straalebehandling-palliativ (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Lindre symptomer fra kr&aelig;ft</li>
</ul>
<h3>Generelt om behandling</h3>
<ul>
    <li>Patientens almentilstand og dermed den forventede restlevetid skal vurderes, f&oslash;r patienten bliver&nbsp;henvist til str&aring;lebehandling. Patienten b&oslash;r have en forventet restlevetid p&aring; 8-12 uger </li>
    <li>Str&aring;lebehandling b&oslash;r overvejes ved:</li>
    <ul>
        <li>Smertefulde knoglemetastaser </li>
        <li>Kompression af medulla spinalis </li>
        <li>Obstruktion&nbsp;af luftveje </li>
        <li>Obstruktion af &oslash;sofagus </li>
        <li>Bl&oslash;dning is&aelig;r fra bl&aelig;ren</li>
        <li>Hjernemetastaser </li>
        <li>Lokaliserede bl&oslash;ddelsmetastaser eller solide tumorer med symptomer, hvor operation ikke er mulig eller &oslash;nskelig</li>
    </ul>
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<h3>Str&aring;lebehandling</h3>
<h4>Smertefulde knoglemetastaser</h4>
<ul>
    <li>Behandlingen bliver givet med f&aring;&nbsp;behandlinger med relativt&nbsp;store doser for at &oslash;ge effekten og&nbsp;reducere antallet af fremm&oslash;der. Som regel&nbsp;giver det kun beskedne bivirkninger<a href=" " data-type="journal-reference" data-value="Hoskin P, Rojas A, Fidarova E, Jalali R, Mena Merino A, Poitevin A, Oucrif S, Abdelwahab S, Kochbati L, Plieskiene A, Casas F, Stojanovic S, Schneider G, Jeremic B, IAEA randomised trial of optimal single dose radiotherapy in the treatment of painful bone metastases.. Radiother Oncol 2015;116: 10-4" data-value-piped="Hoskin P, Rojas A, Fidarova E, Jalali R, Mena Merino A, Poitevin A, Oucrif S, Abdelwahab S, Kochbati L, Plieskiene A, Casas F, Stojanovic S, Schneider G, Jeremic B|IAEA randomised trial of optimal single dose radiotherapy in the treatment of painful bone metastases.|Radiother Oncol|2015|116|10-4|26026485" data-url="reference-link" data-pubmedid="26026485" title="Hoskin P, Rojas A, Fidarova E, Jalali R, Mena Merino A, Poitevin A, Oucrif S, Abdelwahab S, Kochbati L, Plieskiene A, Casas F, Stojanovic S, Schneider G, Jeremic B, IAEA randomised trial of optimal single dose radiotherapy in the treatment of painful bone metastases.. Radiother Oncol 2015;116: 10-4">1</a> </li>
    <li>Ved knoglesmerter opn&aring;r man&nbsp;effekt hos 70-90 % af patienterne 1-2 uger efter afsluttet behandling. Behandlingen kan blive gentaget</li>
    <li>Ved fare for fraktur skal en ortop&aelig;dkirurg vurdere patienten mhp. operativ stabilisering. Der skal kun gives str&aring;lebehandling ved smerter</li>
</ul>
<h4>Kompression af medulla spinalis</h4>
<ul>
    <li>Ved symptomer (smerter eller neurologiske symptomer) giver man&nbsp;h&oslash;jdosis steroider, f.eks. [DliActiveSubstance;5892;prednisolon]&nbsp;150 mg </li>
    <li>Patienten kan henvises til akut vurdering p&aring; neurokirurgisk afdeling eller ortop&aelig;dkirurgisk afdeling med rygkirurger mhp. mulighed for operation, n&aring;r det er relevant. Der er s&aelig;dvanligvis kun indikation for operation ved neurologiske udfald. Patienter med involvering af mange hvirvler eller i d&aring;rlig almen tilstand kan sj&aelig;ldent blive opereret. B&aring;de patienter, der er opereret og patienter, der ikke kan blive opereret, bliver&nbsp;tilbudt str&aring;lebehandling -&nbsp;s&aelig;dvanligvis 30-35 GY i 6-10 fraktioner<a href="%20" title="Rades D1, Abrahm JL., The role of radiotherapy for metastatic epidural spinal cord compression..  Nat Rev Clin Oncol. 2010;7(10): 590-8" data-type="journal-reference" data-url="reference-link" data-value="Rades D1, Abrahm JL., The role of radiotherapy for metastatic epidural spinal cord compression..  Nat Rev Clin Oncol. 2010;7(10): 590-8" data-value-piped="Rades D1, Abrahm JL.|The role of radiotherapy for metastatic epidural spinal cord compression.| Nat Rev Clin Oncol.|2010|7(10)|590-8">2</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Rades D, Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, Rudat V, Schild SE, Final results of a prospective study comparing the local control of short-course and long-course radiotherapy for metastatic spinal cord compression.. Int J Radiat Oncol Biol Phys 2011;79: 524-30" data-value-piped="Rades D, Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, Rudat V, Schild SE|Final results of a prospective study comparing the local control of short-course and long-course radiotherapy for metastatic spinal cord compression.|Int J Radiat Oncol Biol Phys|2011|79|524-30|20452136" data-url="reference-link" data-pubmedid="20452136" title="Rades D, Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, Rudat V, Schild SE, Final results of a prospective study comparing the local control of short-course and long-course radiotherapy for metastatic spinal cord compression.. Int J Radiat Oncol Biol Phys 2011;79: 524-30">3</a> </li>
