Download Handbook of advanced cancer care by Raphael Catane, Nathan Cherny, Marianne Kloke, Stephan PDF

By Raphael Catane, Nathan Cherny, Marianne Kloke, Stephan Tanneberger, Dirk Schrijvers

The therapy of sufferers who've complex melanoma provides a unique set of difficulties: not just does the melanoma itself have to be handled, however the chemotherapy concerned can usually result in actual difficulties of its personal. Psychiatric difficulties and palliative care come to the vanguard of a physician's matters. This well timed instruction manual goals to be a concise and useful reference for all oncologists who're accountable for the care of sufferers with complex melanoma.

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Fractionated treatment (30 Gy in 10 fractions) should be considered when there is: – life expectancy of more than 6 months and few metastases – metastasis in a weight-supporting bone – spinal cord compression. ■ Documentation of radiation fields is required (with simulation films or photography of skin-marked field boundaries), since up to 25% of patients require re-irradiation. g. for vertebral metastases, add 1–2 vertebrae on each side of target lesion(s), and for limb lesions add 5 cm proximal and distal to the lesion.

Xp 4/11/05 2:10 pm Page 31 ■ Treatment planning (often including computed tomography (CT) scanning) is required to define the target volume. It is important to avoid treating unnecessarily large volumes of normal tissue, which may produce toxicity. ■ The treated area should be documented in case reirradiation is required. ■ As in any other area of medicine, informed consent is the cornerstone of the decision. Dying patients should be able to refuse palliative treatments that others believe they should receive.

Excretion – Renal excretion may be influenced by age, medication and other factors. Golmerular filtration rate should always be calculated by the Cockcroft–Gault formula. However, this formula is less accurate in populations with severe renal failure, and decreased muscle mass, as in the elderly. Decline in glomerular filtration rate translates into pharmacokinetic alterations of drugs or their active metabolites excreted by the kidneys. 4). – Hepatic excretion via bile is important for topoisomerase II inhibitors and taxanes.

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