Palliation of pain

Radiophosphorus is used in the treatment of patients with a number of diseases, lliis element has a half-life of about 14 days and emits beta rays. It is taken up by die body in the greatest quantity by those tissues which manufacture blood cells. In polycythemia vera, a condition in which too many red blood cells arc formed, the radiation from this isotope often brings about a sufficient suppression of the blood cell-making tissues to alleviate some of the symptoms of the disease. Leukemia patients, in whom there is an excessive production of white cells, are offered added comfort and, m some instances, prolongation of life by the use of radiophosphorus. This element also may be used m treatment of metastatic cancer to the bone and, although the treatment is not used in an attempt to eradicate cancer, it can result in significant palliation of pain in some patients. 

Atkins HL, Mausner LF, Srivastava SC, Meinken GE, Cabahug CJ, D Alessandro T. Tin-117m(4- -)-DTPA for palliation of pain from osseous metastases a pilot study. J Nucl Med 1995 36(5) 725-9. 

Crawford ED, Kozlowski JM, Debruyne FM, et al. The use of strontium 89 for palliation of pain from bone metastases associated with hormone-refractory prostate cancer. Urology 1994 44 481-485. 

PANCREATIC ENZYMES Chronic pancreatitis is a debilitating syndrome that results in symptoms from loss of glandular function (exocrine and endocrine) and inflammation (pain). The goals of pharmacologic therapy are prevention of malabsorption and palliation of pain. The cornerstone of therapy for malabsorption is the use of pancreatic enzymes. 

Tin-117m has been in Phase II/III clinical trials for palliation of pain caused by breast and prostate cancer metastasized to bone (Atkins et al. 1993, 1995). This isotope of tin can be produced in a reactor by Sn(n,y) Sn and Sn(n,n ) Sn reactions. Alternative production routes via proton-induced reactions on Sb isotopes in an accelerator are also possible. 

Embolization Adrenal arterial emboKzation was performed in nine of our patients, four with inoperable adrenal cortical carcinoma and five with metastatic adrenal tumors. In eight patients, palliative embolization was performed either to decrease tumor bulk, suppress tumor hormonal function (n=3), or relieve pain (n=4). In four patients in whom it was possible to assess the effect of embolization, a striking reduction in size had occurred in one (Fig. 9.13), the lesion remained stable in size for 12 months in two, and the tumor continued to grow in the fourth. A reduction in the production of cortisol for 12 months was seen in two of the three patients with Cushing s syndrome (Fig. 9.13). Adrenal emboKzation resulted in the effective palliation of pain in three out of four patients and may have contributed to its amehoration in the fourth. Apart from a hypertensive episode in one patient, no serious compKcations occurred (O Keeffe et al. 1988). 

Embolization Embolization of skeletal neoplasms was initially performed as an adjunct to surgical resection for hypervascular tumors to decrease operative blood loss (Chuang et aL 1981a Dick et al. 1979). Subsequently, this technique was adapted for palliation of pain caused by skeletal metastases (Feldman et al. 1975). At MDACC, most of the giant cell tumors in a group of 21 patients with these neoplasms were located in the sacrum, Oium, and thoracolumbar spine and had not responded to other forms of therapy. 

Embolization Transarterial embolization produces a reduction in surgical blood loss and allows more extensive surgical procedures to be done. Embolization has also been used for the palliation of pain caused by skeletal metastases (Fig. 9.19) (Reuter et al. 1992). Our efforts have been mostly concentrated on hypervascular metastases such as those from renal and thyroid carcinomas. Metastases from renal cell carcinoma like the primary neoplasm are hypervascular in 65%-85% of cases. The incidence of skeletal metastases is 30%-45% for patients with renal cell or thyroid carcinoma (Monteil et al. 1985 Rowe et al. 1984 Weber 1982). The 5- and 10-year survival rates for this patient population is 65% and 18%, respectively (Marcocci et al. 1989), compared with an 80%-95% 10-year survival in the absence of bone metastases (Schlumberger 1998). 

Interventional radiological techniques aim primarily at the palliation of painful or disabling conditions. They are an essential component of modern palliative medicine and cancer treatment. This book is a timely addition to the series Medical Radiology - Diagnostic Imaging. 

