Katherine Barrett and Andrea Bezjak* Pages 149 - 166 ( 18 )
Palliation may be the goal of care for some patients with intra-thoracic lung cancer. Factors such as the extent of disease, comorbidities, performance status, or symptom burden, may indicate that patients are unsuitable for more aggressive approaches with a curative intent. A palliative treatment plan implies a focus on the effective relief and control of symptoms, while preserving both the quality and quantity of life. Therapeutic measures may include palliative radiotherapy, palliative chemotherapy, or other forms of systemic treatment. In addition, certain interventional procedures may be used to achieve symptom palliation, and to maintain or improve quality of life. While eliciting relatively mild toxicity risks, palliative radiation can offer significant therapeutic value to patients with chest tumors. External beam radiation therapy is the most common technique in these circumstances. Select patients with endobronchial disease may benefit from methods that directly place radioactive sources at tumors that are accessible through the airway. A number of common radiation protocols describe various dose-fractionation patterns. While the efficacy profiles of different radiation schedules have been shown to be comparable, the side effects with each regimen, as well as the potential duration of benefit, often differ. Studies to date show that there is no clear advantage to combining chemotherapy concurrently with radiation for the palliative treatment of chest tumors.
Overall, the coordination and quality of care regarding selected treatment modalities, in continuity with efforts to support patient-defined goals, are of prime importance.
Palliative care, lung cancer, radiation treatment, metastases, chemoradiotherapy, radiotherapy.
Department of Radiation Oncology, University of Toronto, Toronto, 014, Department of Radiation Oncology, University of Toronto, Toronto, 014