Clinical oncology : a journal of the Royal College of Radiologists
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Clin Oncol (R Coll Radiol) · Jan 1998
A detailed baseline audit of radiotherapy for primary breast cancer: old habits, new principles.
In the UK, fundamental changes are occurring to the organization and delivery of services to breast cancer patients, prompted by the Calman/Hine initiative and by the perception that outcomes in the UK compare unfavourably with the rest of Europe and North America. Breast cancer, being a common malignancy, has often been treated by general surgeons and oncologists rather than by site-specialized multidisciplinary teams. Outcome results for many of these surgeons and oncologists may be unknown, so it becomes difficult, in any particular centre, to quantify changes that arise from the reorganization of treatment services and adherence to new guidelines without first determining baseline results. ⋯ The adherence to agreed guidelines is likely to ensure more appropriate surgery of the primary disease and will limit radiotherapy compared with 1988-1989 in that much radiation to the axilla and Internal Mammary Chain and 'booster' treatment to the primary site will be avoided in the future. The incidence of brachial plexus neuropathy was consistent with the radiation doses used and an analysis of this data suggests that the adoption of the guidelines will probably result in the complete avoidance of this complication in the future. Likewise, it is expected that the incidence of soft tissue fibrosis, telangiectasia and pneumonitis should diminish, but this and the effect of the clinical guidelines on local recurrence rates remains to be demonstrated by future comparable audits.
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Clin Oncol (R Coll Radiol) · Jan 1998
Historical ArticleThe history of radium in medicine in Manchester.
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Clin Oncol (R Coll Radiol) · Jan 1998
The future of oncology training: from the trainees' perspective.
A fundamental step towards any potential integration of the specialties of medical and clinical oncology into a common faculty in the UK, is to establish a core curriculum of training in both cancer sciences and clinical cancer medicine for both specialties. A questionnaire was sent to all UK trainees in cancer medicine in March 1997 to establish a baseline of patterns of training and to gather information on the trainees' views regarding the future of oncology training. The results of this survey are presented along with suggestions for discussion on the future of oncology training.
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Clin Oncol (R Coll Radiol) · Jan 1998
Case ReportsSpontaneous fracture and embolization of a central venous catheter: prevention and early detection.
Central venous catheters are used increasingly in oncology patients. Spontaneous fracture and embolization of a catheter is a rare complication. ⋯ Impending line fracture may be detected by the 'pinch-off sign' on a chest radiograph. Prevention may be possible by inserting the catheter more laterally.
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Clin Oncol (R Coll Radiol) · Jan 1998
Pelvic exenteration for advanced primary rectal cancer in male patients.
Between November 1987 and January 1996 pelvic exenteration for primary rectal cancer was carried out in 11 male patients. Two underwent a primary resection with subtotal cystectomy. In the remaining nine patients, the treatment commenced with a staging laparotomy and the fashioning of an end colostomy of the descending colon, followed by preoperative radiotherapy (50-56 Gy in 5 weeks). ⋯ One patient is alive 20 months after exenteration, with two pulmonary metastases having been recently excised. We conclude that, notwithstanding the morbidity rate, total pelvic exenteration is an acceptable option for advanced primary rectal cancer in male patients. Preoperative radiotherapy should be administered for cancers seated in the lower two-thirds of the rectum and perioperative chemotherapy should be considered seriously.