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Pancreas
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Sandra Van Schaeybroeck, Mark Lawler, Patrick G. Johnston
In view of the low resectability rates and the poor long-term outcomes, a number of investigators have conducted studies of preoperative treatment with chemoradiotherapy in an attempt to improve resectability. The use of chemoradiotherapy may have four advantages: The use of preoperative treatment rather than postoperative allows a greater proportion of patients to receive all components of the planned treatment.Preoperative treatment allows a period of observation that will avoid patients with rapidly progressive disease undergoing surgery.It may allow the downstaging of localized tumours, increasing the chance of obtaining an R0 resection.It may allow the early treatment of micrometastatic disease.
Radiotherapy: Scientific Principles and Practical Application in Urogical Malignancies
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Angela Swampillai, Rachel Lewis, Mary McCormack, Heather Payne
The combination of chemotherapy or biological agents with radiotherapy is increasingly used to try and improve local control rates and eradicate micrometastases. The effects of multimodality treatment can be additive, synergistic or independent. By using two treatment modalities, resistance mechanisms are more likely to be overcome. The systemic agents may also radiosensitize tumor tissue and may favorably alter the tumor biology, for example, by reoxygenation, cell cycle redistribution, inhibiting DNA repair and impairing accelerated repopulation. This concept is being evaluated for bladder cancer in a randomized controlled trial comparing radical radiotherapy with radiotherapy plus concomitant 5 FU/mitomycin C. Theoretically, 5 FU would kill radioresistant cells in the S phase of the cell cycle. In addition, radiation induces the expression of thymidine phosphorylase in cancer tissues, which is the first enzyme involved in the activation of 5 FU (12).
Pathology
Published in Jim Cassidy, Patrick Johnston, Eric Van Cutsem, Colorectal Cancer, 2006
Micrometastasis is defined as metastasis 0.2 cm or less in greatest dimension. Cases with only micrometastasis may be identified by the addition of “(mi)” to the pN and/or pM category, e.g., pNl(mi) or pMl(mi). In micrometastasis, tumor cells penetrate the wall of lymph sinus or blood vessels and there is extrasinusoidal or extravascular proliferation (10–22). Micrometastasis has to be distinguished from isolated (disseminated or circulating) tumor cells in lymph nodes, blood or bone marrow, or at other distant sites. Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters of cells not more than 0.2 mm in greatest dimension that are usually detected by immunohisto-chemistry or molecular methods [flow cytometry or polymerase chain reaction (PCR)], but which may be verified with H and E stains (6). ITCs do not typically show evidence of metastatic activity (e.g., proliferation or stromal reaction) or penetration of vascular or lymphatic sinus walls. ITCs are not considered in the TNM classification, because their independent prognostic significance remains to be proven. It is recommended that positive morphological findings of ITC should be indicated by the addition of (i+), and positive nonmorphological findings by the addition of (mol+), e.g., pN0(i+) or M0(mol+).
The effect of consolidation chemotherapy after concurrent chemoradiation on the prognosis of locally advanced cervical cancer: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Lan Zhong, Kemin Li, Liang Song, Rutie Yin
In conclusion, CCRT has become a standard treatment for bulky and locally advanced cervical cancer because of excellent local control. Even though, there remained inevitable local and distant recurrence. New treatment schedules such as consolidation chemotherapy emerged aimed at eradicating subclinical micrometastasis. Our pooled data showed solid evidence of benefit on survival outcome and local/distant recurrence due to consolidation chemotherapy for LACC. Considering significant toxicities related to consolidation chemotherapy, we should manage to identify the suitable candidates with high-risk factors of distance metastasis. In the future, we need more clinical studies with high quality to verify the role of consolidation chemotherapy in cervical cancer, and further to optimise the criteria for it, like cycles and regimens, etc.
Risk factors for short recurrence-free survival after resection of pancreatic neuroendocrine tumor (PanNET) liver metastases: which patients should undergo resection?
Published in Scandinavian Journal of Gastroenterology, 2020
Toshihiko Masui, Kazuyuki Nagai, Takayuki Anazawa, Yosuke Kasai, Asahi Sato, Kenzo Nakano, Yuichiro Uchida, Akitada Yogo, Yoshiya Kawaguchi, Kyoichi Takaori, Shinji Uemoto
In this study, the actual Ki67 index of the primary NET was evaluated, and it was found that a high Ki67 index correlated with a shorter RFS. Because Ki67 index values of the metastatic sites vary from tumor to tumor, it is difficult to evaluate them before operation. The Ki67 in primary tumors can be obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) before operation even for synchronous metastases. Moreover, the metastasis arises from primary PanNET, indicating that the malignant phenotype of the primary rather than the metastatic sites is important for assessing recurrence in the liver. Elias et al. [22] reported that only 49% of pathologically detected metastatic NET liver tumors could be radiographically detected, suggesting that half of the metastatic tumors reside microscopically even after curative resection. Gibson et al. reported that micrometastasis less than 1 mm was related to the presence of visible tumors of more than 5 mm and was related to a poor prognosis [23]. In fact, the number, but not the size, of the radiographically detected tumors correlated with short RFS. These also coincide with the argument that the residual undetected tumors at the time of resection become radiographically visible. In this study, adjuvant pharmacotherapy was given to 15.3% of the resected patients, but it did not correlate with RFS, probably because of the selection bias of the patients. Further study of RFS/OS with more patients with propensity score matching is necessary to elucidate the impact of adjuvant therapy.
State-of-the-art, approved therapeutics for the pharmacological management of osteosarcoma
Published in Expert Opinion on Pharmacotherapy, 2021
Cristina Meazza, Sebastian Dorin Asaftei
In addition, the bone micro-environment is a unique compartment of the immune system, in which cytokines and intercellular crosstalk are important to bone development and homeostasis. The high levels of genomic instability characteristic of OS make immunotherapies particularly suitable, because they can express neo-epitopes that provide the substrate for the immune-mediated killing of cancer cells. Immunotherapies could have their greatest effect in the setting of micrometastatic disease. In future, chemotherapy and surgery will probably remain the backbone of conventional treatments for localized OS patients, while combinations of immunotherapies with standard cytotoxic agents may be the way to go for patients with advanced disease at diagnosis, whose outcome today remains grim.