Antagonistas Colinérgicos/uso terapéutico , Tos/tratamiento farmacológico , Tos/radioterapia , Disnea/etiología , Expectorantes/uso terapéutico , Hemoptisis/radioterapia , Humanos , Terapia por Inhalación de OxígenoRESUMEN
AIMS: Endobronchial brachytherapy (EBBT) is a useful modality for the palliation of endobronchial symptoms in advanced non-small cell lung cancer (NSCLC). We report our experience with a special emphasis on duration of symptom palliation and the impact on quality of life (QOL). MATERIALS AND METHODS: The records of 95 previously untreated patients with locally advanced NSCLC were treated with palliative radiation using EBBT with or without palliative external radiation (XRT) were analysed. Eighty patients received EBBT and palliative XRT. EBBT was delivered in two sessions of EBBT 8Gy each or a single session of 10Gy. Fifteen patients received EBBT alone to 15Gy in a single session. Symptomatic response rates, duration of symptom palliation, obstruction scores and complications were assessed and compared. Quality of life outcomes, measured using the EORTC QLQ C30 and LC13 questionnaires, were analysed. RESULTS: The overall symptomatic response rates were 93% for dyspnea, 81% for cough, 97% for haemoptysis and 91% for obstructive pneumonia. The median time to symptom relapse was 4-8 months for all symptoms, and the median time to symptom progression was 6-11 months. Quality of life showed significant improvement in symptom scores, functional scales and overall QOL. Complication rates were low. Only one patient died of fatal haemoptysis. CONCLUSION: EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, with a relatively long duration of symptom palliation and a considerable improvement in the quality of life. There is significant reduction of endobronchial obstruction.
Asunto(s)
Braquiterapia , Neoplasias de los Bronquios/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Cuidados Paliativos , Calidad de Vida , Adulto , Anciano , Braquiterapia/efectos adversos , Tos/etiología , Tos/radioterapia , Disnea/etiología , Disnea/radioterapia , Femenino , Hemoptisis/etiología , Hemoptisis/radioterapia , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neumonía/etiología , Neumonía/radioterapia , Dosificación RadioterapéuticaRESUMEN
Passive smoking has been shown to be a risk factor for respiratory diseases in children. Some authors reported reduced lung function of children exposed to passive smoking. The purpose of the study was to assess the prevalence of exposure to passive smoking and its relation to respiratory health of Kaunas children. In 1998-2000 a cross-sectional survey was conducted in 20 kindergartens of Kaunas. Survey participants were 594 children (356 boys and 238 girls) aged 6-7 years. Children's parents filled out a questionnaire of the Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution designed on the basis of International Study of Asthma and Allergy in Childhood. Exposure to passive smoking was determined by an answer "everyday" or "sometimes" to the question "How often is your child in surrounding where someone smokes?". The parameters of respiratory function (FVC, FEV1, FEV1/FVC, FEF25, FEF50, FEF75, PEF) were measured with Pony Graphics 3.5. Response rate was 58.6% to 69.2% depending on a kindergarten. More than two fifth of children were exposed to passive smoking at home. Cough that lasted for at least four weeks during the past year was experienced by 24.5% and 16.9% of children with and without exposure to passive smoking (p<0.05). Wheezing in the past was found in 43% and 27% of children in groups compared (p<0.05). There was a significant difference in prevalence of sneezing or a runny/blocked nose when a child did not have a cold among children with and without exposure to passive smoking (46.6% and 36.6%, respectively, p<0.05). FEF25, FEF50, FEF75 and PEF of exposed girls were significantly lower than that of girls not exposed to passive smoking. Multiple regression analysis that included variables such as passive smoking, family history of allergy, smoked mother during pregnancy, gas stove and pets in child's room showed that FEF25 and FEF50 in girls were related to passive smoking. Our data show that more than two fifth of children are exposed to passive smoking which is associated with increased prevalence of chronic cough, wheezing, running nose and sneezing without cold. Passive smoking is also related to decreased lung function, especially for small airway flows.
