Nursing care of the patient receiving high dose rate brachytherapy.

Over the past few decades, a significant increase in the incidence of lung cancer has occurred. In the majority of patients, the failure to cure lung cancer is related in part to an inability to obtain locoregional control of the disease. Remote afterloading high dose rate (HDR) brachytherapy has tremendous potential as a way to increase treatment to the primary site of lung cancer and to improve palliative management of recurrent disease when conventional treatments have failed. Because remote afterloading is used, the medical staff is not exposed to ionizing radiation, and since the duration of treatment is short, HDR brachytherapy is convenient for the patient and can be delivered on an outpatient basis. Fifty-two patients were treated endobronchially for carcinoma of the lung at Parkview Regional Oncology Center in Fort Wayne, IN, between May 1, 1988, and September 1, 1990. Nursing care during treatment and recovery of these patients will be discussed in this paper.

A teaching booklet for patients receiving high dose rate brachytherapy.

A teaching booklet developed for patients with lung cancer who were about to receive high dose rate (HDR) brachytherapy is described and presented. The booklet was developed by nurses assigned to a radiation oncology center and details the procedure using text and photographs.

Unresectable non-oat cell carcinoma of the lung: definitive radiation therapy.

Between 1976 and 1983, 267 patients with non-oat cell carcinoma of the lung were treated with radiation therapy alone. One hundred thirty-four patients had squamous cell carcinoma; 69, large cell carcinoma; and 64, adenocarcinoma. Stage III carcinoma was diagnosed in 87% of the patients. Total radiation dose was less than 45 Gy in 69 patients (low dose group), 45-55 Gy in 161 (middle dose group), and 55-65 Gy in 37 (high dose group); dosage was 180-200 cGy daily, 5 days per week. Minimum follow-up was 3 years (median, 6 years). Tumor control within the radiation fields was achieved in 12%, 43%, and 78% of the low, middle, and high dose groups, respectively. A complete response rate of 13%, 23%, and 35% and an overall response of 43%, 71%, and 86% were seen in the low, middle, and high dose groups, respectively. The 5-year recurrence-free survival rate for all patients was 7% and was dependent on radiation dose and tumor response. This study indicates that tumor control and complete response rates are improved with a radiation dose of 55-65 Gy and that complete responders have improved survival.

Effects of fluid manipulation on the incidence of vomiting during outpatient cisplatin infusion.

The influence of fluid intake and hydration rate on the frequency of vomiting was evaluated during 254 outpatient cisplatin infusions administered to 60 patients. The basic antiemetic regimen was consistent and used metoclopramide hydrochloride (Reglan) 2 mg/kg/dose (means = 150 mg) starting 30 minutes before cisplatin for a total of three doses; dexamethasone (Decadron) mean - 15 mg - and lorazepam (Ativan) 1 mg intravenous bolus before cisplatin, along with thiethlperazine maleate (Torecan) given routinely throughout the treatment beginning the evening before. Only 20% (38/192) of patients experienced symptoms of vomiting when hydrated at a rate of greater than 333 cc/hour as opposed to 44% (27/62) patients hydrated at a rate of 300 cc/hour or less (p = 0.01). Patients whose oral intake ranged from 400 cc to 1000 cc experienced noticeably less vomiting (14%) than patients who either refused fluids (39%, p = 0.001) or exceeded 1000 cc oral intake (36%, p less than 0.05) during treatment. Manipulation of total fluid intake (IV plus oral), although not statistically significant, seemed to affect the incidence of vomiting. By maintaining a positive intake/output ratio greater than 1, patients were able to decrease their vomiting episodes. Patients who gained weight during the treatment experienced significantly fewer episodes of vomiting (29%) than those who either lost or maintained their weight (71%). Findings suggest that manipulating both oral and IV fluid intake as well as the IV fluid rate may reduce symptoms of vomiting in the outpatient cisplatin setting.