Clinical oncology : a journal of the Royal College of Radiologists
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Clin Oncol (R Coll Radiol) · Jan 2019
Barriers to Referral for Palliative Radiotherapy by Physicians: A Systematic Review.
Palliative radiotherapy (PRT) can relieve symptoms and improve quality of life, but remains underutilised, possibly due to lack of referrals. We conducted a systematic review to study barriers impeding referral for PRT. ⋯ Published high-quality data on barriers to PRT referral are limited to survey studies. Barriers to PRT referral include referrers' unfamiliarity regarding risks and benefits, cumbersome referral processes and perceived inconvenience of treatment. Interventions to increase referrals should be tailored to different professional groups and may include increased expert participation in multidisciplinary palliative care, shortening treatment courses and in-person interprofessional education.
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Clin Oncol (R Coll Radiol) · Oct 2018
Practice GuidelineGuideline for the Initial Management of Small Cell Lung Cancer (Limited and Extensive Stage) and the Role of Thoracic Radiotherapy and First-line Chemotherapy.
We investigated the efficacy of adding radiotherapy to chemotherapy in patients with extensive stage small cell lung cancer (ES-SCLC) and the appropriate timing, dose and schedule of treatment for patients with ES-SCLC or limited stage SCLC (LS-SCLC). ⋯ In patients with LS-SCLC (stage I, II and III), the addition of thoracic radiotherapy to standard chemotherapy is recommended. However, there is no clear evidence to inform definitive recommendations for optimal timing, sequential versus concurrent therapies and optimal dose or regimen. In patients with LS-SCLC, etoposide-cisplatin is the preferred regimen for adults who are being treated with combined modality therapy with curative intent. In patients with ES-SCLC (stage IV), there is insufficient evidence to recommend the addition of thoracic radiotherapy to standard chemotherapy as a standard practice for survival benefit; however, it could be considered on a case-by-case basis to reduce local recurrence. In patients with ES-SCLC, a platinum agent plus etoposide is the preferred regimen for adult patients who are being treated with combined modality therapy. Cisplatin and irinotecan represents an alternative treatment option to this, but is associated with increased rates of adverse events such as diarrhoea.
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Thyroid cancer typically has a good outcome following standard treatments, which include surgery, radioactive iodine ablation for differentiated tumours and treatment with thyrotropine hormone-suppressive levothyroxine. Thyroid cancers that persist or recur following these therapies have a poorer prognosis. Cytotoxic chemotherapy or external beam radiotherapy has a low efficacy in these patients. 'Target therapy' with tyrosine kinase inhibitors (TKIs) represent an important therapeutic option for the treatment of advanced cases of radioiodine refractory (RAI-R) differentiated thyroid cancer (DTC), medullary thyroid cancer (MTC) and possibly for cases of poorly differentiated (PDTC) and anaplastic thyroid cancer (ATC). ⋯ The objective of this overview is to present the current status of the treatment of advanced DTC, MTC, PDTC and ATC with the use of TKIs by describing the benefits and the limits of their use. A comprehensive analysis and description of the molecular basis of these drugs and the new therapeutic perspectives are also reported. Some practical suggestions are also given for the management to the potential side-effects of these drugs.
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Clin Oncol (R Coll Radiol) · Nov 2016
ReviewWhat is the Optimum Screening Strategy for the Early Detection of Lung Cancer.
Early diagnosis of lung cancer is currently the most effective way of reducing lung cancer mortality other than quitting smoking because the treatment of late stage disease has little impact. Improving the awareness of the risk of lung cancer and warning symptoms, recognition and prompt referral, and screening with low dose computed tomography (LDCT) are potential ways to improve early diagnosis. ⋯ Many of these questions are being answered by on-going European trials that are reporting their findings. Here we review the research evidence for LDCT screening and explore the important issues that need to be addressed to optimise effectiveness.
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Clin Oncol (R Coll Radiol) · Aug 2016
ReviewTargeting the MET Pathway in Gastric and Oesophageal Cancers: Refining the Optimal Approach.
Gastric and oesophageal cancers are a major cause of global cancer-related morbidity and mortality. Improvements in treatment for locoregional and metastatic gastric and oesophageal cancer have been incremental and the overall prognosis remains poor. Increasingly, molecular classification has identified recurrent, therapeutically relevant, somatic alterations in gastroesophageal malignancies. ⋯ Small series have shown activity of MET-directed tyrosine kinase inhibitors, but the clinical benefit of anti-MET antibodies has been disappointing. Here we discuss the MET pathway in gastroesophageal cancers, the clinical data for MET small molecule tyrosine kinase inhibitors, anti-MET antibodies and future clinical directions for targeting MET in gastric and oesophageal cancers. To our knowledge, this is the most comprehensive review of the clinical experience with MET-directed therapies in gastric and oesophageal cancers.