Darrel a 14yo MN DSH presented for a consultation at the VCC. Upon his arrival it was noted he was dyspneic by the front desk and was rushed to the treatment area. An IV catheter was placed and flow by oxygen was given. A pulse oximetry was taken while on flow by oxygen and was 50%. A BP was done using a doppler and the systolic was 150mmHG. It was recommended he be taken to an emergency hospital. It was recently discovered Darrel had a laryngeal mass and was biopsied a few days ago.
At the emergency hospital they performed a tracheostomy and feeding tube placement. He was put in an oxygen cage and put on IV fluids. The final biopsy came back as laryngeal squamous cell carcinoma. Dr. Farrelly our radiation oncologist spoke to the owners about pursuing palliative radiation. Radiation would be the best chance for Darrel to survive. He was oxygen dependent at this point.
Palliative radiation are higher doses of radiation given in small fractions usually between 1 - 6 treatments. This type of treatment is recommended to help improve quality of life. This is sometimes accomplished by killing cytokine cells which cause inflammation in most tumors, making the tumor static or decreasing tumor size. There is also little in terms of side effects because the overall dose they receive is small compared to definitive treatment protocols.
Darrel had to be transported in an oxygen tank via an emergency vehicle from the emergency clinic to VCC. He still had a tracheostomy tube in place. Darrel was in critical but stable condition at this time. He was given sedation to prevent him from moving during radiation. Darrel's radiation protocol was 8 Gy x 4 fractions. He received his first dose of radiation with no problems and was sent back to the emergency hospital to continue his care. During the first week Darrel's condition remained the same and could not come out of the oxygen cage. He received his second dose of radiation without incident and was again transported back to the emergency hospital. After his third treatment Darrel was improving. He was out of oxygen and started eating on his own. He received his last radiation treatment without any complications. Dr. Farrelly did an oral exam with each treatment. He recommended they remove the tracheostomy tube. The owners were reluctant so it was removed a few days later.
At his 1 week recheck appointment Darrel was doing very well. He still had a feeding tube in place but was eating on his own. He was on oral prednisolone and clavamox. The feeding tube was to be removed a few days later. An in house CBC and chemistry were done and were WNL. He received his first dose of carboplatin. Darrel has received 2 cycles of chemotherapy with no complications. Darrel continues to improve. He has gained weight and recently went outdoors to enjoy some sunshine. He is due to come back for this third dose of carboplatin.
Although Darrel's prognosis is still poor the owner's are extremely happy with how he is doing. Palliative radiation is a good treatment option to help improve quality of life. There are minimal side effects from radiation and anesthesia time is limited. While the normal life expectancy is a few months I have seen patients live a good quality of life for years.