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Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Robert D. Morgan, Andrew R. Clamp, Gordon C. Jayson
Patients with newly diagnosed Stage III disease should undergo aggressive tumor debulking surgery, as observational studies have indicated that when there is no gross residual tumor, the survival rate can be as high as 100%. Patients with bulk residual disease after surgery have a better prognosis than those with Stage III epithelial ovarian cancer, but the volume of residual disease is an important prognostic factor.138 There is no evidence to support the use of post-operative chemo- or radiotherapy for early- or advanced-stage borderline disease.
Dopamine and Tumorigenesis in Reproductive Tissues
Published in Nira Ben-Jonathan, Dopamine, 2020
Cancer of the ovary is the fourth leading cause of cancer mortality among women, causing more deaths than other female reproductive cancers [70,71]. The typical age of diagnosis is 63. The confounding problem is that ovarian cancer is difficult to detect early, because women with this cancer often have no symptoms, or just mild symptoms until the disease is in an advanced stage. Ovarian cancer is highly heterogeneous, and tumors can occur in the stroma, follicles, and germ cells. There are no reliable biomarkers for ovarian cancer, although CA-125 has been used with a mixed success. In addition, relatively little is known about risk factors or the tumorigenic mechanisms that underlie this disease [70]. Diagnosis can be done by imaging, followed by laparoscopic evaluation or laparotomy to determine tumor staging. Standard treatments include aggressive debulking surgery, radiotherapy, chemotherapy, and their combinations.
General Principles
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
In such an approach, surgery may play an important role in the management of the cancer patient. Patients with surgically incurable cancer may be candidates for a variety of palliative procedures to manage complications arising from their disease or therapy hoping to improve their survival and quality of life. Frequently, splenectomy is required in patients with advanced stages of lymphoma and leukemia to improve their hematologic picture so that they can tolerate further chemotherapy. Debulking procedures, i.e., surgical removal of gross tumors, leaving minimal disease for chemotherapy that follows, such as in ovarian and to some extent in testicular cancers, can improve survival. Toilet mastectomy is utilized to eliminate ulcerated, infected, and bleeding cancerous growth which interferes with chemotherapy and radiation therapy administration. Liver resections are performed in some patients with liver metastasis from large bowel cancers. Amputations may be required to eliminate pain, infection, and odor from fungating large tumors of the extremities. Locally advanced tumors can be managed by repeated fulguration, cryosurgery, or laser surgery to establish patency or stop bleeding, e.g., in the upper aerodigestive system. Feeding gastrostomies are sometimes required for feeding advanced head and neck cancer patients. Elimination of bowel obstruction in patients with metastases may prevent starvation.
Rare forms of inflammatory myopathies - part II, localized forms
Published in Expert Review of Clinical Immunology, 2023
Claudio Galluzzo, Ilaria Chiapparoli, Ada Corrado, Francesco Paolo Cantatore, Carlo Salvarani, Nicolò Pipitone
The cornerstone of treatment of IOM is systemic glucocorticoids. The initial dose should be about 1 mg/kg/day of prednisone for a couple of weeks, followed by gradual tapering over three months [5]. A major clinical response to glucocorticoids is usually observed within two days; lack of, or poor response to glucocorticoid treatment should prompt a reevaluation of the diagnosis of IOM. However, flares upon tapering of the glucocorticoid dose or relapses following glucocorticoid withdrawal are not uncommon (1/4 to ½ of cases) [2]. In relapsing patients synthetic or biologic immunosuppressive agents can be used as glucocorticoid-sparing agents. There are no controlled trials to guide the therapeutic management of such patients, but methotrexate, azathioprine, mofetil mycophenolate, TNF-alpha inhibitors (especially infliximab), ciclosporin, tacrolimus, rituximab and tocilizumab have all been tried with variable response rates [5–7]. In our experience, two patients have entered glucocorticoid-free remission with ciclosporin and another one (intolerant to ciclosporin) with rituximab. Intravenous immunoglobulins have also been used [8], while radiotherapy is of limited value because of the low radiosensitivity of IOM [2]. In highly refractory cases, surgical debulking may be considered [9].
Early tangential excision debulking after free latissimus dorsi flap reconstruction for soft tissue defects: presentation of three cases
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hiroko Murakami, Kazuo Sato, Yuta Izawa, Tatsuhiko Muraoka, Yoshihiko Tsuchida
One-stage debulking surgery shortens the total treatment time. However, an average waiting period of 3.7 months after free flap reconstruction is required until debulking surgery. Especially, del Rio et al. also reported one-stage debulking surgery. In that report, the average time of one-stage debulking surgery after reconstruction was 9.3 months, which is much shorter than multiple debulking surgery procedures. However, it is still a relatively long treatment period in total. In the cases reported in this article, we started early debulking surgery with tangential excision at approximately 1 week after free flap reconstruction when blood supply became stable. Furthermore, we repeated this procedure three to four times and then performed FTSG to complete it. The total debulking procedure took 3–4 weeks after free flap reconstruction to perform FTSG, thus tremendously shortening treatment periods.
Oxford’s clinical experience in the development of high intensity focused ultrasound therapy
Published in International Journal of Hyperthermia, 2021
Ishika Prachee, Feng Wu, David Cranston
This case series demonstrated both the safety and feasibility of successful ablation of chordoma [11]. Although there are some risks named above, when placed against its alternative – debulking surgery – it still is positively comparable. Also, surgery may involve pelvic exenteration. In order to further investigate the effectiveness of HIFU in sacral bone tumours, a national trial was established: phase IIb trial of clinical efficacy, South East Scotland REC 02 Ref12/SS/0144, ISCRTN 91527768. The primary end points of the trial include 5-year survival, pain and of quality-of-life measures. The volume of tumour ablation as well as the number and level of adverse events were chosen as secondary end points. This further research will help determine whether this non-invasive treatment gives rise to improved patient outcomes.