1,720,970 research outputs found
Neoadjuvant treatment for locally advanced rectal adenocarcinoma
No full textRectal cancer is one of the most common neoplasms of Western Countries. Overall mortality at 5 years is about 40%. This cancer is commonly diagnosed at a precocious stage, but because of local relapse and/or metastatic disease, only half of radically resected patients can be considered disease free. The value of adding radiotherapy to surgery in the treatment of patients with resectable rectal cancer has been assessed in trials using either preoperative or postoperative irradiation. Preoperative irradiation is more “dose-effective” than postoperative radiotherapy; that is, a higher dose is needed postoperatively to reduce rates of local recurrence to the same extent as preoperative radiation. Nevertheless, preoperative treatment has not been routinely recommended, mainly because it has not been shown to improve overall survival and because in some trials it has been associated with increased postoperative mortality. This paper critically reviews clinical trials of chemoradiotherapy on whether an optimal combination exists for locally advanced rectal cancer. Even if in the latest years, recent advances in surgery have improved the local control of disease, the next steps in rectal cancer care should aim at the improvement of local cure rates and the enhancement of systemic control. New approaches to CT treatment are necessary. Patient enrolment into rigorous and well-conducted clinical trials will generate new information regarding investigational therapies and it will offer improved therapies for patients with this disease
Older age limits the use of adjuvant chemotherapy according to all negative risk factors in early breast cancer patients.
No full textAdjuvant chemotherapy of elderly women is currently perceived as one of the priorities in breast cancer (BC) research and prospective trials are still lacking. We performed a retrospective analysis of the actual use of adjuvant cytotoxic treatment according to each negative prognostic factor at our Institution. Methods: Charts of 384 women 70 yrs with BC referred from 2000 to July 2003 were reviewed for tumor stage and treatment, and compared with an equal cohort of younger, randomly selected post-menopausal patients (pts) (control group). Results: 232 elderly pts with histologic diagnosis of early BC were eligible, mean age 75 yrs, range 70–97 (vs 61 yrs, range 50–69). Fifty-four percent of pts underwent conservative surgery (vs 68.7%); nodal dissection was performed in 85% (vs 92.2%), sentinel node biopsy in 4.7% (vs 5.9%). Tumor size was pT2-T3 in 43% of pts, grading was G3 in 26.7%, hormonal status was positive in 79%, lymphnodes were positive in 35%. Of 161 elderly pts presenting one or more risk factors (pT2-T3, N+, G3 or ER-), 50.3% (vs 6.7%) were not proposed adjuvant chemotherapy. Were considered unfit for adjuvant chemotherapy 50% of women with pT2-pT3 (vs 11.7%), 39.5% with nodal involvement (vs 4.3%), 38.7% with G3 (vs 1.4%) and 22.5% of ER- (vs 0%). Thirteen pts (16%) of those proposed for chemotherapy refused (vs 7.3%), while 19 women starting treatment (27.9%) were not able to complete the planned number of cycles (vs 13.2%). Toxicity in pts receiving CMF (and not anthracyclines) is outlined in table
Alterazioni endocrine nei pazienti trattati per neoplasia cerebrale.
No full textLe disfunzioni endocrinologiche possono realizzarsi a vari livelli dell’asse ormonale ipotalamo-ipofisi-organi bersaglio nei pazienti con neoplasie cerebrali. L’ipotalamo e l’ipofisi possono subire delle alterazioni dopo trattamento chirurgico o radioterapico. Mentre la tiroide e le gonadi più spesso dopo irradiazione spinale o chemioterapia
Determining therapeutic approaches in the elderly with rectal cancer
No full textBACKGROUND: To evaluate the toxicity and feasibility of pelvic radiotherapy (RT) and/or surgery in elderly patients with locally advanced low-lying rectal cancer.
PATIENTS AND METHODS: From November 1999 to November 2005, 51 patients aged >or=70 years who underwent RT for locally advanced low-lying rectal cancer were retrospectively examined. Variables considered were age, co-morbidities (evaluated according to the Charlson score and the Cumulative Illness Rating Scale-Geriatric [CIRS-G] score) and surgery versus no surgery.
