Cancer treatment reviews
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Cancer treatment reviews · Oct 2009
ReviewMultidimensional geriatric evaluation for older cancer patients as a clinical and research tool.
The comprehensive geriatric assessment (CGA), originally developed by geriatricians as a multidimensional evaluation of the older patients, has become in the recent years a fundamental aid for evaluation and treatment planning of older cancer patients. Traditional parameters used by oncologists (such as performance status assessment) are insufficient to properly address older cancer patients' issues. Therefore CGA encompasses several items which help to identify, manage and possibly correct issues which could interfere with oncologic treatment. ⋯ Beside its clinical importance, CGA constitutes a major tool in research for elderly cancer patients, since it provides better categorization of patients for enrolment in clinical trials and consent comparison of results among homogenous cohorts of patients. CGA should therefore be always performed when approaching elderly cancer patients, yet it might be time-consuming in the common practice. To overcome this issue, shortened forms of CGA are being implemented.
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Cancer treatment reviews · Apr 2009
ReviewHER2-targeted therapy in breast cancer. Monoclonal antibodies and tyrosine kinase inhibitors.
There is strong clinical evidence that trastuzumab, a monoclonal antibody targeting the human epidermal growth factor receptor (HER) two tyrosine kinase receptor, is an important component of first-line treatment of patients with HER2-positive metastatic breast cancer. In particular the combination with taxanes and vinorelbine has been established. In the preoperative setting inclusion of trastuzumab has significantly increased the pathological complete response rate. ⋯ The clinical problem of tumours developing resistance to HER2-directed therapy is becoming increasingly important. Several issues about optimal selection of patients, prevention of resistance and use of different treatment options are still unresolved. In this article, we summarise the current knowledge on clinical evidence of HER2-directed therapy and the potential mechanisms of underlying resistance, including the possible clinical implications and review new therapeutic options.
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Cancer treatment reviews · Dec 2008
Review Comparative StudyDermatofibrosarcoma protuberans: wide local excision vs. Mohs micrographic surgery.
Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor of the skin with high rates of local recurrence. It is debated whether Mohs micrographic surgery (MMS) involves lower recurrence rates than wide local excision (WLE). Recent preliminary reports indicate more consistently favorable cure rates with MMS. We report comparative observational data on 41 patients who underwent MMS and 38 who underwent WLE. Their data were then pooled with those available in the medical literature to obtain more precise estimates of recurrence rates with MMS and WLE. ⋯ Significantly lower recurrence rates were recorded in our patients subjected to MMS compared with those treated with WLE. The pooled data also indicated a clear advantage of MMS. There is inconclusive evidence for any advantage of MMS in non-primary cases, while MMS was most effective in treating head and neck tumors. These data may be useful to guide clinicians in the choice of the more appropriate surgical treatment for DFSP patients.
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Cancer treatment reviews · Nov 2008
ReviewThe influence of endocrine treatments for breast cancer on health-related quality of life.
Many hormonal modalities are available for breast cancer treatment, such as selective oestrogen receptor modulators (SERMs), aromatase inhibitors, progestins and luteinising hormone-releasing hormone (LHRH) agonists. The long-term impact of these endocrine manipulations is an issue, because the duration of adjuvant treatment is still increasing, as is the number of breast cancer survivors. Premature menopause is induced at a young age, and may often be permanent after chemotherapy. The purpose of this review is to provide a literature-based overview of the side effects of endocrine treatment in pre- and postmenopausal breast cancer patients and the influence on HRQoL, especially on sexual functioning. The collection of health-related quality of life (HRQoL) data can result in better treatment recommendations during endocrine therapy. ⋯ HRQoL mostly is severely influenced by chemotherapy and part of these symptoms may be lasting, especially when associated with the induction of premature menopause. Similar symptoms may be encountered during ovarian suppression therapy by LHRH analogs, but they will usually prove to be reversible. The varying side effect profiles of tamoxifen and aromatase inhibitors did not lead to significant difference in overall HRQoL. HRQoL during progestins and the SERM fulvestrant has been compared to this during aromatase inhibitors, and a large number of studies on HRQoL during endocrine therapy will be discussed.
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Cancer treatment reviews · Nov 2008
CommentHyperbaric oxygenation for tumour sensitisation to radiotherapy: a systematic review of randomised controlled trials.
Radiotherapy is a well-established treatment for some solid tumours. Hyperbaric oxygenation (HBO) may improve radiotherapeutic killing of hypoxic cancer cells, so the simultaneous administration of radiotherapy and HBO may reduce mortality and tumour recurrence. ⋯ There is some evidence that HBO improves local tumour control and mortality for cancers of the head and neck, and local tumour recurrence in cancers of the uterine cervix. These benefits may only occur with unusual fractionation schemes. HBO is associated with significant adverse effects including oxygen toxic seizures and severe radiation tissue injury. The methodological and reporting inadequacies of the studies included in this review demand a cautious interpretation. More research is needed for head, neck and uterine cervical cancer, but is probably not justified for bladder cancer. There is little evidence available concerning malignancies at other sites.