Integrative hyperthermia treatments for different types of cancer
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
Radiotherapy is one of the effective methods for the treatment of endometrial cancers. Radiotherapy alone is only suitable for patients who are frail, patients with serious medical complications who cannot tolerate surgery or have contraindications for surgery, as well as patients above stage III who are unfit for surgery, including intracavitary and external irradiation. Postoperative adjuvant radiotherapy is often used in clinical applications. Indications for postoperative radiotherapy are as follows: lymph node metastasis or suspicious lymph node metastasis as shown by surgical detection; uterine myometrial invasion greater than 1/2 or G2, G3; special histological types, such as serous carcinoma and clear cell carcinoma; and cancer residual at the vaginal cutting edge. For the first three cases, whole pelvic irradiation is given; for the last case, brachytherapy needs to be added.
Principles of oncology
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Second, there is the question of the intent underlying the treatment. Radiotherapy, chemotherapy, or the combination of the two, may be used with curative intent. More usually, chemotherapy or radiotherapy is used to lower the risk of recurrence after primary treatment with surgery, so-called adjuvant therapy. Implicit within the concept of adjuvant therapy is the realisation that much of what is done is unnecessary, or futile, or both. The need for adjuvant therapy, to treat the risk that residual disease might be present after apparently curative surgery, is an acknowledgement of the current inability to detect or predict, with sufficient precision, the presence of residual disease. It also explains why the incremental benefits from adjuvant treatments are so small, and why the existence of these benefits can only be proven using randomised controlled trials including many thousands of patients. As illustrated in Figures10.7and10.8, the current approach to the selection of patients for postsurgical adjuvant treatment is both intellectually impoverished and inefficient. Patients might have been far better off if, rather than so much time and effort being invested in attempting to discover new ‘cures’ for cancer, equivalent resources had been devoted to devising clinically useful tests to detect residual cancer cells persisting after apparently successful initial therapy. Had this been the case, we might now be better able to distinguish between those patients with systemic disease at presentation and those with truly localised disease.
Premalignant and malignant disease of the lower genital tract
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Adjuvant radiotherapy, given after surgery with curative intent, is indicated when vulval excision margins are close or involved or in the presence of two or more groin node metastases. Adjuvant radiotherapy is given to reduce the risk of recurrence. Neoadjuvant radiotherapy, given before surgery to shrink the tumour and render it operable, is used for very large vulval tumours, particularly those that involve the urethra or anus and where adequate surgical effort would have functional urinary or bowel implications. Occasionally, radical radiotherapy is given instead of surgery in women who are not fit for an anaesthetic due to severe medical comorbidities (see previous section). Chemoradiotherapy is associated with improved cure rates compared to radiotherapy alone. Treatment of recurrent disease and palliative treatment follows the same principles as for cervical malignancy discussed in the previous section
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
In China, HIFU therapy for soft tissue sarcoma is also an established treatment method [1]. A chordoma is a form of low-grade soft tissue sarcoma, which arises from the remnants of the notochord. This tumour subtype is rare, with a prevalence of less than one case per million per annum. The critical problem with treating this tumour type is the location as it is adjacent to many critical pelvic structures. Hence the mainstay treatment option, curative surgical resection, is not always feasible. Another key problem is delayed presentation as the symptoms are slowly progressive and non-specific during the early stages of the disease. Symptoms include bladder and bowel dysfunction, sacral and lower limb pain, as well as pelvic masses. Alongside surgery, adjuvant radiotherapy is given. Radiotherapy has a maximum dose and so repeated cycles are not always possible. HIFU is able to overcome some of these challenges and has been shown to successfully treat sacral chordomas in four patients at the Churchill Hospital, Oxford [11,26].
Matched analysis of the prognosis of amelanotic and pigmented melanoma in head and neck
Published in Acta Oto-Laryngologica, 2020
Wei Guo, Gaofei Yin, Hongfei Liu, Hanyuan Duan, Zhigang Huang, Xiaohong Chen
Currently, treatment and staging of melanoma based on pigment classification has not been developed. Therefore, patients are still treated in accordance with the guidelines for head and neck mucosal melanoma, and surgical treatment is the first choice. However, in terms of postoperative adjuvant treatment, according to our center’s research, patients with amelanotic melanoma have a higher risk of distant metastases with poor prognosis. We suggest that, no matter the stage, patients with amelanotic melanoma need postoperative adjuvant treatment and also close follow-up. To prevent local recurrence after surgery, postoperative adjuvant radiotherapy is recommended. However, as yet, no treatment has been identified which might lower the risk of distant metastases. Chemotherapy does not provide an obvious treatment effect for head and neck mucosal melanoma, and no clinical research has been carried out on treatments for AM. A recent review [20] has also shown that no particular type of treatment can improve the survival rate of patients with AM (p > .05). A combination of surgery and surgery plus adjuvant therapy is the method most commonly used (76%). In recent years, immunotherapy has been widely used in melanoma. For head and neck mucosal melanoma, which has a low immune response rate, further clinical experiments are needed, especially for special types such as amelanotic melanoma.
Giant malignant phyllodes tumor with metastasis to the brain
Published in Baylor University Medical Center Proceedings, 2019
Alden P. Gregston, David M. Metter, Cynthia R. C. Osborne, John Pippen
Treatment for large PT typically involves a total mastectomy without axillary dissection and nodal sampling unless metastasis is confirmed by intraoperative biopsy due to presumed hematogenous spread.13 Adjuvant radiotherapy is associated with decreased local recurrence and may be considered if further surgery would cause considerable morbidity, but it has not been shown to impact overall survival.18 Due to the paucity of metastatic malignant PT cases, there are no randomized controlled trials specifically assessing the benefit of chemotherapy. However, in a retrospective single institution study of 37 patients with metastatic PTs, patients receiving a doxorubicin-based polychemotherapy had an improved mean survival of 9 months compared to those treated with endocrine therapies (mean survival of 2 months) versus single-agent chemotherapies (mean survivals ranging from 5 to 7 months).6 The National Comprehensive Cancer Network currently recommends that cases of recurrent metastatic PT follow treatment guidelines for metastatic soft tissue sarcomas.19
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