Home About us Contact
|
Home About us Contact | ||
|
|
||
Radical Treatment (radical + treatment)
Selected AbstractsSquamous cell carcinoma arising from a congenital duplication cyst of the esophagus in a young adultDISEASES OF THE ESOPHAGUS, Issue 3-4 2001S. Singh Squamous cell carcinomas arising from the congenital anomalies in the esophagus are rare. One such case of an 18-year-old man, with an associated history of ventricular septal defect, who developed an epithelial malignancy within the duplication cyst extending to involve the lower third of esophagus is presented here. He responded well to radical treatment using concurrent chemo-irradiation, and continues to be free of disease after a follow-up of 14 months. [source] FDG PET studies during treatment: Prediction of therapy outcome in head and neck squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2002Eva Brun MD Background Positron emission tomography (PET) provides metabolic information of tissues in vivo. The purpose of this study was to assess the value of PET with 2-[18 F] fluoro-2-deoxy- D -glucose (FDG) in prediction of therapy outcome (tumor response, survival, and locoregional control) in locally advanced HNSCC. Methods Between 1993 and 1999 47 patients underwent PET before (PET1) and after (PET2) 1 to 3 weeks of radical treatment with evaluation of metabolic rate (MR) and standardized uptake value (SUV) of FDG. All patients received radiotherapy, and 10 also received neoadjuvant chemotherapy. Median follow-up time was 3.3 years. Results Low and high MR FDG at PET2, with median value as cutoff, was associated with complete remission in 96% and 62% (p = .007), with 5-year overall survival in 72% and 35% (p = .0042) and with local control in 96% and 55% (p = .002), respectively. Conclusions FDG PET in the early phase of treatment of HNSCC is associated with tumor response, survival, and local control. © 2002 John Wiley & Sons, Inc. [source] A salvage treatment for solid liver metastasis after radical resection of Klatskin tumourHPB, Issue 4 2003Yuji Nakagawa Background Long-term survival has not been described following surgical resection for liver metastasis after radical resection of an advanced hilar bile duct carcinoma (Klatskin tumour). One such patient who developed liver metastasis after radical treatment for stage IVA (pTNM) hilar cholangiocarcinoma has survived 5.5 years after resection of the liver metastasis followed by chemotherapy. Case report A 50-year-old man developed a solid liver metastasis in segment VIII 17 months after radical resection of a stage IVA (pT3 pN1 M0) Klatskin tumour followed by postoperative radiotherapy (54 Gy) and systemic chemotherapy (oral UFT 450 mg/day plus intravenous cisplatin 20 mg on 5 consecutive days each month). The patient is alive at 7 years after the primary resection followed by resection of the liver metastasis plus further systemic chemotherapy comprising oral UFT combined with intravenous adriamycin (ADM) and mitomycin C (MMC). Conclusion Aggressive salvage resection surgery can be an effective component of a multidisciplinary treatment regimen, even for a postoperative liver metastasis that developed after radical resection of an advanced Klatskin tumour, provided that the metastasis is solid and has not failed local-regional control. [source] Offline adaptive radiotherapy for bladder cancer using cone beam computed tomographyJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2009F Foroudi Summary We investigated if an adaptive radiotherapy approach based on cone beam CT (CBCT) acquired during radical treatment was feasible and resulted in improved dosimetric outcomes for bladder cancer patients compared to conventional planning and treatment protocol. A secondary aim was to compare a conventional plan with a theoretical online process where positioning is based on soft tissue position on a daily basis and treatment plan choice is based on bladder size. A conventional treatment plan was derived from a planning CT scan in the radical radiotherapy of five patients with muscle invasive bladder cancer. In this offline adaptive protocol using CBCT, the patients had 10 CBCT: daily CBCT for the first five fractions and then CBCT scan on a weekly basis. The first five daily CBCT in each patient were used to create a single adaptive plan for treatment from fraction eight onwards. A different process using the planning CT and the first five daily CBCT was used to create small, average and large bladder volumes, giving rise to