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Palliative Radiation Oncology, 1st Edition

Neha Vapiwala, Joshua Jones, Kavita Dharmarajan
ISBN: 9780323876889
ISBN: 9780323876889
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Offering practical, comprehensive coverage of the many nuanced technical and clinical aspects of this growing field, Palliative Radiation Oncology provides up-to-date clinical guidance in a thorough yet concise manner. In an easy-access format, it integrates basic science, pathologies, and research with clinical applications, covering different ways to approach problems, tumor assessment, precise target definition, and dosing-specific guidelines to minimize side effects/toxicities while balancing with desired outcomes.
Key Features
  • Discusses optimal communication skills for pediatric, adult, and elderly patients.
  • Contains decision-making algorithms to guide individualized palliative radiation oncology treatment plans.
  • Reviews all the latest modalities with technical tips and pitfalls.
  • Covers key procedures such as external beam radiation therapy, intensity modulated radiation therapy, stereotactic body radiation therapy, and stereotactic radiosurgery.
  • Features step-by-step body site-specific guidelines with integrated symptom and toxicity management.
  • Covers symptom and symptom-cluster management, including pain and psychosocial or spiritual distress.
  • Ideal for radiation oncology residents, fellows, and practitioners, as well as medical oncologists, surgical oncologists, oncology nurses, and radiation technicians—all clinicians who work in this highly collaborative, team-based specialty.
  • An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud.
Author Information
Edited by Neha Vapiwala, M.D. , Associate Professor and Vice Chair of Education, Department of Radiation Oncology, Assistant Dean of Students, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ; Joshua Jones, M.D., M.A. , Assistant Professor of Clinical Radiation Oncology, Department of Radiation Oncology, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania and Kavita Dharmarajan, M.D. , Assistant Professor of Radiation Oncology, Assistant Professor of Geriatrics and Palliative Medicine, Mount Sinai Hospital, New York, New York

Περιεχόμενα

  • Cover image
  • Title page
  • Table of Contents
  • Copyright
  • Dedication
  • Contributors
  • Acknowledgment
  • Foreword
  • Preface
  •     List of Tables
  •     List of Illustrations
  • Section I. Foundations and Principles of Palliative Care in Oncology
  • 1.  Definition of palliative care
  •     What is palliative care?
  •     What is the difference between palliative care and hospice?
  •     How does palliative care differ from traditional oncologic care?
  •     What is the evidence that palliative care helps patients living with cancer?
  •     How does palliative care augment traditional oncologic care?
  •     How do communication and shared decision making help patients with cancer?
  •     What is the role of palliative care within radiation oncology?
  •     Summary
  •     References
  • 2.  Introduction to prognostication
  •     General principles of prognostication
  •     Strategies for estimating prognosis
  •     The SEER database
  •     Clinical factors related to prognosis
  •     Clinical prediction of survival
  •     Performance status
  •     Physical symptoms
  •     Laboratory studies
  •     Prognostication scores
  •     A final common pathway?
  •     Prognostic considerations in radiation therapy
  •     Clinical considerations
  •     Painful bone metastases
  •     Spinal cord compression
  •     Brain metastases
  •     Communicating prognosis
  •     Conclusion
  •     References
  • 3.  Basic communication frameworks
  •     Introduction
  •     Building rapport
  •     Screening for distress
  •     Responding to emotion
  •     Disclosing difficult news
  •     Discussing prognosis
  •     Managing uncertainty
  •     Medical jargon
  •     Cultural aspects of medical care
  •     Referral to specialist palliative care
  •     Discussing hospice care
  •     Challenging scenarios
  •     Additional communication training resources
  •     References
  • 4.  Troubleshooting difficult conversation
  •     Why is it important?
  •     Introductions
  •     Nonverbal communication
  •     Information and decision-making preferences
  •     Agenda-setting
  •     Recognizing and responding to emotion
  •     Sharing information
  •     VALUES
  •     Communicating serious news
  •     Preferences around prognosis
  •     Communicating prognosis
  •     Goals of care
  •     Communication pearls for the radiation oncologist
  •     Further resources
  •     References
  • 5.  Models of multidisciplinary management
  •     Background
  •     Early palliative care
  •     Palliative care delivery models
  •     Impact
  •     Limitations
  •     Future directions
  •     References
  • Section II. Techniques and Modalities
  • 6.  Palliative radiation
  •     What is the approach to the patient referred for palliative radiotherapy?
  •     Is the patient a candidate for palliative radiotherapy?
  •     What is the etiology of the patient’s symptom?
  •     Will radiation be able to help this symptom?
  •     Will the patient live long enough to derive benefit from radiotherapy?
