Role of immediate-release morphine (MIR) in the treatment of predictable pain in radiotherapy.

Radiotherapy is crucial in the management of cancer patients in both the curative and palliative settings. However, patients often report pain both during positioning for, and execution of, radiotherapy and this may be a reason for interrupting the radiotherapy session. This observation is common even if the patient is undergoing baseline drug therapy for cancer pain. Recent data suggest that orally administrated immediate-release morphine (MIR) is able to reduce pain in patients with predictable pain. The authors tested a rescue dose of MIR 10 or 20 mg, 20 to 60 minutes before radiotherapy, to verify the effectiveness of MIR in this setting and also to assess the patient's ability to receive the full course of radiotherapy. One hundred forty consecutive patients were evaluated during radiotherapy treatment and visual analogue scale (VAS) and positioning VAS scores were assessed. All patients completed the course of scheduled radiotherapy and pain was well controlled, despite the fact that previous pharmacological treatment had not been able to completely control chronic cancer pain. These data strongly suggest a role for MIR pretreatment in patients with pain due to positioning during radiotherapy.

Cross-cultural adaptation of the Greek version of the Knee Outcome Survey--activities of Daily Living Scale (KOS-ADLS).

The purpose of this study was to cross-culturally adapt and validate the Greek version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), a self-reported instrument used for patients with various knee pathological conditions including osteoarthritis. Ninety-four patients (57 males and 37 females) with a variety of pathological knee disorders and impairments being referred to physical therapy for evaluation and treatment were included in the study. For the crοss-cultural translation, a back-translation procedure was utilized by 3 bi-lingual translators. To assess test-retest reliability the patients were asked to complete the KOS-ADLS twice at initial visit; before and after physiotherapy treatment. To assess responsiveness, patients completed the KOS-ADLS at the end of all physiotherapy sessions and the score was compared with KOS-ADLS at initial (pre-treatment) visit. Finally, concurrent validity was measured by comparing the responses to the KOS-ADLS scores against the scores obtained from Visual Analogue Scale (VAS) and Global Rating Scale (GRS). Reliability was found satisfactory (ICC=0.97; SEM=3.03; SDD=23.05; Cronbach's alpha=0.98). Moreover, a gender subgroup analysis showed that women were more reliable than men. Minor floor/ceiling effects were detected. Concerning validity, all correlations were statistically significant, ranging from r=0.315 to r=0.741, however GRS presented higher correlations with KOS-ADLS in comparison with VAS. Finally, Greek KOS-ADLS was able to detect changes over time (standardized effect size=1.31 and standardized response mean=1.64). The Greek version of KOS-ADLS was found to be reliable, valid, responsive and comprehensible to use with patients with knee pathology.

High-dose rate brachytherapy of bronchial cancer: treatment optimization using three schemes of therapy.

PURPOSE: Our aim is to demonstrate that a fractionated high-dose rate endobronchial brachytherapy (HDRBT) treatment is tolerable for patients with advanced (IIIA-IIIB) non-small cell lung cancer and gives an improvement of symptoms. Patients and Methods. From January 1992 to July 1997, we treated 320 patients with external beam radiotherapy (EBRT) and concomitant HDRBT with Ir192. Eighty-four patients received 10 Gy in one fraction from January 1992 to March 1993 (Group A); 47 patients received two fractions of 7 Gy each from April 1993 to December 1993 (Group B), and 189 patients received three fractions of 5 Gy each from January 1994 to July 1997 (Group C). RESULTS: Mean survival from diagnosis is 11.1 months and mean survival from last HDRBT is 9.7 months. The symptomatic response rate is 90% for dyspnea, 82% for cough, 94% for hemoptysis and 90% for obstructive pneumonia. Performance status was improved in 70% of patients. Follow-up is in the range of 5-36 months with 280/320 evaluable patients (87.5%) (40 patients were lost to follow-up). For the patients treated with three fractions of HDRBT plus EBRT, a smaller number of side effects occurred while relief from symptoms linked to bronchial obstruction and survival was similar for the three groups. CONCLUSIONS: A three-fraction brachytherapy results in fewer side effects, such as bronchial fibrosis with or without stenosis, while survival and symptomatic relief are similar in the three groups treated.

Hyperfractionated split-course thoracic radiation-therapy plus chemotherapy in locally advanced nonsmall cell lung-cancer.

Hyperfractionated split course radiotherapy combined with carboplatin, etoposide and mitomycin C was administered to 76 patients with stage III non-small cell lung cancer. Grade 4 leukopenia occurred in 5 patients; 4 toxic deaths were observed. The overall response rate was 45%, including a 9% rate of complete responses, which lasted > 12 months in four cases. The median survival was 13 months, 2-year progression-free survival 17%, actuarial 2-year survival rate 22%. Age > 65, performance status > 1, no response to prior treatment were predictors of poor outcome. Our treatment plan, particularly because of the long lasting complete responses, warrants further investigation.

Clinical experience in the treatment of dental pain.

Good dental analgesia requires drugs that are endowed with strong and fast activity and that are well tolerated. In addition, optimal analgesia should essentially be of the peripheral type, thereby eliminating the risk of sedation that may cause unpleasant effects on the patient's daily life. Meclofenamic acid is among those substances whose analgesic effect is more evident than that of anti-inflammatory action. The mechanism of action of meclofenamic acid makes it distinctly different from other nonsteroidal anti-inflammatory drugs (NSAIDs) in that it inhibits the metabolic pathways of arachidonic acid and, at the same time, antagonizes the effects of prostaglandins at the peripheral receptor level. A number of controlled clinical trials showed that meclofenamic acid is an excellent analgesic, offering good tolerability when used in oral surgery, dysodontiasis, avulsion of the third impacted molar, and periodontitis. The following report is a presentation of results obtained in a controlled clinical trial in which the speed of pain relief was assessed in 20 patients suffering from acute periodontitis. The patients were treated orally with a single dose of meclofenamate sodium (100 mg) or with piroxicam-beta-cyclodextrin (20 mg). The intensity of the drug's analgesic effect was measured at 0.5, 1, 2, 4, and 6 h after administration. After initial testing, meclofenamate sodium was found to be significantly more effective than piroxicam-beta-cyclodextrin. Both the physician and patient found this drug to be considerably better. Pain relief after treatment with meclofenamate sodium was clinically and statistically faster than piroxicam-beta-cyclodextrin, and both drugs were found to be well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)