Congress Abstracts 2005

57

IMAGE GUIDED INTENSITY MODULATED RADIATION THERAPY (IMRT) AND STEREOTACTIC IMMOBILIZATION BODY FRAME: A NOVEL APPROACH TO TREATMENT OF PARASPINAL TUMORS. Joan Zatcky, RN, ANP, Memorial Sloan-Kettering Cancer Center, New York, NY.

Stereotactic immobilization body frame and image guided IMRT is a new treatment that allows delivery of high dose radiation to precisely targeted tumors thereby limiting damage to surrounding normal tissue. This technique is an option for newly diagnosed or previously treated patients.

It is essential that oncology nurses understand this new technology so that they can identify potential candidates, educate patients and families and provide symptom assessment and management.

Radiation therapy for primary and metastatic paraspinal tumors is a challenge due to the proximity of the spinal cord to the treatment field. Traditionally, paraspinal tumors were treated with surgery, radiation therapy or a combination of both. Conventional radiation techniques were limited due to morbidity associated with radiation doses greater than 5000 cGy to the spinal cord. The use of the stereotactic immobilization body frame with IMRT and image guided verification is a new technique that allows delivery of precisely targeted high dose radiation while respecting spinal cord and dose tolerances.

At this NCI-designated comprehensive cancer center, sixty-one patients with paraspinal disease were treated in this fashion. During treatment, patients are placed in a customized body frame and immobilized for up to two hours. Extensive preparation and treatment time require nursing interventions and standardized patient education to ensure psychologic and physical comfort during the treatment.

Patients are imaged and assessed six to eight weeks post treatment and then every three months thereafter. Although radiologic response varies, treatment overall, has been well tolerated, as evidenced by improved clinical outcomes (ie. decreased symptoms, reduced narcotic requirements, improved neurological function) and minimal side effects.

Image guided IMRT with body frame immobilization is proving to be a viable treatment option for patients with paraspinal tumors. Oncology nurses may encounter patients in their practice who have received or are candidates for this treatment. It will be necessary for the oncology nurse to understand the treatment, eligibility criteria, management and guidelines in caring for patients with primary or metastatic paraspinal tumors. This treatment has changed practice in this institution, and will undoubtedly warrant changes in the oncology community.