  •     Is it safe to deliver radiotherapy?
  •     Are other evaluations or interventions needed prior to palliative radiotherapy start?
  •     For patients that are candidates for palliative radiotherapy, what is the optimal radiotherapy technique and dose?
  •     Summary
  •     References
  • 7.  Selecting modalities
  •     General considerations
  •     External beam radiation therapy with forward planning
  •     Intensity-modulated radiation therapy
  •     Stereotactic body radiation therapy
  •     Stereotactic radiosurgery
  •     Other treatment modalities
  •     References
  • 8.  Treatment planning in palliative radiotherapy
  •     Introduction
  •     Part I: Approaches for conventional external beam and stereotactic radiotherapy
  •     Part II: Additional innovative approaches for palliative radiotherapy
  •     Summary
  •     References
  • 9.  Alternate modalities for palliation
  •     Introduction
  •     Types of cancer pain
  •     Etiology of cancer pain
  •     When to consider alternative modalities of palliation
  •     General considerations when considering interventions in cancer populations
  •     Types of interventional pain specialists
  •     Commonly used interventional procedures
  •     Conclusion
  •     References
  • 10.  Combining radiation and systemic therapy
  •     Introduction
  •     Principles of combining radiation and systemic therapy
  •     Combining radiation with cytotoxic chemotherapy
  •     Combining radiation with targeted therapies
  •     Concluding remarks
  •     References
  • 11.  Considerations involving reirradiation
  •     Principles of reirradiation
  •     Techniques for reirradiation
  •     Reirradiation by site
  •     Conclusion
  •     Acknowledgments
  •     References
  • Section III. Foundations and Principles of Palliative Radiation by Body Site or Special Population
  • 12.  Palliative radiotherapy in the head and neck
  •     Introduction
  •     Palliative radiation therapy
  •     Overview of palliative regimens
  •     QUAD shot
  •     Addition of concurrent chemotherapy to QUAD shot
  •     30 to 32 Gy/5 to 8 fractions
  •     24 Gy/3 fractions
  •     20 to 25 Gy/5 fractions
  •     30 Gy/10 fractions
  •     40 Gy/10 fractions
  •     40 to 50 Gy/16 fractions
  •     Higher dose (50 to 72 Gy) regimens
  •     Stereotactic body radiation therapy
  •     Comparative studies of palliative radiation regimens
  •     Immunotherapy
  •     Discussion
  •     Conclusions
  •     References
  • 13.  Palliative thoracic radiation
  •     Introduction
  •     Thoracic radiation
  •     Superior vena cava syndrome
  •     Esophageal compression
  •     Malignant airway obstruction
  •     Recurrent laryngeal nerve paralysis
  •     Oligoprogressive disease
  •     Conclusions
  •     References
  • 14.  Palliative radiotherapy in the breast and chest wall
  •     Introduction
  •     Indications for palliative radiation
  •     Dose and techniques of palliative radiation
  •     Treatment of the breast in the setting of distant metastases
  •     References
  • 15.  Palliative radiotherapy for gastrointestinal malignancies
  •     Pancreatic cancer
  •     Anal cancer
  •     References
  • 16.  Palliative radiotherapy for gynecologic malignancies
  •     Introduction
  •     Common histologies
  •     Initial workup and indications for palliative radiation
  •     Tools for prognostication
  •     Review of studies: Palliative radiation therapy regimens
  •     Non-radiotherapeutic palliative management
  •     Palliative systemic therapy for advanced gynecologic malignancies
  •     Treatment planning considerations
  •     Conclusion
  •     References
  • 17.  Palliative radiotherapy in pediatrics
  •     Background
  •     Solid malignancies
  •     Central nervous system malignancies
  •     Leukemia
  •     Barriers to pediatric palliative radiation
  •     Conclusions and future research
  •     References
  • 18.  Radiotherapeutic palliation of lymphoma
  •     Introduction
  •     Indolent non-Hodgkin lymphoma
  •     Aggressive non-Hodgkin lymphoma
  •     Hodgkin lymphoma
  •     Cutaneous T-cell lymphomas
  •     Treatment planning in palliation of lymphoma
  •     Summary
  •     References
  • 19.  Radiotherapeutic palliation of bone marrow diseases—leukemia and multiple myeloma
  •     Introduction
  •     Palliative radiation therapy for leukemia
  •     Multiple myeloma
  •     Summary
  •     References
  • 20.  Palliative radiotherapy in bones
  •     Introduction
  •     Indications for palliative radiation
  •     Common histologies
  •     Tools for prognostication
  •     Review of studies
  •     Conclusion
  •     Acknowledgments
  •     References
  • 21.  Palliative radiotherapy in the brain
  •     Indications for palliative radiation
