For instance, hair loss, which is one of the major concerns for some patients, such as a young lady with BM of breast cancer, is a less frequently encountered problem with SRS than WBRT as a result of the smaller irradiated field size and focalized dose distribution Figure 2. All the aforementioned advantages of SRS are provided by utilization of multiple convergent narrow beams to deliver high dose focal irradiation in a single fraction by using multiple cobalt sources, linear accelerators or cyclotrons cancer more aggressive after chemo, Similar with neurosurgery, SRS alone or in combination with WBRT has been exhibited to associate with prolonged overall survival, local control and also better neurologic status in these patients compared to WBRT alone 33, However, SRS differs from neurosurgery by offering a chance of ablative treatment to those patients who are not appropriate candidates for neurosurgery due to various reasons.
Albeit such an approach may be beneficial in cancer more aggressive after chemo select group of patients, prerequisites for close monitorization with monthly cancer laringian stadii bimonthly magnetic resonance imaging MRI and risk for unavoidable repeat SRS procedures for newly emerging BM, both increasing the total cost of overall treatment, should be carefully considered Moreover, contrasted with SRS and WBRT combination, the risk for a plausibility of inferior survival outcomes with SRS alone in patients with controlled primary and no extracranial disease should be kept in mind, as it has been accentuated previously by various authors 41, Although local- and distant brain control rates were reported to be better with the addition of WBRT, this distinction did not translate into a notable survival advantage in any study.
Furthermore, in the study by Chang et al. It is unfortunate to point out that the results of these RCTs ought to be interpreted with caution because of cancer more aggressive after chemo insufficient design to explicitly concentrate on survival endpoints, such as significant imbalances between the study groups with regards to the prognostic factors and utilization of salvage WBRT in SRS alone cohorts 43, First meta-analysis was performed by Duan cancer more aggressive after chemo al.
In the second meta-analysis, Hasan et al. Thirdly, the meta-analysis by Soon et al. In the fourth and most recent meta-analysis, by Sahgal et al. Additionally omission cancer more aggressive after chemo WBRT in this subgroup was not identified to relate with increased rates of distant brain relapses.
In a recent systematic review of 14 studies incorporating BM patients, Gans et cancer more aggressive after chemo. Therefore, although the concept of TC-SRS is relatively new, with its acceptable toxicity rates the results appear to be encouraging for irradiation of a limited area with ablative doses of radiotherapy.
In a study by Pinkham et al. Verbal memory and fine motor functions were the commonest parameters to be impaired in this study Theoretically, restriction of the irradiated brain volume with local therapies like surgery and SRS may prove beneficial in preservation of neurocognitive functions without any scarification in tumor control rates.
Although results of some studies appear to support this idea 35others reported poorer neurocognitive outcomes with omission of WBRT. In one such study, with the end goal of preserving neurocognitive functions with maximum BM control rates, Aoyoma et al.
Because many of the traditionally argued WBRT toxicity data is derived from small-cell lung carcinoma patients treated with chemotherapy prior to prophylactic cranial irradiation, caution is advised when diagnosing WBRT toxicity. Therefore, as the side effects evoked by cranial irradiation are largely similar, it is not astounding that the impacts were preferably ascribed to the radiation than to chemotherapy. This information is of foremost significance for radiation oncologists considering the way that almost all toxicities following therapeutic WBRT are almost constantly ascribed to cranial irradiation anamie klassifikation the other oncologic disciplines.
Deteriorations in neurocognitive functions may also be already present before the initiation of WBRT. This issue has been addressed in two key studies by Meyers et al.
In the second study by Komaki et al. The authors pointed out that roughly half of all eligible patients had neurocognitive shortages before the onset of cranial prophylaxis, and observed a somewhat noteworthy decay in executive function and language after one year, which turned inconsequential in later evaluations. These two excellent studies strongly emphasize the paramount importance of implementation of neurocognitive function tests prior to WBRT in order to reflect the actual impact of therapeutic WBRT on neurocognitive domains.
Moreover, the negative neurocognitive impact of progressive BM may further be ameliorated or even improved by WBRT in some patients groups with resultant enhancement in executive functions and fine motor co-ordination as neurologic deterioration is reported to directly relate with disease progression in the brain 51, Management of this regretful complication of cancer involves neurosurgery, WBRT, SRS, chemotherapy, and targeted agents individually or as any combination of them, regarding the prognostic factors.
Curr Probl Surg J Clin Oncol Cancer Oncologist Cancer Metastasis Rev J Cell Biochem Berk L: An overview of radiotherapy trials for the treatment of brain metastases. Oncology Williston Park ; discussion, Radiother Oncol Sperduto PW, Kased N, Roberge D, et al: Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. Abrahams JM, Torchia M, Putt M, et al: Risk factors affecting survival after brain metastases from non-small cell lung carcinoma: a follow-up study of 70 patients.
J Neurosurg Chin Clin Oncol BMC Cancer Strahlenther Onkol Rades D, Dziggel L, Haatanen T, et al: Scoring systems cancer more aggressive after chemo estimate intracerebral control and survival rates of patients irradiated for brain metastases. Topkan E, Parlak C, Kotek A, et al: Impact of prophylactic cranial irradiation timing on brain relapse rates in patients with stage IIIB non-small-cell lung carcinoma treated with two different chemoradiotherapy regimens.
Coia LR: The role of radiation therapy in the treatment of brain metastases. Cancer Res Biomater Artif Cells Immobilization Biotechnol Mehta MP, Rodrigus P, Terhaard CH, et al: Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. Scott C, Suh J, Stea B, et al: Improved survival, quality of life, and qualityadjusted survival in breast cancer patients treated with efaproxiral Efaproxyn plus whole-brain radiation therapy for brain metastases.
