THERAPEUTIC INTERVENTIONS IN HEMOSTATIC RADIOTHERAPY: CASE REPORT

Introduction: Bleeding is a common cancer emergency in patients with locally advanced and / or metastatic cancer. Management of this condition involves hemostatic radiotherapy (HRT) and nursing interventions. Goal: To describe a case of HRT hemorrhagic cancer wound treatment and nursing interventions. Method: Data were obtained through anamnesis and physical examination of the patient, photographic record of the lesions and review of medical records. Case report. Male patient, 84 years old, with malignant fusocellular scalp neoplasia (T2aN0M0), who underwent five local graft surgeries and compromised margins. Due to toxicity did not tolerate neoadjuvant chemotherapy. Admitted to the radiotherapy sector with stage 4 cancer wound, exposure of the skullcap, various vegetative lesions, friable, with intense pain and bleeding, absence of odor and phlogistic signs. The patient underwent HRT with a total dose of 4000cGy followed by adjuvant radiotherapy (ADRT) in the parieto-occipital region with a total dose of 4000cGy, both in 20 fractions. After HRT sessions, cold saline 0.9% soaked compresses were applied around the skull circumference for 10 minutes followed by cleaning the wound bed with jet saline, superficial surgical debridement to remove necrotic and fibrinoid tissue. and cover with hydrogel, rayon and gauze. Significant improvement in local bleeding was observed after eight applications of HRT (1600cGy). In the ADRT, the tumor wound evolved with a large amount of necrotic tissue and spinal cord removed through debridement and adequate coverage, regressing about 75% of the initial volume at the end of treatment. After 40 months of treatment completion, there was no wound rebleeding and the patient reports good quality of life and preserved self-care. Discussion: This case demonstrates the effectiveness of radiotherapy associated with nursing interventions in the management of hemorrhagic cancer wound in a patient under palliative care. This association allows both HRT bleeding control and wound care, characterized by debridement, essential for removal of devitalized tissues and reduction of colonization, and adequate coverage, which contributes to hemostasis, analgesia and healing. The present case reports excellent performance and outcome regarding symptomatic relief and improved quality of life despite the limited prognosis.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019