small, average and large adaptive bladder treatment plans, respectively. In a retrospective analysis using the CBCT scans, we compared the clinical target volume (CTV) coverage using three protocols: (i) conventional; (ii) offline adaptive; and (iii) online adaptive with choice of ,plan of the day'. Daily CBCT prolonged treatment time by an average of 7 min. Two of the five patients demonstrated such variation in CTV that an offline adaptive plan was used for treatment after the first five CBCT. Comparing the offline adaptive plan with the conventional plan, the CTV coverage improved from a minimum of 60.1 to 94.7% in subsequent weekly CBCT. Using the CBCT data, modelling an online adaptive protocol showed that coverage of the CTV by the 95% prescribed dose line by small, medium and large adaptive plans were 34.9, 67.4 and 90.7% of occasions, respectively. More normal tissue was irradiated using a conventional CTV to planning target volume margin (1.5 cm) compared to an online adaptive process (0.5 cm). An offline adaptive strategy improves dose coverage in certain patients to the CTV and results in a higher conformity index compared to conventional planning. Further research in online adaptive radiation therapy for bladder cancer is indicated. [source] Oxidative gating of water channels (aquaporins) in Chara by hydroxyl radicalsPLANT CELL & ENVIRONMENT, Issue 9 2004T. HENZLER ABSTRACT Hydroxyl radicals (*OH) as produced in the Fenton reaction (Fe2+ + H2O2 = Fe3+ + OH, + *OH) have been used to reversibly inhibit aquaporins in the plasma membrane of internodes of Chara corallina. Compared to conventional agents such as HgCl2, *OH proved to be more effective in blocking water channels and was less toxic to the cell. When internodes were treated for 30 min, cell hydraulic conductivity (Lp) decreased by 90% or even more. This effect was reversed within a few minutes after removing the radicals from the medium. In contrast to HgCl2, radical treatment reduced membrane permeability of small lipophilic organic solutes (ethanol, acetone, 1-propanol, and 2-propanol) by only 24 to 52%, indicating some continued limited movement of these solutes across aquaporins. The biggest effect of *OH treatment on solute permeability was found for isotopic water (HDO), which largely used water channels to cross the membrane. Inhibition of aquaporins reduced the diffusional water permeability (Pd) by about 70%. For the organic test solutes, which mainly use the bilayer to cross the membrane, channel closure caused anomalous (negative) osmosis; that is, cells had negative reflection coefficients (,s) and were transiently swelling in a hypertonic medium. From the ratio of bulk (Lp or osmotic permeability coefficient, Pf) to diffusional (Pd) permeability of water, the number (N) of water molecules that align in water channels was estimated to be N = Pf/Pd = 46 (on average). Radical treatment decreased N from 46 to 11, a value still larger than unity, which would be expected for a membrane lacking pores. The gating of aquaporins by *OH radicals is discussed in terms of a direct action of the radicals when passing the pores or by an indirect action via the bilayer. The rapid recovery of inhibited channels may indicate an easy access of cytoplasmic antioxidants to closed water channels. As hydrogen peroxide is a major signalling substance during different biotic and abiotic stresses, the reversible closure of water channels by *OH (as produced from H2O2 in the apoplast in the presence of transition metals such as Fe2+ or Cu+) may be downstream of the H2O2 signalling. This may provide appropriate adjustments in water relations (hydraulic conductivity), and a common response to different kinds of stresses. [source] Long-Term Outcome of Adult-to-Adult Living Donor Liver Transplantation for Post-Kasai Biliary AtresiaAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2006Y. Uchida Our objective was to analyze problems in the perioperative management and long-term outcome of living donor liver transplantation (LDLT) for biliary atresia (BA). Many reports have described the effectiveness of liver transplantation (LT) for BA, particularly in pediatric cases, but little information is available regarding LT in adults (,16 years old). Between June 1990 and December 2004, 464 patients with BA underwent LDLT at Kyoto University Hospital, of whom 47 (10.1%) were older than 16 years. In this study, we compared the outcomes between adult (,16 years old) and pediatric (<16 years old) patients. The