Palliative Treatment Of Advanced Cancer Research Articles

Palliative radiotherapy for children: Symptom response and treatment-associated toxicity according to radiation therapy dose and fractionation.

Radiotherapy is an effective palliative treatment in advanced cancer. Shorter palliative treatment courses are recommended for adults, though pediatric data addressing treatment efficacy and toxicity according to radiation therapy (RT) dose and fractionation are limited. Total 213 patients aged 21years or younger receiving 422 palliative radiotherapy treatment courses from 2003 to 2016 were included. Symptom response and treatment-associated toxicity were recorded and analyzed in relationship to demographic and treatment variables. Common diagnoses included sarcoma (32.5%), neuroblastoma (24.9%), leukemia/lymphoma (14.9%), and central nervous system tumors (10.9%). The most common indication for treatment was pain (46.7%). Patients received a median of 10 fractions, 2.5Gy dose per fraction, and 21Gy total dose. Number of RT fractions was five or less in 166 (39.3%), six to 10 fractions in 117 (27.2%), and 10 or more fractions in 139 (32.9%) of courses. Complete or partial pain relief was achieved in 85% (151 of 178 evaluable patients), including 77.8% receiving five or less fractions and 89.6% receiving more than five fractions. Highest toxicity was grade 1 in 159 (38.9%), grade 2 in 26 (6.4%), and grade 3 in two (0.5%) treatments. On multivariable analysis, RT delivered 30 or more days from death (OR 12.13, 95% CI: 2.13-69.2, p=.005) and no adjuvant chemotherapy (OR 0.14, 95% CI: 0.03-0.54, p=.005) were significantly associated with pain response, and five or less fractions were significantly associated with lower toxicity (OR 0.24, 95% CI: 0.06-0.97, p=.045). Palliative RT courses of five or less fractions result in high rates of pain control and are associated with low toxicity in pediatric patients with cancer.

Practical approaches to minimize problems with missing quality of life data.

Missing information on quality of life (QOL) is a significant problem in many cancer trials particularly for patients with advanced disease, where clinical deterioration may be a reason for not responding to quality of life assessments. Examples from four clinical trials are presented where non-respondents to quality of life assessments have poorer health than respondents. In this context, auxiliary outcome variables, such as health status, may be useful proxies in assessing the impact of missing QOL data on estimated treatment effects. This approach is illustrated in a trial of palliative treatment in advanced cancer. A method for imputation of missing QOL data based on auxiliary outcome variables is also illustrated. However, the most effective method of minimizing the problem of missing data is in designing the trial with preventative strategies in place. Since some missing data due to deteriorating health may still occur, the design should include the collection of auxiliary QOL information. Preventative strategies are illustrated with an ongoing trial in advanced breast cancer.

A randomised trial of low-dose/high-frequency chemotherapy as palliative treatment of poor-prognosis small-cell lung cancer: a Cancer research Campaign trial

We report the results of a randomised trial in extensive small-cell lung cancer (SCLC) of a novel approach to palliative chemotherapy. A widely used 3 weekly regimen was compared with the same drugs given at half the dose but twice the frequency with the same intended overall dose intensity (DI). A total of 167 patients defined as having extensive SCLC with adverse prognostic features were randomised to receive either a 3 weekly regimen of cisplatin 60 mg m-2 i.v. on day 1 and etoposide 120 mg m-2 i.v. on day 1 and 100 mg b.d. orally on days 2 and 3 alternating with cyclophosphamide 600 mg m-2 i.v., doxorubicin 50 mg m-2 i.v. and vincristine 2 mg i.v. all on day 1 for a maximum of six courses (3 weekly); or treatment with the same drugs but with each course consisting of half the 3 weekly dose given every 10 or 11 days for a maximum of 12 courses. In the 10/11 day regimen overall response rate was 58.9% (95% CI, 47.9-69.2%) with 12.8% complete responses (CR). For the 3 weekly treatment the overall response rate was 44.9% (95% CI, 35.0-55.5%) with 10.1% CR. Median survival was similar in the two arms at 6.4 months (95% CI, 4.9-7.3 months) and 5.8 months (95% CI, 4.0-6.6 months) respectively. Survival at 1 year was 9.9% (95% CI, 5.0-18.5%) and 8.9% (95% CI, 4.6-16.6%). The 95% CI for the difference in survival at 1 year is -7.09% to +9.09%. Haematological toxicity and treatment delays owing to infection were more frequent with the 10/11 day regimen but other toxicities were equal in both arms. Other aspects of quality of life were measured in a small representative cohort of patients using a daily diary card (DDC). There was a trend of improved quality of life on the 10/11 day arm, but there was little difference between the two treatments. The trial shows that a low-dose/high-frequency regimen with the same DI as conventionally scheduled chemotherapy gives similar response rates and survival. This and other modifications of the schedule may offer new approaches to palliative treatment of advanced cancer. However, in this trial there was no significant benefit in toxicity or other aspects of quality of life.

