The Canadian journal of oncology
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Non-small cell lung cancer is the most common cause of cancer death in both males and females. Despite this high incidence and mortality, comparatively little research has addressed the palliative treatment of thoracic symptoms. Until recently, information regarding the indications and effectiveness of radiation in this setting was obtained from retrospective reviews of single institutional experiences. ⋯ The panel agreed that favourable patients with stage IIIB NSCLC should be offered combined modality therapy with the intent of prolonging survival, and that patient preferences regarding the risks and benefits of this therapy should be considered. Further study was recommended, namely, a randomized trial evaluating five fractions of radiation vs a single fraction, using patient-based evaluation of palliation. The panel also recommended phase II development of a combined chemotherapy and low-dose radiation protocol appropriate for future study.
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In fact that radiation therapy is often the most effective means of palliating symptoms caused by cancer is well recognized in the United States. Estimates of the proportion of patients treated in the US with radiation therapy who are treated for palliative rather than curative intent range from 15% to 50% and depend on the geographic location, cancer incidence, referral patterns, etc. ⋯ Estimates from patterns of care studies indicate that over 250,000 patients were treated with palliative radiation therapy at a cost of between $1.0 and $1.8 billion in 1994. The scope of this presentation will cover four aspects of palliative radiation therapy in the United States: 1. existing practice patterns; 2. factors affecting treatment patterns; 3. the cost of palliative radiation therapy; and 4. present research and guidelines developments efforts.
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Comparative Study
Controlling the toxicity of palliative radiotherapy: the role of 5-HT3 antagonists.
A significant number of cancer patients undergoing palliative radiotherapy experience treatment-related nausea and vomiting. A number of factors are known to influence the incidence and severity of radiation-induced sickness including the site, field size and dose per fraction. The age of the patient and the level of patient anxiety may also play a role. ⋯ It is generally accepted that there is a high risk of nausea and vomiting associated with high doses of radiotherapy; however, this effect has never been adequately quantified. Nonetheless, as a consequence of radiation-induced nausea and vomiting, patients may experience a decrease in their quality of life and may choose to delay or even refuse further treatment. Thus, controlling the adverse side effects associated with radiation therapy is critical to optimal patient care.