incidence of post-transplant intestinal perforation, intra-abdominal bleeding necessitating repeat laparotomy and biliary leakage was significantly higher (p < 0.0001, <0.001 and <0.001, respectively) in adults. Overall cumulative 1-, 5- and 10-year survival rates in pediatric patients were significantly higher (p < 0.005) than in adults. Two independent prognostic determinants of survival were identified: a MELD score over 20 and post-transplant complications requiring repeat laparotomy. Outcome of LDLT in adult BA patients was poorer than in pediatric patients. It seems likely that LT will be the radical treatment of choice for BA and that LDLT should be considered proactively at the earliest possible stage. [source] TMPRSS2:ERG fusion transcripts in urine from prostate cancer patients correlate with a less favorable prognosisAPMIS, Issue 8 2009KARI ROSTAD Rostad K, Hellwinkel OJC, Haukaas SA, Halvorsen OJ, Řyan AM, Haese A, Budäus L, Albrecht H, Akslen LA, Schlomm T, Kalland K-H. TMPRSS2:ERG fusion transcripts in urine from prostate cancer patients correlate with a less favorable prognosis. APMIS 2009; 117: 575,82. The transcription factor ERG is highly upregulated in the majority of prostate cancers due to chromosomal fusion of the androgen responsive promoter of TMPRSS2 to the ERG reading frame. Our aim was to identify this gene fusion in urine samples from prostate cancer patients prior to radical treatment and to compare fusion status with clinicopathological variables. Urine fractions from 55 patients (with and without prior prostatic massage) were analyzed for the presence of TMPRSS2:ERG isoforms using real-time qPCR. Sixty-nine percent of urine samples following prostatic massage were positive for TMPRSS2:ERG isoforms a or b, five out of which were positive for both, vs 24% of samples obtained without prior massage. Isoform a seems to be most prevalent and some patients may be positive for more than one fusion variant, reflecting the multifocality of prostate cancer. Prostatic massage prior to sampling, analysis of pelleted urine material and detection of cDNA provided the highest sensitivity. Positive statistical correlations were identified between TMPRSS2:ERG fusion and high s-PSA, pathological stage and Gleason score. Our findings contribute to the increasing elucidation of the role of TMPRSS2:ERG in the development of prostate cancer. [source] Changes of the total antioxidative status of blood cells in the progression of stomach and large bowel cancers in patients subjected to primary radical treatmentBIOFACTORS, Issue 1-4 2004Z. Kopański Abstract The analysis included 53 patients (32 men and 21 women) aged 43 to 66 years, who were subjected to radical treatment (surgical or combined) because of stomach (22 patients) or large bowel (31 patients) cancer. All the patients were included in the same model of control examinations, which considered evaluation of the erythrocytes TAS and of the Ca19,9, CEA and AFP concentrations in serum. It was confirmed that in all the patients in whom the recurrence and/or the dissemination occurred of the cancer, the average erythrocytes TAS value increased 5.5 times by comparison with the period before progression and 7 times in comparison with the patients without recurrence and/or dissemination of the cancer. Moreover it was shown that statistically significantly higher TAS values were associated with the progression of the large bowel cancer in comparison with the stomach cancer and that the blood cells TAS positively correlated with the changes of the Ca19,9, CEA and AFP concentrations in patients with progression of the cancer after radical treatment. [source] A preliminary report on a patient-preference study to compare treatment options in early prostate cancerBJU INTERNATIONAL, Issue 3 2002The North West Uro-oncology Group Objectives,To prospectively record prognostic factors, quality-of-life and outcome data in a patient-preference controlled study comparing radical prostatectomy with radical radiotherapy for the treatment of early prostate cancer. Patients and methods,All patients suitable for radical treatment of early prostate cancer were identified and provided with information from a urologist, oncologist and nurse to allow them to choose a treatment option. Prognostic and demographic data were recorded for all patients and patients followed up uniformly, with the additional collection of quality-of-life data. Results,In a 38-month period, 196 patients were recruited to the trial; of these, 81 chose