Guidelines for Palliative Treatment of Spinal Metastases: Choosing Between Stereotactic Body Radiation Therapy and Conventional Fractionation.

Symptomatic spinal metastasis is a frequent complication of cancer that had been treated, until relatively recently, with primitive techniques to modest radiation dose levels, with a baseline assumption of limited survival and poor patient performance in that setting. In the era of targeted and personalized therapies, many patients are living longer and more functionally and are able to manage their disease on the model of chronic illness. Given these developments, an attractive option is the use of stereotactic body radiation therapy (SBRT) to deliver high biologically effective doses of radiation conformally to maximize the palliative gains of treatment. However, randomized data to guide practice are scarce. We review the extant literature and present an algorithmic approach to selecting patients with metastatic disease for palliative spinal SBRT favoring the results of available randomized studies and remaining within the safety constraints supported by evidence from randomized trials.

Recognising metastatic spinal cord compression.

Metastatic spinal cord compression (MSCC) is a potentially life changing oncological emergency. Neurological function and quality of life can be preserved if patients receive an early diagnosis and rapid access to acute interventions to prevent or reduce nerve damage. Symptoms include developing spinal pain, numbness or weakness in arms or legs, or unexplained changes in bladder and bowel function. Community nurses are well placed to pick up on the 'red flag' symptoms of MSCC and ensure patients access prompt, timely investigations to minimise damage.

Overview of stereotactic body radiotherapy and the nursing role.

Stereotactic body radiotherapy (SBRT) is a rapidly emerging technology that enhances radiation therapy delivery. It allows for tightly conformed treatment fields and accurate delivery even with moving targets in the body. SBRT currently is used most commonly in treatment of medically inoperable stage I non-small cell lung cancers, as well as lung, liver, and spinal metastases. Studies to date are encouraging for increased local control with acceptable patient tolerance. This article familiarizes nurses with the use of this new technology and proposes the potential nursing role in maximizing patient preparation and follow-up care.

Spinal metastasis in glioblastoma multiforme: a case study.

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor. Spinal metastasis is rare. However, as local control of the primary tumor improves, metastatic disease is increasingly possible. The neuroscience nurse plays an instrumental role in caring for patients with GBM, developing a plan of care based on each patient's needs and outcomes.

Upper cervical spine chordoma: a case study.

Cervical chordomas are rare, slow-growing, but locally aggressive tumors. Predominantly found in people 50-69 years old, a chordoma arises from remnants of the primitive notochord. It is most often found in the sacrococcygeal or skull base areas. However, it can be found throughout the spine. Because chordomas are slow growing, they may reach considerable size before the patient becomes symptomatic. Surgical resection with a wide margin is the only curative procedure. Usually, because of tumor location and infiltration, this is not possible. Although this type of tumor is generally considered radioresistant, radiation therapy is often prescribed after surgical resection. The following case study illustrates the clinical presentation, surgical interventions, and neuroscience nursing considerations for a patient undergoing a posterior stabilization as well as a midline mandibulotomy-glossotomy approach for an upper cervical spine chordoma resection.

Cancer: new therapies and new approaches to recurring problems.

Caring for patients with cancer presents unique challenges to anesthetists. Chemotherapeutic regimens can cause cardiac, pulmonary, and other complications that will influence the anesthesia provider's care. New surgical techniques, including vertebroplasty, vertebrectomy, radiofrequency ablation of the liver, and sentinel node biopsy, present issues related to the surgical techniques and drugs administered. Recurring problems, including tumors of the airway and cardiac tamponade, continue to present challenges for anesthesia providers. Many patients with cancer who undergo surgery not only have acute pain related to the surgical procedure but also have chronic pain that will influence anesthetic and postoperative pain management. This Journal course discusses new therapies and procedures and approaches to recurring problems in cancer care.

Caring for patients with a diagnosis of cancer and spinal metastatic disease.

This article aims to provide a greater understanding of the process involved in diagnosing cancer, particularly that associated with spinal metastasis. The article focuses on the diagnosis of secondary cancer of the spine, however, the information and discussion might also be relevant to other anatomical areas.

Tumors of the spine and spinal cord.

OBJECTIVES: To provide an overview of spinal cord neoplasms with a focus on location, histology, pathophysiology, diagnosis, treatment and nursing assessment and management. DATA SOURCES: Published books and peer-reviewed articles. CONCLUSIONS: Tumors of the spine and spinal cord are rare, and they can have grave implications for the patient. The key in the management of spinal cord tumors is their timely diagnosis and treatment to preserve function. IMPLICATIONS FOR NURSING PRACTICE: A thorough nursing assessment and timely intervention can have a positive impact on the outcome of patients with tumors of the spine and spinal cord.

[Visiting nurse support for patients wishing to die at home].

Thirty-two (1994) and 55 (1995) patients in the terminal stage of many kinds of cancer were cared for satisfactorily at home by a visiting team of nurses from Niigata Cancer Center Hospital. A prostate cancer patient with multiple bone metastasis was suffering from morphine-resistant intractable pain, and highly dependent on medical care. We continued to take care of him by frequent visitation and psychological assist until he eventually died at home according to his wishes. It is important to create a suitable support team for the continual difficult home care of each terminal patient.