Congress Abstracts 2004

94

RADIATION THERAPY ADVANCES FOR TREATING PATIENTS WITH LUNG CANCER: IMPLICATIONS FOR NURSES. Elizabeth Tateo, Memorial Sloan-Kettering Cancer Center, New York, NY.

Advances have been made in radiation planning and treatment for patients with lung cancer to improve outcomes and minimize toxicities. Nurses play a vital role in educating patients about treatment and side effects, and it is critical for nurses to have an understanding of these new treatment modalities.

Lung cancer is the leading cause of cancer death in men and women in the United States. It is estimated that there will be 157,200 deaths in 2003, accounting for 28% of all cancer deaths. Approximately 60% of patients with lung cancer will undergo radiation therapy (RT). Side effects include dysphagia, odynophagia, cough, shortness of breath, fatigue, and skin reaction.

Four RT advances are being used: Three-dimensional conformal RT (3D-CRT), intensity modulated RT (IMRT), techniques to control tumor motion, and combined modality therapy (CMT).

3D-CRT delivers radiation using multiple fields that configure precisely to the shape of the target volume. This enables larger doses to be delivered to the tumor increasing cell kill, while minimizing radiation to surrounding normal tissues and decreasing side effects. IMRT involves inverse treatment planning, in which desired doses of radiation to the target and normal tissue are predetermined, and treatment is delivered using dynamic multi-leaf collimation, which modulates the intensity of the radiation beam while it is being delivered. Techniques to control tumor motion are used because patients breathe during treatment, causing their tumors to move. With deep inspiration breath hold (DIBH) the patient takes a deep breath and holds it while the radiation beam is delivered; with gated RT, radiation is delivered only during a specific phase of the breathing cycle. These techniques control tumor motion and allow the radiation portal size to be reduced, reducing toxicity. (4) CMT uses chemotherapy with RT to improve local control and overall survival. Recent studies suggest that concurrent chemotherapy is more effective than sequential, however, toxicity is higher.

This presentation will explain these advances and describe the nurse’s role in educating patients about these treatments, managing side effects, selecting appropriate patients for DIBH and gating, and coordinating care with CMT.