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Radiation oncology considerations
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Gwendolyn Joyce McGinnis, Anuja Jhingran
Currently, postoperative chemoradiation therapy is recommended for all patients at high risk for recurrence.65,66 Patients are considered high risk if surgical pathology demonstrates positive margins, positive pelvic or paraaortic lymph nodes, and positive parametrium.67,68
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Curative treatment uses chemoradiation, delivering concurrent chemotherapy with the course of radiation. This should be considered preoperatively for patients who should undergo surgical resection for adenocarcinomas greater than T1N0 and as a definitive treatment option instead of surgery in squamous carcinomas. It can also be used for tumours that are not amenable to surgery. Around 30% of patients with oesophageal cancer receive radiotherapy. Although distant metastases are a contraindication to radical radiotherapy, extra-oesophageal invasion can still be encompassed within the radiation high-dose zone. Treatment is given daily over 5–6 weeks.
Management of Anaplastic Thyroid Cancer/Lymphoma
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
James D. Brierley, Richard W. Tsang
Most of the newer studies combining radiation and chemotherapy utilize IMRT. With this technique it is possible to generate concave dose distributions and narrow margined dose gradients so that normal structures can be spared while complex volumes are treated.17, 28, 29 Despite modern radiation techniques, the toxicity from hyperfractionated radiation or concurrent chemoradiation can be significant and enteral nutrition with a feeding tube and growth factor support may be required, especially if large tumour volumes are treated. There has been no comparison of altered fractionation alone compared to chemoradiation with standard or hyperfractionated radiation and the potential benefits remain unanswered especially when more aggressive therapy is associated with increased toxicity.30
Safety considerations with new treatment regimens for anal cancer
Published in Expert Opinion on Drug Safety, 2021
Sarah K Cimino, Kristen K. Ciombor, A Bapsi Chakravarthy, Christina E. Bailey, M Benjamin Hopkins, Timothy M. Geiger, Alexander T. Hawkins, Cathy Eng
An interdisciplinary team approach is essential to mitigate risks associated with the treatments for anal cancer. Some of the specific concerns with chemoradiation include chemotherapy and radiation-related toxicities. Mitomycin has been associated with profound myelosuppression which may lead to neutropenic infections or other complications [10]. Therefore, it is recommended that doses of mitomycin do not exceed 12 mg/m2 and are also capped at a maximum dose of 20 mg [12]. In addition, radiation has established risks including acute and delayed toxicities. Furthermore, in the metastatic setting, carboplatin and paclitaxel can both be associated with life-threatening hypersensitivity reactions, and immunotherapy may lead to overactivation of the immune system and subsequent thyroiditis, colitis, or pneumonitis. Further details regarding safety considerations for the current treatments of anal cancer are listed in Tables 1 and 2.
Prognostic Nutritional Index and Clinical Response in Locally Advanced Cervical Cancer
Published in Nutrition and Cancer, 2020
This study included 583 women from two cancer centers presenting with histologically proven locally advanced cervical cancer (FIGO stages IIB- IVA) between February 2007 and January 2014. During assessment at baseline, each patient underwent routine investigations and the PNI was calculated from the results of the baseline blood tests. In addition to the baseline PNI, the histology, the baseline hemoglobin levels, tumor stage, and the presence of pelvic inflammatory disease at the first visit were recorded in every case. In view of the known association between nutrition and immune balance, the neutrophil lymphocyte ratio (NLR), widely used as a marker of inflammatory status, was calculated at baseline for each subject. The women in this cohort received pelvic chemoradiation to a dose of 50 Gy in 25 fractions over 5 weeks, with weekly concomitant Cisplatin at a dose of 40 mg/m2. The treatment was completed after the conclusion of subsequent brachytherapy. Tumor response was assessed clinically by gynaecological examination at 6 weeks after treatment completion. The duration between the completion of chemoradiation, and the first fraction of brachytherapy, ranged between 7 and 12 day. Clinical response was considered to be complete if there was no evidence of tumor on speculum inspection and bimanual examination.
Primary neoplasms of the uterus simultaneously presenting as neuroendocrine carcinoma of the cervix and adenosquamous carcinoma of the endometrium: a case report
Published in Journal of Obstetrics and Gynaecology, 2019
Seokmin Jeong, Sung Bin Park, Eun-Ju Lee, Mi Kyung Kim, Sang Lim Choi, Hyun Jeong Park, Eun Sun Lee
A 55-year-old woman experiencing vaginal bleeding for the past two months visited our hospital. The results of laboratory tests showed that her complete blood count, electrolyte levels and liver function were within the normal ranges. The levels of serum tumour markers were also within normal ranges. A physical examination revealed a palpable, enlarged uterus of the size observed at 12 gestational weeks. A pelvic examination revealed an enlarged, movable cervix with a grossly-smooth appearance. Magnetic resonance imaging demonstrated a 5.1 × 3.1 cm sized heterogeneous mass in the uterine cervix and multiple polypoid masses, approximately 3.0 × 2.5 cm in size, in the endometrial cavity (Figure 1) with high signal intensity in the T2-weighted image. The patient tested negative for human papillomavirus. Based on these results, radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymph node dissection were performed. Pathological results indicated a neuroendocrine carcinoma of the cervix (stage IB2) and an adenosquamous carcinoma of the endometrium (stage IB) (Figure 1). We administered concurrent chemoradiation therapy. She is alive without evidence of recurrence after six months of follow-up.