    <li>Pareser af mere end 24 timers varighed bliver ofte permanente</li>
    <li>Efter behandling skal patienten tilbydes genoptr&aelig;ning, hvis det er muligt</li>
</ul>
<h4>Symptomer fra luftveje</h4>
<ul>
    <li>Kan have effekt p&aring; h&aelig;moptyse og&nbsp;<a href="~/link.aspx?_id=9979053B75294BAB9A6C0DB4E5BD3C31&amp;_z=z">vena cava superior syndrom</a></li>
    <li>Ikke veldokumenteret effekt p&aring; hoste eller vejrtr&aelig;kningsbesv&aelig;r som ikke skyldes obstruktion<a href=" " data-type="journal-reference" data-value="Christian E, Adamietz IA, Willich N, Schäfer U, Micke O, German Working Group Palliative Radiotherapy., German Society for Radiation Oncology (DEGRO)., Radiotherapy in oncological emergencies--final results of a patterns of care study in Germany, Austria and Switzerland.. Acta Oncol 2008;47: 81-9" data-value-piped="Christian E, Adamietz IA, Willich N, Schäfer U, Micke O, German Working Group Palliative Radiotherapy., German Society for Radiation Oncology (DEGRO).|Radiotherapy in oncological emergencies--final results of a patterns of care study in Germany, Austria and Switzerland.|Acta Oncol|2008|47|81-9|17851852" data-url="reference-link" data-pubmedid="17851852" title="Christian E, Adamietz IA, Willich N, Schäfer U, Micke O, German Working Group Palliative Radiotherapy., German Society for Radiation Oncology (DEGRO)., Radiotherapy in oncological emergencies--final results of a patterns of care study in Germany, Austria and Switzerland.. Acta Oncol 2008;47: 81-9">4</a></li>
</ul>
<h4>Obstruktion af &oslash;sofagus</h4>
<ul>
    <li>Kan lindre dysfagi hos 50-75 % </li>
    <li>For 30-50 % varer denne effekt patientens levetid ud</li>
</ul>
<h4>Bl&oslash;dning</h4>
<ul>
    <li>God effekt p&aring; h&aelig;maturi og vaginalbl&oslash;dning</li>
</ul>
<h4>Hjernemetastaser</h4>
<ul>
    <li>Til&nbsp;symptomlindring af hovedpine, svimmelhed, kvalme eller neurologiske udfald</li>
    <li>Str&aring;lebehandlingen kan gives som stereotaksi (pr&aelig;cisionsstr&aring;lebehandling), hvis patienten&nbsp;h&oslash;jst har fire metastaser, som er op til 3 cm store</li>
    <li>H&oslash;jdosis <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/171030">glukokortikoid</a>, f.eks. [DliActiveSubstance;5892;prednisolon]&nbsp;150 mg kan give god effekt ved intrakranielle tryksymptomer</li>
    <li>Moderat dosis f.eks. 25 mg daglig bliver anvendt til patienter med neurologiske udfald</li>
    <li>50-60 % vil have effekt af str&aring;lebehandling<a href=" " data-type="journal-reference" data-value="Tsao MN, Lloyd N, Wong R, Chow E, Rakovitch E, Laperriere N, Whole brain radiotherapy for the treatment of multiple brain metastases.. Cochrane Database Syst Rev 2006;: CD003869" data-value-piped="Tsao MN, Lloyd N, Wong R, Chow E, Rakovitch E, Laperriere N|Whole brain radiotherapy for the treatment of multiple brain metastases.|Cochrane Database Syst Rev|2006||CD003869|16856022" data-url="reference-link" data-pubmedid="16856022" title="Tsao MN, Lloyd N, Wong R, Chow E, Rakovitch E, Laperriere N, Whole brain radiotherapy for the treatment of multiple brain metastases.. Cochrane Database Syst Rev 2006;: CD003869">5</a></li>
</ul>
<h4>Lokaliserede bl&oslash;ddelsmetastaser eller solide tumorer</h4>
<ul>
    <li>Indikation for str&aring;lebehandling, hvis metastaserne/tumorerne giver smerter eller s&aring;rdannelse, og anden behandling ikke er mulig<br>
    <ul>
        <li>F.eks. lymfeknudemetastaser, som komprimerer plexus brachialis</li>
        <li>Inoperabel f.eks. bl&aelig;recancer, rektumcancer, gyn&aelig;kologisk cancer, hvor anden behandling ikke er mulig<a href=" " data-type="journal-reference" data-value="Cameron MG, Kersten C, Vistad I, Fosså S, Guren MG, Palliative pelvic radiotherapy of symptomatic incurable rectal cancer - a systematic review.. Acta Oncol 2014;53: 164-73" data-value-piped="Cameron MG, Kersten C, Vistad I, Fosså S, Guren MG|Palliative pelvic radiotherapy of symptomatic incurable rectal cancer - a systematic review.|Acta Oncol|2014|53|164-73|24195692" data-url="reference-link" data-pubmedid="24195692" title="Cameron MG, Kersten C, Vistad I, Fosså S, Guren MG, Palliative pelvic radiotherapy of symptomatic incurable rectal cancer - a systematic review.. Acta Oncol 2014;53: 164-73">6</a></li>
    </ul>
    </li>
</ul>
<h3>Klinisk vejledning&nbsp; &nbsp;</h3>
<ul>
    <li><a rel="noopener noreferrer" href="https://www.sst.dk/da/udgivelser/2018/nkr-behandling-af-hjernemetastaser" target="_blank">Nationale kliniske retningslinjer for behandling af patienter med hjernemetastaser, 2018</a></li>
    <li><a href="https://vaelgklogt.dk/anbefalinger/palliation">Palliation | V&aelig;lg Klogt (vaelgklogt.dk)</a></li>
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