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Sexually Transmitted Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Aarthy K. Uthayakumar, Christopher B. Bunker
Course: HIV is a chronic condition, that no longer carries the same mortality and morbidity once feared with the use of ARV. HIV-infected adults with CD4 > 500 × 106/L continuing on long-term combination treatment have the same mortality rates as the general population. Treatment failure can be attributed to several reasons, including poor compliance and drug adherence. There are second-and third-line treatments in addition to salvage therapy.
Brachytherapy Treatment Planning
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
Margaret Bidmead, Dorothy Ingham, Peter Bownes, Chris D. Lee
Some early published series suggest there is a potential role for salvage brachytherapy for local failures after seed implantation or external-beam treatments. There are no formal recommendations for salvage therapy, as there is limited experience in the literature. Salvage treatments are typically with a focal approach to the area of local failure.
Germ-Cell Cancer of the Testis and Related Neoplasms
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
In seminoma a residual mass (<3 cm) of pure seminoma should not be primarily resected especially if tumor markers have normalized. Patients should undergo close surveillance with marker monitoring and serial imaging with CT or PET-CT. PET-CT is of prognostic value in such patients.47,99 No surgery is usually required if post-chemotherapy PET-CT is negative. On the contrary, a positive PET-scan performed 4–5 weeks after day 21 of chemotherapy may be a predictor of residual viable tumor.47,99 Resection (or another means of obtaining histological confirmation) is often advised in this situation. On progression, salvage therapy is indicated.
Balancing efficacy with long-term side-effects: can we safely de-escalate therapy for germ cell tumors?
Published in Expert Review of Anticancer Therapy, 2023
They split outcomes into three major groups – good, intermediate, and poor – with a 5-year survival of >96%, 89%, and 67%, respectively. In the last 20 years, the biggest improvement has been in the poor prognosis group whose survival has increased from 48% to 67% [5]. Salvage therapy is responsible for around a third of the survival of poor prognosis patients [6]. With an increasing survival being evident in the poor prognosis group and yet 33% of patient still succumbing, intensification of therapy in this group would still be considered more a priority than de-escalation, although whether cisplatin-based therapy should form the cornerstone for salvage therapy needs to be explored. For the good risk group, de-escalation would seem to be the priority. Efforts toward achieving this are underway, and include the recently published phase 2 dose-reduction SEMITEP trial in metastatic good-prognosis seminoma [7].
Radiation therapy prior to CAR T-cell therapy in lymphoma: impact on patient outcomes
Published in Expert Review of Hematology, 2022
Nicholas B Figura, Austin J Sim, Michael D Jain, Julio C Chavez, Timothy J Robinson
Non-Hodgkin Lymphoma (NHL) is the most common hematologic malignancy in the United States leading to 77,200 diagnoses and nearly 20,000 deaths in 2020 [1]. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL, encompassing 30–40% of all NHL diagnoses. The primary treatment for DLBCL is combination chemoimmunotherapy, consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). While R-CHOP cures the majority of patients, up to 30–40% of patients will either have primary refractory disease or will develop a recurrence following initial complete response [2]. Patients with recurrent or refractory (R/R) disease following first-line therapy typically undergo an intense course of salvage chemotherapy, followed by consolidative autologous stem cell transplant (ASCT). Even in the subset of patients who achieve a complete response to salvage chemotherapy and are able to make it to ASCT, half will experience disease relapse [3] – at which point further treatment options are not well established. The multi-institutional SCHOLAR-1 study evaluated the clinical outcomes of 636 R/R DLBCL patients (defined as having progressive or stable disease as best response to chemotherapy or experiencing relapse at ≤12 months from ASCT) following salvage systemic therapy. Pooling the data from two observational cohorts and two randomized prospective phase 3 trials, the outcomes with salvage therapy were sobering, with a reported objective response rate (ORR) of 26%, complete response (CR) of 7%, and a median overall survival (OS) of 6.3 months [4].
Effect of anthracyclines/ifosfamide-based adjuvant chemotherapy for soft tissue sarcoma: a conventional and network Meta-analysis
Published in Journal of Chemotherapy, 2021
Qingling Hua, Guojie Xu, Lei Zhao, Tao Zhang
One important finding of the present study is that adjuvant chemotherapy appears to have more of an effect on RFS than on OS. This is similar to the results of both the SMAC and Pervaiz meta-analyses. Several hypotheses could explain this. It could be that effective salvage therapy particularly improves the survival of patients who relapse. Alternatively, there may be different rates of relapse between patients who received chemotherapy and those who received local treatment only; thus, in cases for which recurrence is managed by local treatment, such as lung metastases, there will be greater variance in overall survival. On the other hand, it is possible that patients who initially received adjuvant chemotherapy were more likely to develop resistance to drugs later. Therefore, patients encountering salvage chemotherapy for the first time during recurrence may have more success.