Dopamine and Tumorigenesis in Reproductive Tissues
Nira Ben-Jonathan in Dopamine, 2020
The biomedical community is confronted by breast cancer on two fronts: One is how to implement an early accurate diagnosis, and another is how to provide an effective clinical management [29]. Some breast cancers are aggressive and life-threatening and must be managed robustly, i.e., by surgery, radiotherapy, and chemotherapy. Neoadjuvant chemotherapy is used to reduce tumor size before surgery, while adjuvant chemotherapy is used after tumor excision. Chemotherapy is the mainstay treatment for patients with triple-negative tumors, which are resistant to hormone or targeted therapy, and for those with advanced metastatic disease [30]. Over the years, dozens of anticancer drugs have been developed, with treatment options taking into account tumor grade and histology and whether the desired outcome is curative or palliative. Most regimens combine drugs acting by different mechanisms so as to improve the odds of suppressing tumor growth.
The urinary bladder
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The treatment of cancer with proven muscle invasion remains a subject for debate. Whatever the modality of treatment employed, few centres have 5-year survival rates of more than 50%. There is a move towards primary surgical treatment in most centres. The use of systemic chemotherapy with a combination of agents - cisplatin, methotrexate, doxorubicin and vinblastine (M-VAC) or cisplatin plus gemcitabine given before (neoadjuvant) radical cystectomy - has been shown to be of benefit. The current evidence is that neoadjuvant chemotherapy improves survival by about 5-7%. There is no good evidence for the use of adjuvant chemotherapy in these patients. Survival from MIBC has not improved over the past two decades, and newer immunotherapy approaches are being evaluated, in particular immune-checkpoint inhibitors with antibodies targeting the programmed cell death 1 ligand 1 (PDL1) pathway with promising results.
Integrative hyperthermia treatments for different types of cancer
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
Surgical resection is the primary means for the treatment of osteosarcomas. Amputation and disarticulation are the most common methods. However, with the progress of chemotherapy in recent years, some researchers have begun applying resection of tumor segment or total femur resection, with artificial prosthetic for replacement. Limb salvage has become a major operation. Conduct preoperative standardized chemotherapy for 6–8 weeks, and then implement tumor resection. Resection margin is required to be radical or extensive. Artificial joint replacement is commonly used for bone defects. If limb salvage is not suitable or in the case that there is no condition for limb salvage, amputation should be decisively implemented, but postoperative chemotherapy has to be applied. Chondrosarcoma treatment focuses on surgery, and the efficacy depends on the breadth of tumor resection and malignancy of histological grade. Ewing’s sarcoma is very sensitive to radiation and chemotherapy. In current treatment protocols, the most advocated is neoadjuvant chemotherapy combined with extensive or radical resection of tumor. The therapeutic principle of treatment for bone malignant fibrous histiocytoma is similar to that of osteosarcoma.
Radiomics in surgical oncology: applications and challenges
Published in Computer Assisted Surgery, 2021
Travis L. Williams, Lily V. Saadat, Mithat Gonen, Alice Wei, Richard K. G. Do, Amber L. Simpson
Appropriate selection of patients for neoadjuvant therapy remains a top research priority for a myriad of oncologic diseases. The intent of neoadjuvant therapy is to decrease tumor size, control micro-metastatic disease, and allow for appropriate patient selection for surgery. Radiomics have been studied as a tool for the a priori identification of patients who would benefit from such upfront chemotherapy. For patients with gastric cancer, for example, radiomics have been utilized to accurately predict response to systemic therapy. A recent study, including 106 patients with neoadjuvant chemotherapy before gastrectomy, introduced a CT-based radiomics score to predict response. The published” radclinicalscore” incorporated clinical variables and radiomic features, and was demonstrated to be highly effective at predicting treatment responders (AUC 0.77 in the training cohort, and AUC 0.82 in the validation cohort) [50].
Applying adjuvant therapy for melanoma into clinical practice
Published in Expert Review of Anticancer Therapy, 2021
Tharani Krishnan, Alexander M Menzies, Rachel Roberts-Thomson
Neoadjuvant systemic therapy in melanoma is not yet an established treatment pathway; however, a number of studies using various agents have been reported [35–39]. Neoadjuvant therapy may have numerous advantages, including reducing tumor burden to facilitate resection and providing information regarding pathological response (which has been used as a surrogate endpoint of improved survival in the treatment of other cancers). This needs to be weighed against the risks of treatment toxicity and surgery delay. Patients who might be suitable for this approach are those with clinically apparent resectable stage IIIB to IIID disease and oligometastatic stage IV disease, and treatment duration should be 6 to 8 weeks [40]. Close clinical and radiological monitoring for potential progression during neoadjuvant therapy is recommended.
Highlights from a Virtual ASCO 2020
Published in Oncology Issues, 2020
In Abstract 4504, D. Sohal et al. compared patients with pancreatic cancer treated with neoadjuvant mFOLFIRINOX for six cycles vs. neoadjuvant gemcitabine plus nab‐paclitaxel (GP) for nine doses. In all patients, neoadjuvant chemotherapy was followed by surgery and then post‐op chemotherapy. Two‐year OS was 43% for mFOLFIRINOX vs. 47% for GP. At surgery, pathologic CR or major response was seen in 25% for mFOLFIRINOX vs. 42% for GP.In Abstract 4505, P. Ghaneh et al. compared IS for pancreatic cancer vs. neoadjuvant gemcitabine plus capecitabine followed by surgery (GC) vs. neoadjuvant FOLFIRINOX followed by surgery vs. neoadjuvant combined chemotherapy plus radiation therapy followed by surgery (CRT). Twelve‐month OS was 42% for IS, 79% for GC, 84% for FOLFIRINOX, and 64% for CRT. Neoadjuvant therapy was superior to IS, HR 0.27, p = 0.001.
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