Spatially fractionated (GRID) radiation for palliative treatment of advanced cancer

To evaluate the use of single large doses spatially fractionated radiation (GRID) therapy either alone or in combination with conventional radiation in the palliative treatment of advanced cancer. Sixty-one patients with advanced cancer who had exhausted conventional approaches to palliative treatment with surgery, chemotherapy and/or radiotherapy were treated with high dose GRID therapy using high energy photons. Seventy-two symptomatic areas of disease were irradiated. A 50:50 GRID (open to closed areas) was utilized and a single fraction of 1,000–2,000 cGy to dmax was delivered to the open areas using a single field with either 6 MV or 25 MV photons. Follow-up ranged from 2 weeks to 28 months. Short follow-up times in some patients was due to their end stage disease. Patients were analyzed for palliation of symptoms and normal tissue morbidity. Sixty-four of 72 treatments were evaluable for palliative response. The results of treatment indicated a 27% (17/64) complete palliative response. A partial response was obtained in 64% (41/64). Overall response rate was 91%. Pain was the primary reason for treatment. Twenty-eight percent complete pain relief and 62% partial pain relief was achieved with GRID therapy. Symptoms related to large tumor masses were completely relieved in 19% and partially relieved in 71%. No acute morbidity was observed in spite of the large single doses delivered. Eight patients who were followed 12 to 28 months have shown no late morbidity. The use of spatially fractionated GRID therapy to deliver large single doses of radiation for palliative treatment has proven effective, especially for patients with short life expectancies. Further optimization of the GRID radiation distribution and maximum tolerable doses need to be established. Radiat Oncol Invest 1996;4:41–47. © 1996 Wiley-Liss, Inc.

Spatially fractionated (GRID) radiation for palliative treatment of advanced cancer

Spatially fractionated (GRID) radiation for palliative treatment of advanced cancer

The Karnofsky performance status scale re-examined: a cross-validation with the EORTC-C30

A cross-validation of the Karnofsky Performance Status (KPS) and quality of life (QOL) as measured by item 30 of the quality of life questionnaire developed by the European Organization for Research and Treatment of Cancer Study Group (EORTC QLQ-C30) was conducted using ordered logit analysis and prospective data from a continuous sample of 139 lung cancer patients. The QOL is found to be a much broader concept than the KPS, since it likely captures not only physical functioning but also functioning in the non-physical dimensions of social, emotional, and possibly cognitive well-being as well as the level of distress in the physical dimensions of pain, breathing and fatigue. These results suggest that the palliative treatment of advanced cancer and the terminally ill should be guided by a broad concept of well-being that goes beyond one based only on physical functioning.

Palliative treatment of advanced cancer using multiple nonconfluent pencil beam radiation: A pilot study

In the era of orthovoltage radiation, multiple nonconfluent pencil beam radiation (GRID) therapy was utilized to minimize superficial normal tissue damage while delivering tumorcidal doses at specified depths in tissues. The success of GRID therapy was based on the fact that small volumes of tissues could tolerate high doses of radiation. Since the development of megavoltage radiation and skin sparing, GRID therapy has been abandoned. In a pilot study, the authors adapted the principles of GRID therapy to megavoltage photon beams to treat patients with massive tumors or recurrent tumors after tolerance doses of radiation. Twenty-two patients have been entered in the study. All patients were symptomatic and had exhaustive conventional surgery, chemotherapy, and radiotherapy approaches to treatment. A 50:50 GRID (open to closed areas) was utilized, and a prescribed dose of 1000 to 1500 cGy to the open areas was given using a single photon field. In four patients, a second GRID treated was delivered at a split course interval of 4 weeks. The follow-up in these patients ranges from 1 month to 18 months. The results of treatment have been remarkable with 20 of 22 patients achieving dramatic relief of severe symptoms, and several patients showing significant objective regression. No acute effects have been observed, including those patients having large volumes of the abdomen irradiated. No unusual skin or subcutaneous early or late damage has been observed in follow-up.

A METHOD OF CALCULATING THE VALUE OF PALLIATIVE CARE OF CANCER PATIENTS

There are no entirely satisfactory methods for measuring the value of palliative treatment of advanced cancer. A useful instrument of measurement should take into account both length and quality of survival. A method is proposed for determining the area under the time-quality of life curve, using Simpson's discrete approximation, an algorithm which can be programmed simply into a small computer or programmable calculator. The Karnofsky index has been used as an indicator of the quality of life, but the method is adaptable to other quality of life scales. Efficiency of palliation can be estimated by comparison with the area produced by theoretically perfect palliation. The ability to quantitate palliation in these ways might help to resolve uncertainties that surround the alternative methods of management of incurable cancer.

Effects of intensive sex steroid hormone therapy in advanced breast cancer.

Intensive therapy with estrogens and androgens is employed in the palliative treatment of advanced cancer of the breast. 1 Since observations of the systemic effects and complications of this therapy may provide a clue to the mode of action of the sex steroids in breast cancer, they may be important. Many effects of sex hormone therapy have been recorded, but additional manifestations not commonly recognized have become prominent and more frequently noted at the higher dosages usually employed in breast cancer. The purpose of this report is to record these reactions and their relative frequency with intensive and prolonged hormone therapy. The duration of treatment varied from a few days to several years. Deleterious reactions occurred early in some patients, necessitating discontinuance of therapy. Thus, effects that might have occurred at later intervals could not be recorded. Most of the patients, however, were treated for a minimum of one month,