Bayer first sold aspirin powder to the public in 1899, and introduced a water-soluble tablet in 1900. The company estimates that 50 billion tablets are now consumed yearly on a worldwide basis. In addition to tablets, the French prefer their aspirin in suppository form, while the Italians prefer it fizzy. Aspirin is no longer just taken for headaches and aches and pains. According to Bayer market research, palliation of heart disease is now the number one use of aspirin. 

Photodynamic therapy using porfimer sodium is indicated for palliation of symptoms in patients with completely or partially obstructing esophageal cancer or micruinvasive. small cell lung cancer. Adverse reactions include ocular sensitivity. chest pain, and respiratory distress. 

Radiation therapy (radiotherapy) is used in a variety of settings for the treatment of NSCLC. Thoracic radiotherapy may be administered with curative intent for treatment of smaU localized tumors in some patients. Radiotherapy is most commonly administered postsur-gically (adjuvant therapy) for prevention of local disease recurrence, as well as in advanced disease for the palliation of tumor-related symptoms (i.e., control of pain from bone metastases, hemoptysis, or obstructive symptoms). 

Kan MK. 1995. Palliation of bone pain in patients with metastatic cancer using strontium-89 (Metastron). Cancer Nurs 18(4) 286-291. 

Tc and, in fewer cases. Re compounds have found applications in medicinal inorganic chemistry as radiopharmaceuticals for clinical diagnosis ( Tc for scintigraphic and emission tomographic imaging) or even therapy ( Re e.g. for the palliation of severe bone cancer pain). ... 

Indications Androgen deficiency (growth deficits, impotence), delayed puberty in males, palliation of breast cancer, postpartum breast pain and engorgement. 

A radiopharmaceutical emitting alpha or beta radiatimi can be used for therapeutic or palliative purposes. These types of radiopharmaceuticals deposit their energy on very short distances. For alpha emitters this distance is much shorter than for beta emitters. This high-dose locally accumulated radioactivity is used in radionuclide therapy (pain palliation of bone metastases, therapy for some specific types of cancer). 

The patient is placed in a supine position on the CT table. At the level of T12, the celiac and superior mesenteric arteries are localized after intravenous bolus injection of the contrast medium. Precise localization of the celiac plexus is obtained from these vascular structures which represent the most constant landmarks. A 22-gauge needle is inserted by an anterior approach to reach the pre-aortic retroperitoneal area. After CT scan confirmation of the needle tip position immediately lateral to the celiac artery and in front of the anterior aspect of the aorta, 2 ml of diluted contrast medium are injected to predict the diffusion of ethanol. After the injection of 10 ml of 1% lidocaine to palliate the painful alcohol injection, neurolysis is achieved with 25 ml of 50% ethanol... 

Palliation of symptoms in nonoperable patients was also included in some outcome analyses. The details of symptoms and therapeutic effects of renal artery embolization are generally lacking, but studies generally reported thathematuria, pain, and paraneoplastic symptoms were alleviated. In one study, severe hematuria resolved in 11 of 14 patients, and incomplete embolization of the tumor blood supply from parasitized lumbar arteries resulted in persistent hematuria in 3 of 14 patients [11]. In another study, malignant hypercalcemia resolved after embolization [10]. Kalman and Varenhorst concluded that a small group of patients with specific, tumor-related symptoms may benefit from embolization. However, the palliative effect of embolization cannot be evaluated from the available data, and the effectiveness of the procedure awaits validation. 

RF ablation is a good method of palliation in patients who have severe pain caused by distension of the liver capsule by large tumours. In such cases, coagulation of the tumour often provides rapid relief of pain (Fig. 24.2). 

Radiation is an important modality in the treatment of symptomatic metastatic disease. The most common indication for treatment with radiation therapy is painful bone metastases or other localized sites of disease refractory to systemic therapy. Radiation therapy gives significant pain relief to approximately 90% of patients who are treated for painful bone metastases. Radiation is also an important modality in the palliative treatment of metastatic brain lesions and spinal cord lesions, which respond poorly to systemic therapy, as well as eye or orbit lesions and other sites where significant accumulation of tumor cells occurs. Skin and/or lymph node metastases confined to the chest wall area also may be treated with radiation therapy for palliation (e.g., open wounds or painful lesions). 

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