The management of metastatic bone pain in a developing country: the role of radiotherapy as an adjunct to weak opioids.

Bone pain secondary to metastatic cancer is the commonest intractable pain and is a major concern in most oncology units the world over. Cancer pain management is multidisciplinary in approach, so there is no universal or singular modality of treatment. In a developing country like Nigeria, only external radiotherapy and adjuvant weak opioids are readily available, so it is of interest to review the response of these patients to this management option. This is a retrospective review of 92 patients aged 16-80 years with radiologically confirmed metastatic bone disease associated with pain who received external radiotherapy and weak analgesics. The results showed that 23 (25%) patients had a complete response and 67 (73%) had a partial response within four weeks of treatment. Total response was over 90%, which suggests external radiotherapy has an effective palliative role. The study also demonstrated the pattern of bony involvement among the common cancers seen in our environment. The availability of strong opioids (e.g. morphine and pethidine) will obviously consolidate the gains achieved with external radiotherapy in the management of metastatic bone pain in our environment.

Radiotherapy in the management of early breast cancer in Ibadan: outcome of chest wall irradiation alone in clinically nodes free axilla.

The study was carried out to identify the group of patients with early breast cancer [stage I and II] after surgery in which chest wall irradiation alone was given without lymphatic irradiation thus reducing morbidity and also creating room for more patients on the available limited treatment facility. 92 patients with histologically confirmed early breast cancer that attended Radiotherapy clinic between June 1995 and May 1998 that satisfied selection criteria were studied. They all received External Radiotherapy to the chest wall, meadiasternum inclusive and breast if still in-situ. All also received cytotoxic chemotherapy. Majority of the patients 67 [84.8%] were recurrence free in 2 years while 12 [15.2%] had recurrent disease, the recurrent sites were axilla 4 [5.06%], chest wall 3 [3.80%] and supraclavicular 2 [2.52%]. Average time to recurrence was 3-12 months. In view of majority being recurrence free, chest wall irradiation alone in early breast cancer [stage I and II] could be encouraged, thus creating access to treatment for more patients in centers like ours with limited therapy facilities.

Complications following sedation of paediatric oncology patients undergoing radiotherapy.

Sedation is often required to achieve immobilisation of small children during radiotherapy to avoid irradiation of normal tissues during the course of treatment. At the University College Hospital, Ibadan radiotherapists provide sedation for such patients with administration of parenteral and/or oral promethazine, diazepam, chlorpromazine and paraldehyde. This retrospective review of 84 children aged 1 month to 6 years who received sedation for radiotherapy over a period of twenty-one to twenty-eight days showed that 48% had complications. These included injection cellulitis (85.3%), injection abscess (4.87%), paresis of the lower limb (7.3%), aspiration pneumonia (2.4%). Anaesthetists in developing countries should be encouraged to extend their expertise in caring and resuscitation of sedated or unconscious patients to the radiotherapy unit. This will allow for the use of a wider variety of sedative agents and better monitoring as well as minimise or eradicate complications.