Am J Clin Oncol Quantin X, Khial F, Reme-Saumon M, et al: Concomitant brain radiotherapy and vinorelbine-ifosfamide-cisplatin chemotherapy in brain metastases of non-small cell lung cancer. Lung Cancer Mornex F, Thomas L, Mohr P, et al: A prospective randomized multicentre phase III trial of fotemustine plus whole brain irradiation versus fotemustine cancer more aggressive after chemo in cerebral metastases of malignant melanoma.
Melanoma Res Ushio Y, Arita N, Hayakawa T, et al: Chemotherapy of brain metastases from lung carcinoma: a controlled randomized study. Neurosurgery Ann Oncol Antonadou D, Paraskevaidis M, Sarris G, et al: Phase II randomized trial of temozolomide and papilloma virus al naso radiotherapy in patients with brain metastases.
Lancet Fabi A, Felici A, Metro G, et al: Brain metastases from solid tumors: cancer more aggressive after chemo outcome according to type of treatment and therapeutic resources of the treating center. J Exp Clin Cancer Res Histology, multiplicity, surgery, and survival.
Chang EL, Wefel JS, Hess KR, et al: Neurocognition in patients with brain metastases treated with detoxifiere cu suc de citrice or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol Shaw E, Scott C, Souhami L, et al: Single dose radiosurgical treatment of recurrent previously irradiated cancer more aggressive after chemo brain tumors and brain metastases: final report of RTOG protocol Aoyama H, Shirato H, Tago M, et al: Stereotactic radiosurgery plus whole-brain radiation cancer more aggressive after chemo vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.
JAMA Kocher M, Soffietti R, Abacioglu U, et al: Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC study.
Pirzkall A, Debus J, Lohr F, et al: Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases. Role of adjuvant radiation and prognostic variables in patients. Knisely JP: Focused attention on brain metastases. Sahgal A, Aoyama H, Kocher M, et al: Phase 3 trials of stereotactic radiosurgery with or without schistosomiasis treatments radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis.
Duan L, Zeng R, Yang KH, et al: Whole brain radiotherapy combined with stereotactic radiotherapy versus stereotactic radiotherapy alone for brain metastases: a meta-analysis. Asian Pac J Cancer Prev Pract Radiat Oncol Neurosurgery ; discussion Clin Oncol R Coll Radiol Vardy J, Tannock I: Cognitive function after chemotherapy in adults with solid tumours.
Crit Rev Oncol Hematol J Natl Cancer Inst Wefel JS, Lenzi R, Theriault RL, et al: The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results cancer more aggressive after chemo a prospective, randomized, longitudinal trial. Meyers CA, Smith JA, Bezjak A, et al: Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial.
Your share could raise €30
Komaki R, Meyers CA, Shin DM, et al: Evaluation of cognitive function in patients with limited small cell lung cancer prior to and shortly following prophylactic cranial irradiation. Regine WF, Huhn JL, Patchell RA, et al: Risk of symptomatic brain tumor recurrence and neurologic deficit after radiosurgery alone in patients with newly diagnosed brain metastases: results and implications.
N Engl J Med Kondziolka D, Patel A, Lunsford LD, et al: Stereotactic radiosurgery cancer more aggressive after chemo whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Mintz AH, Kestle J, Rathbone MP, et al: A randomized cancer more aggressive after chemo to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis.
Ann Neurol Grigorescu3 1. This review focuses on the main diagnostic and treatment aspects concerning anal canal cancer. Anal cancer incidence cancer more aggressive after chemo been increasing in the last years, probably due to the rise in the spread of sexually transmitted diseases, such as HPV and HIV infections.
Although many risk factors have been associated to anal cancer HPV, HIV infection, immunocompromised status, tobacco smokinganal cancer biology is only partly understood. Anal canal cancer should be distinguished from anal margin cancer, which is of better prognosis.
Anal cancer diagnosis is usually delayed, due to its resemblance to benign perianal pathology that justifies the need for a better screening. Anal canal carcinoma therapeutic management has witnessed a major shift in time from a radical surgical abdominoperineal resection to multimodal approach.
Cancer more aggressive after chemo, the standard treatment of anal cancer more aggressive after chemo is represented by radiochemotherapy that is an effective therapy although can associate an important toxicity. Surgical treatment is reserved only to very small anal lesions and especially to residual disease or tumor recurrences after primary therapy, representing a salvage therapy abdominoperineal rectal amputation for these cases.
Inguinal lymphadenectomy is only indicated for voluminous lymphadenopathy blocks and hpv vaccination side effects uk lymph node metastases appeared after radiochemotherapy.
Cuvinte-cheie: cancer canal anal, factori de risc, diagnostic, tratament Background 1. Incidence Anal canal cancer is a relatively rare tumor, representing approximately 1.
It is approximately 20 to 30 times rarer than colon cancer, but its annual incidence is increasing, reaching up to cases, with a female predominance 2. There is an impor- 20 tant geographic variation regarding its incidence, as well as histopathological type. The mainstay of the treatment is represented by chemo-radiotherapy, radical surgery being reserved to residual tumor or recurrences.
Histopathology Depending on the lining epithelium, anal canal is divided into three regions: n colorectal zone: located proximally and containg columnar epithelium; n transitional zone: spread over a distance that varies between 0 and 12 mm that contains a pseudostratified type of epithelium resembling the urothelial one.
A transformation zone is unanimously accepted in uterine cancer. This region of metaplasia is extremely susceptible to HPV action 4 ; n cancer more aggressive after chemo zone: contains a non-keratinized epithelium, without hair follicles.