Palliative treatments

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). 

The goal of treatment depends on the stage of disease. Stages I, II, and III are potentially curable the intent is to eradicate micrometastatic disease. Twenty to thirty percent of patients with metastatic disease may be cured if their metastases are resectable. Most stage IV disease is incurable palliative treatment is given to reduce symptoms, avoid disease-related complications, and prolong survival. 

Blais et al. prepared tri- and tetra-meta-glucosylated chlorin derivatives.77 The aim was to assess how the sugar units linked to chlorin derivatives affect the photoactivity, cell internalization and subcellular localization in HT29 human adenocarcinoma cells. This was compared with the action due to meso-tetrakis(m-hydroxyphenyl)chlorin, a compound being formulated as photosensitiser (Foscan ) for palliative treatment of head and neck cancers. 

Tamoxifen is a competitive inhibitor of estradiol. It is used for palliative treatment of estrogen-receptor positive breast cancer. It is used in combination with other chemotherapeutic agents. Synonyms of this drug are nolvadex, cessar, and others. 

Estrogens, estrone (28.1.9), estradiol (28.1.17), ethynylestradiol (28.1.26), diethylstilbe-strol (28.1.33), and chlorotrianisene (30.5.2), are used for palliative treatment of postmenopausal breast cancer, prostate cancer, and breast cancer in men. It is highly probable that the mechanism of action is similar to the mechanism of action of androgens. 

Progestins, steroid compounds similar to progesterone, such as hydroxyprogesterone caproate (28.3.6), medroxyprogesterone acetate (28.3.7), and megestrol acetate (28.3.7), are used for palliative treatment of breast carcinomas and renal tumors. Progestins can have a direct local effect on cells, and can simultaneously lower the quantity of leutenizing hormone. 

Tamoxifen is used for palliative treatment of breast cancer in pre- and post-menopausal women. 

In combination with 5-fluorouracil (5-FU) to prolong survival in the palliative treatment of patients with advanced colorectal cancer. 

Tumors (tablets only) - Palliative treatment of advanced carcinoma of the breast or endometrium (refer to the monograph in the Antineoplastics chapter). 

Treosulfan is also administrated orally. It is used as a last resort palliative treatment for carcinoma of the ovary. Bone marrow depression constitutes its main toxicity. 

Testolactone is a synthetic drug related to testosterone. It is used for palliative treatment of advanced breast cancer in postmenopausal women and in women who have had their ovaries removed. The principal action of testolactone is reported to be inhibition of steroid aromatase activity and the reduction in estrone synthesis. The most common adverse effects are nausea, vomiting, and anorexia. An advantage is that it does not cause women to develop male characteristics such as a deep voice or facial hair. 

Chemotherapy as a single modality still has a role as palliative treatment in recurrent or metastatic disease. However, the median survival for patients with... 

Busulfan is used in the palliative treatment of chronic granulocytic leukemia. Daily oral therapy results in decreased peripheral white blood cells and improved symptoms in almost all patients during the chronic phase of the disease. Excessive uric acid production from rapid tumor cell lysis should be prevented by coadministration of allopurinol. 

Ketoconazole can be used as palliative treatment for Cushing s syndrome in patients undergoing surgery or receiving pituitary radiation and in those for whom more definitive treatment is still contemplated. Because surgical treatment is not always well tolerated by elderly patients, ketoconazole 200 to 1,000 mg/day can be a valuable alternative for the control of hypercortisolism. Common side effects include pruritus, fiver dysfunction, and gastrointestinal symptoms. 

Palliative treatment of advanced breast cancer PO 160 mg/day in 4 equally divided doses. 

Palliative treatment of advanced endometrial carcinoma PO 40-320 mg/day in divided doses. Maximum 800 mg/day in 1-4 divided doses. 

Besides increasing the cure rate, it is important to improve the tolerance to the treatment and reduce the long-term sequelae. Also, palliative treatments (in particular, pain relief) deserve attention for those patients for whom there is no hope anymore of a cure. 

Many addicts, however, report that weaning themseives off of methadone is just as bad as coming off of heroin or morphine addiction. Ultimately, primary treatments for opiate addiction rely on replacing one drug for another and are essentially palliative treatments. The user is never cured and will always be tormented by the specter of addiction. 

Metabolism occurs primarily in the liver. It is used as palliative treatment of disseminated mammary or prostatic carcinoma. 

Indications Palliative treatment of advanced prostate cancer, management of endometriosis, and treatment of central precocious puberty... 

B. Indications and use Lupron Injection, Lupron Depot, Lupron Depot-3 Month, and Lupron Depot-4 Month are indicated in the palliative treatment of advanced prostate cancer. These products offer an alternative treatment when orchiectomy or estrogen administration is either not indicated or unacceptable to the patient. Lupron Injection Pediatric and Lupron Depot-PED are indicated in the treatment of children with central precocious puberty. Lupron Depot and Lupron Depot-3 Month are indicated for the management of endometriosis, including pain relief and reduction of endometriotic lesions. 

Indications Palliative treatment of advanced carcinoma of the prostate and in combination with flutamide for the management of locally confined Stage T2b-T4 (Stage B2-C) carcinoma of the prostate, and the management of endometriosis. Zoladex is also used as an endometrial-thinning agent... 

---