1,721,245 research outputs found
Capitolo 45 Tumori maligni dell’apparato digerente, del fegato, delle vie biliari e del pancreas
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Guidelines for the treatment of adult intra-cranial grade 2-3 ependymal tumours
No full textIntra-cranial ependymal tumours are very rare in the adult population, so most of reported series are retrospective, include also paediatric patients and have limited statistical power due to the small number of cases. As a consequence, universally accepted prognostic factors and therapeutic guidelines are lacking. The addition of postoperative chemotherapy with lomustine, vincristine and prednisone to cranio-spinal irradiation did not improve survival with respect to RT alone in a randomised phase III trial of children with infratentorial ependymoma. Different chemotherapy regimens have been tested in children with ependymoma or anaplastic ependymoma yielding comparable results to those reported for patients receivin RT alone. No data is available for adult population. Thus far, there is no proof lat the addition of chemotherapy to RT improves the outcome and adjuvant chemotherapy should be confined to investigational controlled clinical trials
Neoadjuvant treatment for resectable pancreatic cancer: Time for phase III testing?
No full textThis paper discusses the rationale for phase III testing of neoadjuvant therapy in patients affected by resectable pancreatic adenocarcinoma. The therapeutic management of patients affected by resectable pancreatic cancer is particularly troublesome due to the aggressiveness of the disease and to the limited efficacy and sometimes unfavourable risk-benefit ratio of the available therapeutic tools. Conflicting data on the role of adjuvant chemoradiation have been reported, while adjuvant single-agent chemotherapy significantly improved overall survival (OS) when compared to surgery alone. However, the OS figures for adjuvant chemotherapy remain disappointing. In effect, pancreatic cancer exhibits a prominent tendency to recur after a brief median time interval from surgery and extra-pancreatic dissemination represents the predominant pattern of disease failure. Neoadjuvant treatment has a strong rationale in this disease but limited information on the efficacy of this approach is available from single arm trials with low levels of evidence. Thus, in spite of two decades of investigation there is currently no evidence to support the routine use of pre-surgical therapy in clinical practice. To foster knowledge on the optimal management of this disease, and to produce evidence-based treatment guidelines, there is no alternative to well designed randomized trials. Systemic chemotherapy is a candidate for testing because it is supported by a more robust rationale than chemoradiation. Combination chemotherapy regimens with elevated activity in advanced disease warrant investigation. Caution would suggest the running of an exploratory phase II randomized trial before embarking on a large phase III study. (C) 2010 Baishideng. All rights reserved
Is withdrawal of consolidation radiotherapy an evidence-based strategy in primary central nervous system lymphomas?
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