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CSB025 > Palliative technique > Flashcards

Palliative technique Flashcards

1
Q

What are the main principles of palliative treatment?

A

manage symptoms, reduce pain and function restore or preserve. Increased QOL

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2
Q

Palliative intent

A

SVC obstruction
Osteolytic bone mets
Brain mets

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3
Q

SVC obstruction

A

a mass pushes against the superior-vena-cava and

impedes heart function.

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4
Q

Osteolytic bone mets

A

eat into healthy bone by ‘lysing’ (cause

destruction) bone cells, causing skeletal dysfunctions.

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5
Q

Brain Mets

A

can disrupt the healthy function of the rest of the brain,
causing confusion and dizziness among other things. RT relieve this
impediment, effectively restoring normal function to the rest of the organ

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6
Q

Pre treatment

A

Medication

Important to ensure the patient has anti-emetics prescribed and taken prior to treatment

Choosing right anti-emetics for each patient

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7
Q

Common anti-emetics:

A
  • Domperidone (relieve nausea and vomiting)
    • Metoclopramide (treat heatburn
    • Ondansetron (prevent nausea and vomiting)
    • Dexamethasone - a steroid that controls vomiting
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8
Q

Palliative treatment sites

A
  • Bone
    • Brain (could be radical)
  • Lung (could be radical)
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9
Q

Patient handling considerations

A

Lots of pain, delicate & fragile

May be suffering the effects of opiate drugs

Neck braces, casts and splints (can have metals in braces)

May be non-ambulant

Need to take it carefully and if necessary slowly

Need LOTS of communication!
Involve nurses and RO’s

May also requires orderlies or ward staff to assist with movement

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10
Q

Field arrangements

A

Minimal for minimal time on couch

Low doses and large margins
Critical structures – Site-specific: cord for higher dose lung volumes. Bowel for lower spines, pelvis and hips

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11
Q

Maximum and minimum dosage for palliative treatment

A

Maximum dosage: 125%

Minimum dosage: 95%

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12
Q

Maximum dose limit for spinal cord:

A

45Gy

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13
Q

How to maintain field QA

A

Single Portal on first fraction

Double exposure if necessary

Subsequent repeats if move was necessary

Weekly if >1 week treatment

Tolerances usually loose (~5mm to 1cm)

Consider intrafraction patient motion for large daily doses and low fractionation
IGRT

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14
Q

Acute side effects of palliative treatment

A

• Oedema, epithelial irritation, presenting symptoms diarrhoea, nausea,
vomiting, increased pain
• fatigue, mild/moderate skin reactions

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15
Q

Longer term side effects of palliative treatment

A

• Oedema, growth stunting, fibrosis, cardiac damage, damage to optic chiasm,
endocrine dysfunction, myelopathy, Lhermitte’s syndrome, infertility, carcinogenesis

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16
Q

Which primary tumours most commonly metastasise to bone?

A

Breast, prostate, lung

17
Q

At autopsy how many patients who die from cancer are shown to have skeletal masses?

18
Q

2 histological cell types

A

Osteolytic and osteoblastic
Osteolytic: deposits in the bone that lyse (cause destruction) to surrounding bone cells
Osteoblastic: cause formation of new bone that is often deformed and weak

19
Q

Osteolytic causes

A

lung, melanoma, thyroid, kidney, colon, breast

20
Q

Osteoblastic causes

A

Breast, prostate, bladder, stomach

21
Q

Bone mets field techniques

A
  • Single field
  • Parallel opposed pair (APPA or Laterals)
  • Direct electron fields
22
Q

Spinal cord compression

A

Medical emergency: 70% T, 20% L, 10% C

23
Q

symptoms of spinal cord compression

A

Pain, weakness of legs, bladder or bowel dysfunction, paraplegia. Should be treated quickly to prevent permanent damage

24
Q

Spinal cord compression Gy

A
  1. 8 Gy in 1
  2. 12 Gy in 2, 7 days apart
  3. 20Gy in 5 given in 1 week
  4. 30 Gy in 10, given in 2 weeks
25
Q

Brain mets origin

A

1/3 of all brain lesions are metastatic

Originates from: Lung (35%), Breast (15%), Melanoma (8%). Renal cell, colorectal

26
Q

Brain mets symptoms

A

ICP and headaches, focal neurological damage, convulsions, personality changes (Aggressive and agitated)

27
Q

Whole brain fractionation

A

• 20Gy in 5# • 30Gy in 10# (most common) • 12Gy in 2#

28
Q

Whole brain side effects

A 
Raised intracranial pressure symptoms
Nausea
Vomiting
Seizures
Coma
Death
29
Q

Lung indications for radiotherapy

A

bronchial involvement, SVCO

30
Q

SVC obstruction symptoms

A

Swelling of face, neck and arms
Characterised by distended veins on the chest
Shortness of breath, hoarse voice and headache

31
Q

Fractionation of SVC

A

• 20Gy in 5# • 30Gy in 10#

32
Q

Haemorrhage

A

Emergency
Lung patients can present with haemoptysis
Advanced gynae tumours can present with pelvic haemorrhage

CSB025 (14 decks)

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