  •     Common histologies
  •     Tools for prognostication
  •     Review of studies
  •     Summary of studies tables
  •     References
  • 22.  Palliative radiotherapy in the spine
  •     Indications for palliative radiotherapy
  •     Common histologies
  •     Tools for prognostication
  •     Review of studies
  •     Conclusion
  •     References
  • 23.  Palliative radiotherapy in oligometastases
  •     Introduction
  •     Indications for radiotherapy
  •     Common histologies
  •     Tools for prognostication
  •     Review of studies
  •     Radiation therapy techniques
  •     Conclusion/future directions
  •     References
  • 24.  Palliative radiotherapy in the older adult
  •     Introduction
  •     Indications for palliative radiation therapy in older adults with cancer
  •     Characterizing heterogeneity in older adults with cancer
  •     Frailty presentations
  •     Tools for prognostication: Screening for frailty
  •     Frailty screening in oncology
  •     The impact of comprehensive geriatric assessment on treatment decision-making in oncology
  •     Implementation of comprehensive geriatric assessment into clinical practice
  •     Conclusion
  •     References
  • Section IV. Management of Symptoms and Treatment-Related Toxicities
  • 25.  General symptom overview: Importance of side effect management, CINV, anorexia, and cachexia
  •     Symptom assessment
  •     Approach to palliative care symptom assessment
  •     Assessment of nausea/vomiting
  •     Chemotherapy-induced nausea and vomiting
  •     Cancer cachexia
  •     Return to the case
  •     References
  • 26.  Management of pain
  •     Types of pain
  •     General principles of analgesic therapy
  •     Opioid titration and rotation
  •     Opioid-induced adverse effects
  •     Adjuvants
  •     Chronic pain in survivorship
  •     Conclusion
  •     References
  • 27.  Management of fatigue
  •     Introduction
  •     Background and significance
  •     Review of the literature
  •     Fatigue related to central nervous system irradiation
  •     Fatigue related to irradiation of non–central nervous system sites
  •     Case study
  •     Assessment
  •     Review of assessment instruments (Table 27.2)
  •     Implications for practice
  •     Treatment
  •     Conclusion
  •     References
  • 28.  Management of skin toxicity
  •     Introduction
  •     Epidemiology
  •     Pathogenesis
  •     Radiation dermatitis—expected time course
  •     Grading
  •     Prevention and management of acute toxicity
  •     Topical treatments
  •     Natural products
  •     Dressings
  •     Systemic prevention
  •     Management of desquamation and ulceration—grade 3 to 4 toxicity
  •     Late reactions
  •     Concurrent EGFR inhibitor therapy
  •     Radiation recall dermatitis
  •     References
  • 29.  Central nervous system: Symptoms and toxicities
  •     Background
  •     Nausea
  •     Fatigue
  •     Alopecia
  •     Neurocognitive dysfunction
  •     Pituitary/hypothalamic dysfunction
  •     Radionecrosis
  •     Optic toxicity
  •     Ototoxicity
  •     References
  • 30.  Management of symptoms and treatment-related toxicities of head and neck cancers
  •     Introduction
  •     Tumor-related complications
  •     Treatment-related complications
  •     References
  • 31.  Chest and thorax: Symptoms and toxicities
  •     Overview
  •     Pneumonitis
  •     Esophagitis
  •     Dermatitis
  •     Cardiac toxicities
  •     Chest wall toxicities: Chest wall pain and rib fracture
  •     Special considerations for anatomic subsites
  •     Systemic therapy considerations
  •     References
  • 32.  Abdomen and pelvis: Symptoms and toxicities
  •     Abdomen and pelvis radiation-related symptoms and toxicities
  •     Nausea/vomiting
  •     Appetite loss/anorexia
  •     Intestinal perforation
  •     Upper gastrointestinal bleeding/hemorrhage
  •     Radiation enteritis/gastritis
  •     Bowel obstruction
  •     Cystitis
  •     Special considerations for anatomic subsites
  •     Systemic therapy considerations
  •     References
  • 33.  Late toxicities management
  •     Late toxicity management
  •     Part I: Late skin toxicity
  •     Part II: Radiation myelopathy
  •     Conclusions
  •     References
  • 34.  Psychosocial and spiritual distress
  •     Introduction
  •     Psychosocial distress in palliative radiation oncology
  •     Differences in psychosocial distress across cancer types
  •     Psychosocial care in radiation oncology
  •     Challenges to implementation of psychosocial care
  •     Multidisciplinary team in radiation oncology
  •     Understanding spiritual distress
  •     Conclusion
  •     References
  • Index

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