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Breast Cancer: Surgical Perspectives
Published in Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack, Radionuclide Imaging of the Breast, 2021
Patricia J. Eubanks, Hernan I. Vargas, Stanley R. Klein
Nonetheless, the NSABP B-18 results show a >50% reduction in tumor size in 80% of patients [72]. Thus, induction chemotherapy may not improve survival, but it can allow improved resectability and even allow for breast conservation treatment. Bonadonna et al. in 1990 reported the use of induction chemotherapy to allow patients with large breast cancers to undergo BCT [73]. One hundred twenty-seven of the 157 patients were able to have lumpectomy with AND after three to four cycles of chemotherapy. Sixty percent of the women had a partial response, and 27 of 157 had a complete response. M.D. Anderson reported partial response in 70.7% and complete response in 16.7% in patients treated with adriamycin/cytoxan based chemotherapy [74], with a 27% rate of breast conservation [75]. More long-term follow-up data are needed, yet the locoregional control appears to be good.
Sinonasal tumours
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Yujay Ramakrishnan, Shahzada Ahmed
In general, surgery tends to be the mainstay of treatment (except lymphoma) and the role of radiation with or without chemotherapy is reserved for adjuvant treatment or palliation. Some studies have shown that induction chemotherapy can be used to treat advanced tumours [10]. Heavy ion therapy like proton or carbon ion beams has also shown promise in the postoperative setting or stand-alone treatment [11].
Oncology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Gill A. Levitt, Penelope Brock, Tanzina Chowdhury, Mark Gaze, Darren Hargrave, Judith Kingston, Antony Michalski, Olga Slater
Response is best monitored with MRI and is usually good initially, though shrinkage is relatively slow in most cases (Figs 12.25, 12.26). After induction chemotherapy, depending on the response and the group stratification the patient might be treated with surgery and or RT, followed by further chemotherapy. Many children still need surgery and RT for cure, but around 50% can be spared the ‘late effects’ of these treatments (Fig. 12.27).
A review of treatment options employed in relapsed/refractory AML
Published in Hematology, 2023
Mohamed Zakee Mohamed Jiffry, Robert Kloss, Mohammad Ahmed-khan, Felipe Carmona-Pires, Nkechi Okam, Prabasha Weeraddana, Dinusha Dharmaratna, Mehndi Dandwani, Kayvon Moin
The choice of therapy depends on several factors. Notwithstanding the above, other factors that will need to be considered include access to an experienced transplant center, resources for home care, and importantly the patient’s own wishes. A patient’s prior experience with induction chemotherapy may also be relevant if they were unable to tolerate it without significant toxicity. The European Prognostic Index for patients with AML in first relapse identified four risk factors (relapse-free interval from first remission, cytogenetics at the time of diagnosis, age at first relapse, HCT before relapse) from which three risk groups have been identified (favorable, intermediate, and high risk) [28]. A retrospective study of AML patients who underwent salvage therapy found that a first CR duration of <12 months and a second CR duration of <6 months adversely affected OS [93].
The pre-surgical factors that determine the decision to proceed to resection in children diagnosed with high-risk neuroblastoma in a resource limited setting
Published in Pediatric Hematology and Oncology, 2023
Jaques van Heerden, Mariana Kruger, Tonya Marianne Esterhuizen, Anel van Zyl, Marc Hendricks, Sharon Cox, Hansraj Mangray, Janet Poole, Gita Naidu, Ané Büchner, Mariza de Villiers, Jan du Plessis, Barry van Emmenes, Elmarie Matthews, Yashoda Manickchund, Derek Stanley Harrison
According to North American protocols, the primary tumor must be resected as soon as it is possible.2,6 Although induction chemotherapy may reduce a primary tumor to optimize the possibility of resection, resection may proceed without induction chemotherapy if resection is possible.2,6 This will occasionally mean excising the primary tumor when metastatic disease is still present and further metastatic response may be anticipated with additional treatment whilst European protocols require metastatic remission before attempting surgery.7,8 The degree of resection of primary tumors is proven to have prognostic value, but is unclear in patients with metastatic disease, who are treated with multimodal therapy.9,10 Image-defined risk factors, namely radiological features seen at the time of NB diagnostic imaging, can predict resectability of a tumor.11,12 Challenges of surgical resection include extensive disease, encasing crucial major vessels and infiltrating organs such as the liver and the spleen, which complicates surgical interventions.13
Tyrosine kinase inhibitors and reduced-dose chemotherapy for adult Philadelphia chromosome-positive acute lymphoblastic leukemia
Published in Hematology, 2022
Chunping Wu, Mengting Zeng, Yuanzhong Chen, Yong Wu
Infections are a major cause of mortality andmorbidity in patients with ALL. In our study, induction mortality(7/205, 3.4%) was mainly accounted for by infections. The major cause of treatment-related mortality in patients with Ph+ ALL is infections, especially occurring during the induction period [27,28]. Although some studies have shown a reduction in the incidence of infection, bacterial resistance often hampers treatment implementation in clinical settings [29,30]. The role of antibacterial prophylaxis during inductionchemotherapy is still controversial. Inthis study, only 14.6% (30/205 patients) received fluoroquinolone prophylaxis during induction chemotherapy. Most patients received antibiotics while developing feverand/or infections, so the efficacy and safety of antibacterial prophylaxis could not be confirmed. Large randomized controlled trials areneeded to confirm the validity of the approach to induction chemotherapy for ALL described in the present study.