Biomedical subjects
Publications and source records attributed to R A Strohl.
Radiation therapy plays a major role in the management of skin cancers. This article presents an overview of nonmelanoma skin cancer. A brief explanation of the mechanisms of action of radiation is provided. Side effects and related nursing management are discussed.
External beam radiation therapy is an effective treatment for selected gynecological cancers, as the primary treatment or in combination with surgery and/or internal radiation therapy. This article reviews the mechanism of action of radiation in cancer treatment, uses of external beam therapy for gynecological cancers, symptom management for commonly reported symptoms, and nursing responsibilities for patient education and preparation for treatment.
Radiation therapy is one of the oldest treatments available for cancer management. Since the discovery of x-rays and radioactivity in the 1890s, patients have been treated with radiation. Advances in equipment and in the understanding of radiobiology permit delivery of effective doses of radiation to tumors while minimizing normal tissue damage. Recent advances in radiation have expanded the scope of treatment. Large-field, large-dose radiation, such as half-body treatment, permits treatment of metastatic disease in an effective and well-tolerated manner in patients too ill to travel for therapy. Total skin electron therapy has been successful in managing extensive skin disease. Hyperfractionated treatment is an experimental approach that attempts to achieve better tumor control by treating with two fractions per day. Intraoperative radiation is a conceptually sound but logistically cumbersome plan in which treatment is given in a single fraction at the time of surgery. Its full potential may be realized when the technical difficulties of administration can be overcome. Brachytherapy is the use of radioactive sources implanted directly into the tumor or in a cavity in proximity to the tumor. Techniques have improved in both surgery and radiation, which allow previously inaccessible sites such as the brain to be implanted. Early-stage breast cancer has been effectively managed with lumpectomy followed by radiation. Hyperthermia is the use of heat in conjunction with radiation. Heat has been found to enhance the effect of radiation and limit the repair of radiation damage. The properties of heat cause it to be more damaging to tumor cells than to normal ones. The ability to sensitize cancer cells to radiation and protect normal cells from radiation has been an ongoing research objective. Clinical trials are in progress to isolate effective, easily administered, and nontoxic compounds. The nurse caring for the patient receiving radiation must have an understanding of how radiation works and what the treatment goals are for the patient. Radiation is a difficult modality for patients to understand. Many fears and concerns are based on this lack of comprehension. The nurse must be prepared to describe the experience of receiving radiation and assist patients to anticipate and manage side effects. Patients need to know what to expect from therapy in terms they can understand. Recent advances and experimental treatments should be explained in terms of what is known including the rationale for the procedures.(ABSTRACT TRUNCATED AT 400 WORDS)
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This is the first report of an on-going Phase III protocol for patients with locally-advanced, non-metastatic, measurable lung cancer. The study randomizes two arms: 6000 rad using 500 rad fractions once a week (1 X W) for 12 weeks with spinal cord (SC) protection at 3000 rad; and 6000 rad using 200 rad fractions daily (5 X W) for 6 weeks with SC protection at 4500 rad. Both arms use an initially large loco-regional field that is further reduced when tumor doses reach 3000 rad in (1 X W) arm and 5000 rad in (5 X W) arm. The protocol was activated April 1982; as of August 1984, it had accrued 100 patients of whom 68 were evaluable [29 (1 X W) and 39 (5 X W)]. There have been no major differences in tumor responses or failure patterns between the (1 X W) and (5 X W) arms; response rates have been 69 and 64%; CR 31 and 20%; total incidence of local failures 20 and 23%; and overall incidence of distant failures 34 and 43%, respectively. The (1 X W) arm has been far better tolerated with 76% of its patients free of any esophagitis and 97% without weight loss, as compared to only 33 and 67% in the (5 X W), respectively. The (1 X W) arm has not conveyed loss in tumor control effectiveness, in-treatment progression, or higher incidence of distant spread. Subacute and chronic complications have been minimal with either treatment. No fatal or life-threatening toxicities have occurred; the incidence of severe complications has been 7% in the (1 X W) arm and 8% in the (5 X W) arm. Nevertheless, the number of patients alive and at risk greater than or equal to 12 months is still relatively small; definitive statements regarding very late toxic reactions cannot yet be made. Compared to their protocyptes [a (1 X W) Pilot Study and the 6000 rad/6 weeks arm of RTOG Protocol 73-01], results in the present protocol arms have not been different from what was expected. Once a week RT yields results that appear no different from those achieved with conventional RT in lung cancer.
Preparing the elderly patient for radiation therapy requires knowledge of the major cancers, the role of radiation treatment, sequelae of treatment, and the age-associated factors that exacerbate treatment reactions. Elderly patients often require long treatment courses. Encouragement to express feelings and report symptoms may be necessary in this patient population. Instructions should be written and repeated, especially for patients with memory loss. The nurse caring for the elderly patient receiving radiation must help the patient to anticipate side effects and manage sequelae of treatment. The patient who knows what to expect is better able to tolerate therapy and to maintain an optimal quality of life during treatment.
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Explore the source record for details and available documents.