surgery, 81 radiotherapy, 30 brachytherapy and four ,watchful waiting'. The distribution of acknowledged prognostic factors was similar between the groups. Conclusion,If patient preference continues to divide this population into roughly equal and comparable arms, it should be possible to answer the underlying questions on the treatment of early prostate cancer using this study design. [source] Prospective study of bone scintigraphy as a staging investigation for oesophageal carcinoma,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2008N. A. Jennings Background: About 10 per cent of patients undergoing radical oesophagectomy for transmural (T3) carcinoma with lymph node involvement (N1) develop symptomatic bone metastases within 12 months of surgery. The aim of this study was to evaluate the introduction of targeted preoperative bone scintigraphy. Methods: Of 790 patients with oesophageal carcinoma staged between December 2000 and December 2004, 189 were eligible for potentially curative treatment. 99mTc-labelled hydroxymethylene diphosphonate bone scintigraphy was performed in those with stage T3 N1 disease (identified by computed tomography and endoscopic ultrasonography) who were suitable for radical treatment. Results: A total of 115 patients had bone scintigraphy. The histological diagnosis was adenocarcinoma in 82 patients and squamous cell carcinoma in 33. Bone scintigraphy was normal or showed degenerative changes in 93 patients, and abnormal requiring further investigation in 22. Plain radiography, magnetic resonance imaging and biopsy confirmed the presence of bone metastases in 11 patients (9·6 per cent). Conclusion: Bone is frequently the first site of identifiable distant metastatic spread, and bone scintigraphy is recommended to exclude metastatic disease before radical treatment of advanced oesophageal carcinoma. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Restaging surgery for women with borderline ovarian tumorsCANCER, Issue 6 2004Results of a French multicenter study Abstract BACKGROUND The purpose of the current study was to examine the surgical management of women with borderline ovarian tumors and the adequacy of initial staging according to the guidelines of the International Federation of Gynecology and Obstetrics; to evaluate the impact of restaging operations; and to identify risk factors for initial understaging. METHODS In a retrospective French multicenter study, 54 of 360 women with borderline ovarian tumors underwent a restaging operation. After excluding women with initial complete staging (n = 62), epidemiologic, surgical, and histologic parameters and risk of recurrence were compared between women who underwent restaging (n = 54) and those who did not (n = 244). RESULTS One hundred fifty (41.6%) of 360 women underwent intraoperative histologic examination, which led to the diagnosis of a borderline tumor in 97 cases (64.7%). Thirty-seven (38.1%) of these 97 women had undergone complete initial staging procedures. A restaging operation was performed for 54 women. A lower median age and a higher rate of conservative treatment were noted in the group that underwent restaging. Eight (14.8%) of the 54 women who underwent restaging had their tumors upstaged: 7 of the 41 cases initially diagnosed as Stage IA tumors were upstaged to Stage IB (n = 3) or to Stage IIA, IIB, IIIA, or IIIC (n = 1 for each); in the eighth case, a Stage IC tumor was upstaged to Stage IIIA. Upstaging tended to be more common in women with serous borderline tumors (P = 0.06) and in women who underwent cystectomy (P = 0.08). There was no difference in recurrence rates according to whether a restaging operation was performed. The recurrence rates after conservative and radical treatment were 15.6% (25 of 160) and 4.5% (9 of 200), respectively (P < 0.001). CONCLUSIONS Women who initially were diagnosed with Stage IA disease and who had serous borderline tumors or underwent cystectomy appeared to derive the most benefit from restaging surgery. Nonetheless, the indications for restaging surgery remain controversial, as no difference in recurrence rate was observed between women who underwent restaging and those who did not. Cancer 2004. © 2004 American Cancer Society. [source] Phase II study of alpha-tocopherol in improving the cognitive function of patients with temporal lobe radionecrosisCANCER, Issue 2 2004Agnes S. Chan Ph.D. Abstract BACKGROUND Radiotherapy is an important treatment modality for brain tumors and is the standard radical