Oncological Emergencies Dr. Gary Harding md, frcpc


Definitive choice Portal 8 cm wide



Yüklə 0,69 Mb.
səhifə17/19
tarix25.12.2016
ölçüsü0,69 Mb.
#2822
1   ...   11   12   13   14   15   16   17   18   19

Definitive choice

  • Portal 8 cm wide

  • Centered on spine

  • Extends one to two vertebral bodies above and below the epidural metastasis



  • Relieves pain in most cases

    • Relieves pain in most cases

    • Post-neurological function usually determines response

    • Response most associated with tumor type and radiosensitivity; eg. lymphoma

    • Dosing 20 to 40 Gy in 5 to 20 fractions

    • Popular

      • 30 Gy in 10 fractions


    Surgery

    • Changing role

    • Historically posterior vertebral decompression was done

      • No survival benefit with or without radiation15


    Better techniques today allow aggressive approach

    • Better techniques today allow aggressive approach

    • Gross spinal tumor resection with vertebral reconstruction now possible

    • Experienced surgeon required



    Recent controlled trial comparing aggressive surgery followed by radiation vs. radiation alone16

    • Recent controlled trial comparing aggressive surgery followed by radiation vs. radiation alone16

    • Improvement in surgery+rads

      • Days remained ambulatory (126 vs. 35)
      • Percent that regained ambulation after therapy (56% vs. 19%)
      • Days remained continent (142 vs. 12)
      • Less steroid dose, less narcotics
      • Trend to increase survival



    Yüklə 0,69 Mb.

    Dostları ilə paylaş:
    1   ...   11   12   13   14   15   16   17   18   19




    Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azkurs.org 2024
    rəhbərliyinə müraciət

    gir | qeydiyyatdan keç
        Ana səhifə


    yükləyin