Asunto(s)
Enfermedades Respiratorias/etiología , Contaminación por Humo de Tabaco/efectos adversos , Factores de Edad , Niño , Tos/radioterapia , Estudios Transversales , Femenino , Humanos , Masculino , Pruebas de Función Respiratoria , Hipersensibilidad Respiratoria/etiología , Ruidos Respiratorios , Factores de Riesgo , Factores Sexuales , Estornudo , Encuestas y CuestionariosRESUMEN
PURPOSE: To evaluate prospectively the efficacy, toxicity, and duration of the palliative effect of retreatment with external beam radiotherapy in symptomatic patients with recurrent non-small-cell lung cancer. METHODS AND MATERIALS: Twenty-eight symptomatic patients with local recurrence of non-small-cell lung cancer underwent repeated treatment after previous radiotherapy (equivalent dose, 46-60 Gy). Reirradiation consisted of two fractions of 8 Gy on Days 1 and 8 with two opposed beams using 6-18-MV photon beams at the site of pulmonary recurrence. The physician scored symptom resolution. RESULTS: Relief of hemoptysis and superior vena cava syndrome could be obtained in all assessable cases (100%). Treatment was less effective for coughing (67%) and dyspnea (35%). The overall median duration of this palliative effect was 4 months. Palliation in almost all patients lasted more than one-half of their remaining life span. The Karnofsky performance score improved in 45% of assessable cases. One patient had Grade 2 esophagitis. Complications consisted of tumor-related fatal hemoptysis in 5 patients (17%) and 1 death from bronchoesophageal fistula (4%). CONCLUSION: External beam hypofractionated reirradiation can be effective as a palliative treatment for local complaints in non-small-cell lung cancer. The complication rate of reirradiation was acceptably low.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Recurrencia Local de Neoplasia/radioterapia , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Intervalos de Confianza , Tos/radioterapia , Disnea/radioterapia , Femenino , Hemoptisis/radioterapia , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/complicaciones , Cuidados Paliativos , Estudios Prospectivos , Dosificación Radioterapéutica , Retratamiento , Síndrome de la Vena Cava Superior/radioterapia , Análisis de SupervivenciaRESUMEN
STUDY OBJECTIVE: We evaluated bronchoscopic tumor appearance and tumor location as determinants of response to high-dose rate brachytherapy (HDR-BT) in patients with symptomatic unresectable bronchogenic carcinoma previously treated with external-beam irradiation. PATIENTS AND METHODS: Thirty patients with symptomatic endobronchial bronchogenic carcinoma who had previously completed external irradiation were divided into two groups based on whether the initial bronchoscopic appearance showed an endoluminal mass or submucosal infiltration/extrinsic compression. Furthermore, patients were also classified based on tumor location: central (trachea or mainstem bronchi) and peripheral (lobar or segmental bronchi). Patients underwent three treatments of 800 cGy intraluminal irradiation at 2-week intervals, with follow-up evaluation 4 weeks later. We evaluated response in tumor extent based on bronchoscopic and chest radiograph appearance, as well as symptoms with standardized scales. RESULTS: Fifteen of 24 patients who underwent follow-up bronchoscopy had reductions in the degree of endobronchial obstruction. Seven of 24 patients had radiographic improvement in the extent of atelectasis. Patients with both tumor appearances (endoluminal and submucosal/extrinsic compression) had significant improvements following HDR-BT with regard to hemoptysis. Patients with submucosal disease also had improvement in cough. Patients with peripheral tumors had better rates of response for hemoptysis and cough than did those with central tumors. CONCLUSION: HDR-BT may result in symptomatic improvement in patients with bronchogenic carcinoma, whether characterized endoscopically as endoluminal projection or submucosal infiltration/extrinsic compression. Peripheral tumors have better rates of response than central tumors, possibly on the basis of less extensive disease.