RESULTS: The median age was 80 years (range 70-94 years) and the male : female ratio was 33 : 18. A total of 5.9% of patients were considered 'fit', 72.5% had one or more CIRS-G grade 1 or 2 co-morbidities and 21.6% had one or more CIRS-G grade 3 co-morbidities. 54.9% of patients underwent surgery and 45.1% underwent RT. Only 9 of 21 (42.8%) patients who underwent radical resection received the full course of adjuvant RT and only seven (50%) of all patients treated with RT alone received the full dose of therapy. Patients with one or more CIRS-G grade 3 co-morbidities reported similar numbers of grade 1-2 toxicities as patients with one or more CIRS-G grade 2 co-morbidities.
CONCLUSION: Notwithstanding the small number of patients analysed, the findings of this study indicate that elderly patients with rectal cancer and mild co-morbidities could probably receive the same treatment as fit elderly patients, given that tolerability appeared to be similar in both categories of patients. Neither age nor co-morbidities should be considered reasons to deny the patient the possible benefits of receiving complete treatment. Moreover, Multidimensional Geriatric Assessment should always be undertaken to help clinicians make better decisions about treatment. Further prospective trials are needed to confirm these results
Primary rectal carcinoma in patients with stage IV resectable disease at diagnosis
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Abstract: Although TNF antitumor activity has been demonstrated in many preclinical models and in non-comparative clinical trials, no evidence exists that TNF-based treatments increase patient survival. Moreover, due to systemic toxicity, TNF can only be administered through sophisticated locoregional drug-delivery systems in patients with some types of organ-confined solid tumors; as a corollary, the impossibility to administer TNF through the systemic route does not allow to test the effectiveness of this cytokine in other clinical settings for the treatment of a broader spectrum of tumor types. A challenge many researchers are tackling is to dissect the cascade of molecular events underlying tumor sensitivity to TNF so to fully explore the anticancer potential of this molecule. The rationale for the development of strategies aimed at sensitizing malignant cells to TNF is to exploit tumor-specific molecular derangements to modulate TNF biological activities and ultimately maximize its tumor-selective cytotoxicity. This would not only enhance the anticancer activity of current TNF-based locoregional regimens, but would also open the avenue to the systemic administration of this cytokine and thus to a much wider clinical experimentation of TNF in the oncology field.
In this review we first summarize the molecular biology of TNF and its cancer-related properties then, the available findings regarding some among the most promising and best characterized TNF sensitizers are overviewe
Common polymorphisms in methylenetetrahydrofolate reductase gene predict tumor regression in rectal cancer patients receiving preoperative chemoradiotherapy
No full textHealth-related quality of life outcomes in disease-free survivors of mid-low rectal cancer after curative surgery
No full textIF 3,456
Abstract: Background: The main objective of this study was to investigate health-related quality of life (HRQOL) in terms of symptoms and functional outcomes in disease-free survivors of rectal cancer.
Methods: Consecutive patients (n = 117) who underwent curative surgery for rectal cancer with a minimum of 2 years' follow-up and whose disease had not recurred were asked to complete the European Organization for Research and Treatment of Cancer QLQ-C30 and its colorectal cancer module (QLQ-CR38). Long-term HRQOL outcomes were compared with reference data from the general population. Relevant clinical data including type of surgery, stage of disease, type of treatment, and early and late complications were collected. Univariate and multivariate regression analyses were performed to investigate associations among covariates.
Results: HRQOL functional aspects were similar with that of an age- and sex-matched general population. Although clinically meaningful better outcomes favoring our patients were found for the global health status/HRQOL and the pain scales, constipation was worse in rectal cancer survivors than the general population. Multivariate analysis found that worse physical functioning was associated with increasing age (P < .001), female sex (P < .01), presence of stoma (P < .05), and occurrence of late major complications (P < .05). Worse body image was associated with the presence of stoma (P < .001) and chemoradiotherapy (P < .05).
Conclusion: Overall, patients with rectal cancer recover well in the long run, with HRQOL levels comparable to that of the general population. HRQOL outcomes provide valuable data that may be used to improve information disclosure to patients
Neoadjuvant treatment for rectal cancer in fit and vulnerable patients older than 70 years
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