Palliative Options in Patients with a Poor Performance Status

A combination of neoadjuvant chemotherapy and extensive surgical resection may not be suitable for all patients due to the poor performance status of patients presenting with advanced metastatic disease. Radiotherapy can palliate symptoms such as pain and local bleeding from ulcerative lesions. Local tumor infiltration into the urethra results in obstructive voiding symptoms and therefore some form of urinary diversion is required either via a suprapubic catheter or perineal urethrostomy prior to undertaking further palliative treatment.

Patients presenting with bulky recurrent disease in the inguinal region often have disease encasing the femoral vessels. The femoral vein is often thrombosed and therefore a combination of anticoagulation together with an inferior vena cava filter will reduce the risk of thromboembolism particularly if the tumor responds to chemoradiation. Endoluminal vascular stents can be inserted into the femoral artery in order to keep it patent as well as reduce the risk of hemorrhage due to tumor infiltration.

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