treatment for nasopharyngeal carcinoma (NPC). However, the treatment is not free of side effects, and one possible neurologic sequela is the occurrence of temporal lobe radionecrosis (TLN) associated with cognitive dysfunction. Currently, there is no effective intervention to improve patients' cognitive performance. METHODS Twenty-nine patients with TLN after radiotherapy for NPC were recruited on a voluntary basis. Among them, 19 patients (15 males and 4 females) received a megadose of alpha-tocopherol (vitamin E) (2000 international units per day) for 1 year, whereas the other 10 (5 males and 5 females) served as control patients. Their cognitive function (i.e., global cognitive ability, attention, memory, language, and executive function) was evaluated by a battery of neuropsychological tests before and after treatment. RESULTS Significant improvement in global cognitive ability (P = 0.035) and memory (verbal: P = 0.036; visual: P = 0.007) occurred among patients in the treatment group after a 1-year medication period. In addition, the executive function of the treatment group improved significantly (P = 0.04). No difference was found between the two groups with respect to attention or language. CONCLUSIONS The current investigation was a preliminary study on the effect of alpha-tocopherol on the cognitive function of patients with TLN after radiotherapy for NPC. In view of the absence of effective treatment for patients with cerebral radionecrosis, alpha-tocopherol has the potential to be a complementary intervention for patients with cognitive dysfunction due to TLN. Cancer 2004;100:398,404. © 2003 American Cancer Society. [source] Development of a clinical chart audit programmeJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2006Y Zissiadis Summary Radiation oncology charts containing medical information and treatment details are the major methods of communication between the various personnel involved in delivering radiation therapy to the patient. It is paramount to good patient care for this communication to be clear, precise and accurate in detail. A regular chart audit should be a part of the quality assurance programme of every radiation oncology department. The primary aim of this study was to develop and assess an objective and quantitative programme for reviewing radiation oncology charts, thereby improving the quality of communication and hence patient management. A secondary aim was to compare the charts of radically treated patients with those treated palliatively. A pilot study using a new chart review tool, developed at the Perth Radiation Oncology Centre, was carried out over an 8-month period. A sample of charts, representing 25% of our treatment group, were assessed using the tool on a monthly basis. A total of 156 charts were reviewed during this time period. Fifty-six per cent were radical treatments and 44% were palliative. The overall mean chart scores significantly improved over the time of this study (P < 0.001). The individual radiation oncologists' scores were also seen to improve during the study period. The alpha coefficients for intra-rater and inter-rater reliability were 0.99 and 0.88, respectively. The chart review programme was found to be an easy-to-use and a reliable tool by both medical and non-medical reviewers. It appeared to have a positive influence on the standard of radiation oncology charts in our department. [source] How do waiting times affect radiation dose fractionation schedules?JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2000Conrade Iv Franklin SUMMARY The purpose of the present paper was to evaluate the changing patterns of dose prescription at the Queensland Radium Institute from 1995 to 1998 inclusive. Data were analysed from the treatment files collected on each patient and these were compared with data on delay time. There has been an increased use of shorter fractionation schedules in the period studied. Paradoxically, radical treatments have become longer. The average number of fractions for all patients was 17.4 and for palliative treatments it was 7.4. The monthly delay varied from 0 to 22 working days and the average was 7 working days. When fraction number was compared to treatment delay, there was a negative linear correlation (R = ,0.25). The correlation was stronger (R = ,0.467) when palliative treatments were compared, indicating that clinicians were more prepared to alter palliative treatments in the presence of a treatment delay than curative ones. [source] | |||||||||||||