European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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Editorial Review
Adjuvant chest wall radiotherapy for breast cancer: black, white and shades of grey.
Adjuvant chest wall irradiation after mastectomy remains a core and highly effective element in the loco-regional management of early breast cancer. While the evidence base for postmastectomy radiotherapy (PMRT) in patients with 4 or more involved axillary nodes is robust, its role in 'intermediate' risk patients with 1-3 involved nodes is unclear and practice varies. Traditionally patients have been selected for PMRT on the basis of clinic-pathological factors such tumour size, nodal status, tumour grade and presence of lymphovascular invasion. However these factors alone may not predict the response of individual patients to radiotherapy. There is recent evidence that biological factors such as oestrogen and progesterone receptor and HER-2 status may also influence survival as well as loco-regional control. ⋯ The 2005 Oxford Overview of randomised trials of postoperative radiotherapy established a clear biological link between loco-regional control and survival. Paradoxically the largest survival benefits do not occur in patients at the highest risk of recurrence. Molecular markers to identify exactly which patients are likely to benefit from PMRT are being actively investigated. Surgeons are encouraged to enter patients with 1-3 involved nodes into a clinical trial of postmastectomy radiotherapy.
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Blue dye with or without isotope has been widely used to identify the sentinel lymph node(s) in breast cancer. Patent blue V is used in the UK while its isomer isosulfan blue is used in the US. The allergic potential of isosulfan blue is well documented (1.4% adverse reactions) but that of patent blue V is less clearly defined. ⋯ The allergic potential of patent blue V dye compares favourably with isosulfan blue however both the surgeon and anaesthetist need to be alert to the risk of allergic reactions.
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To evaluate the role of a multi-imaging PET with (18)F-DOPA and (18)F-FDG in comparison with conventional imaging (CI) in recurrent medullary thyroid carcinoma (MTC). ⋯ In MTC patients with rapidly increasing calcitonin levels during follow up, (18)F-DOPA has a good sensitivity and a complementary role with (18)F-FDG PET/CT in detecting metastatic deposits. In our experience, the sensitivity of a multi-imaging (18)F-DOPA &(18)F-FDG PET/CT approach is greater than that obtained with CI. The higher SUV(max) values found with (18)F-FDG in some patients may reflect more aggressive tumors.
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The aim of the present retrospective study was to investigate the influence of neoadjuvant chemotherapy on liver regeneration after portal vein occlusion before major hepatectomy. ⋯ Prolonged neoadjuvant chemotherapy has a small negative effect on liver regeneration induced by portal vein occlusion. Liver regeneration induced by portal vein occlusion is relatively large when tumour burden is small.