Asunto(s)
Braquiterapia , Carcinoma Broncogénico/radioterapia , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Obstrucción de las Vías Aéreas/patología , Obstrucción de las Vías Aéreas/radioterapia , Bronquios , Neoplasias de los Bronquios/patología , Neoplasias de los Bronquios/radioterapia , Broncoscopía , Carcinoma Broncogénico/diagnóstico por imagen , Carcinoma Broncogénico/patología , Tos/radioterapia , Fraccionamiento de la Dosis de Radiación , Disnea/radioterapia , Estudios de Seguimiento , Hemoptisis/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Cuidados Paliativos , Neumonía/radioterapia , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/patología , Atelectasia Pulmonar/radioterapia , Radiografía , Dosificación Radioterapéutica , Inducción de Remisión , Neoplasias de la Tráquea/patología , Neoplasias de la Tráquea/radioterapia , Resultado del TratamientoRESUMEN
In April 1988 the Christie Hospital started using the microSelectron-HDR machine to deliver intraluminal radiotherapy (ILT) to inoperable bronchial carcinomas causing symptoms due to endobronchial disease. Results of treatment in the first 406 patients with primary non-small-cell carcinoma are presented. Three main categories of patient were defined. Category 1 consisted of 324 patients (79.8%) who were previously unirradiated and received a single fraction of ILT as their primary treatment, mostly to a dose of 1500 cGy (76%) or 2000 cGy (23%) at 1 cm from the centre of the iridium-192 treatment source. The percentage of these patients whose symptoms or signs were improved at 6 weeks following ILT were as follows: stridor 92%, haemoptysis 88%, cough 62%, dyspnoea, 60%, pain, 50% and pulmonary collapse, 46%. Approximately two-thirds of these patients (67.3%) derived long lasting palliation and required no further treatment during their lifetime. The other third of patients needed subsequent treatment at some stage because of recurrence of their symptoms and in this situation external beam radiotherapy (EB) or a repeat ILT treatment was effectively utilised. Category 2 consisted of 65 patients (16%) who had previously received EB but required ILT when their tumour recurred. At 6 weeks post-ILT levels of symptom palliation were broadly similar to those obtained if ILT was used in previously unirradiated individuals, although the improvement was not so well sustained with time and only 7% showed improvement in pulmonary collapse at 6 weeks. Category 3 consisted of 17 patients (4.2%) in whom ILT was used concurrently with EB as a combined initial treatment. Similar levels of palliation were seen when compared with patients who received a single ILT treatment only. Overall, ILT was well tolerated in terms of early and late morbidity. In conclusion, the efficiency of a single ILT treatment in palliating symptoms due to endobronchial tumour in previously unirradiated individuals is comparable with that reported in series where treatment for advanced lung cancer combines a prolonged course of EB concurrently with several ILT treatments.
Asunto(s)
Braquiterapia , Neoplasias de los Bronquios/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares , Anciano , Carcinoma de Células Escamosas/radioterapia , Causas de Muerte , Tos/radioterapia , Disnea/radioterapia , Femenino , Estudios de Seguimiento , Hemoptisis/radioterapia , Humanos , Radioisótopos de Iridio/administración & dosificación , Radioisótopos de Iridio/uso terapéutico , Masculino , Recurrencia Local de Neoplasia/radioterapia , Dolor/radioterapia , Cuidados Paliativos , Atelectasia Pulmonar/radioterapia , Dosificación Radioterapéutica , Ruidos Respiratorios/efectos de la radiación , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Fifty patients with inoperable, symptomatic endobronchial carcinoma were treated by a single exposure of intraluminal radiotherapy. A high dose rate afterloading system (the micro-Selectron-HDR) was used to minimise radiation exposure for staff. Haemoptysis was relieved in 24 of 28 patients, breathlessness in 21 of 33 patients, and cough in nine of 18 patients. Radiological collapse resolved in 11 of 24 patients. Treatment was given on an outpatient basis and was well tolerated. Intraluminal radiotherapy appears to offer an effective alternative to conventional fractionated external beam radiotherapy.