A REVIEW OF RADIATION ONCOLOGY EMERGENCIES IN RADIOTHERAPY DEPARTMENT, LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH)
Radiation oncology emergencies are acute life threatening conditions due to cancer, its complications or its treatments which requires the use of radiotherapy. It is common in metastatic or locally advanced cancer and it requires urgent actions. Prompt diagnosis and urgent intervention improves survival and outcome. Radiation Oncology emergency cases accounts for a major component of palliative radiotherapy and a large part of radiotherapy indications in poor resource setting.
Aim and Objectives:
The objective is to review the pattern, presentation, outcome of radiation oncology emergencies in the department of radiotherapy, Lagos university teaching hospital.
This is a retrospective review of patients with radiation oncologic emergencies, seen in the Department of Radiotherapy LUTH Lagos, from 2006-2016. Patient’s bio data, clinical presentation, histologic findings and treatment records were retrieved using data extraction forms and subsequently analysed.
A total of 458 cases of oncologic emergencies were reviewed. The age of patient ranged from 7 to 83yrs. The peak age was in the fourth decade in men and sixth decade in women, mean age was 52.3yrs and M: F ratio was 1.2:2.
The most common primary cancer sites were breast cancer in 212(46%) patients, prostate cancer in 96 (21%) patients, gynaecological cancers in 80 (17%) patients and head and neck cancers in 25(5%) patients. Others were lung cancer, colorectal cancer and renal cell cancer.
Majority of the patients (95%) presented with advanced stage diseases like stage IV in 391(85%) patients, stage III in 45 (10%) patients, stage II in 18(4%) and 4 (1%) was stage I disease.
Frank and impending myelo compression was the commonest indication seen in 247(53.9%) of cases followed by raised intracranial pressure in 101(22.1%) patients and tumour haemorrhage in 98(21.4%) patients.
Time from onset of symptoms to treatment was < 48hours in 75(16.4%) patients, 72hours to 1 week in 295(64.4%) patients and > 1 week in 88(19.2%) patients.
The commonest radiation doses used was 30Gy in 10 fractions over 2 weeks in 346(75.6%) patients given in management of spinal cord compression and raised intracranial pressure cases followed by 15Gy in 3 fractions in 1 week to control bleeding from tumour haemorrhage and the others had 5-10 Gy in 1-2 fractions for various indications.
There was improvement of symptoms and survival in 353(77%) of the patients, no improvement in 52(11%) patients, 5(1.1% had symptoms progression or died but 48(10%) were either lost to follow up or outcome unknown.
Conclusion; Radiation oncologic emergencies is a common occurrence in resource poor setting owing to late presentation. The use of radiation treatment has played a prominent role in reducing morbidity and mortality which may arise from this condition. However, unavailability or non-functioning of radiotherapy machines continue to be a major challenge facing the management of these emergencies.