Current opinion in oncology
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Dyspnea is a common and devastating symptom of life-threatening disease. Approximately 90% of non-small cell lung cancer patients experience moderate to severe dyspnea by death. Currently, the pathology is ill-defined and measurement of this subjective symptom is imprecise. ⋯ This article outlines the current state of knowledge and standards of care for palliative interventions in dyspnea. These include nonpharmacologic interventions, oxygen supplementation, and medications. Further research is needed to clarify the role of each and to develop better pathophysiologic understanding.
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De novo glioblastomas develop in older patients without prior clinical history of less malignant tumors. Progressive glioblastomas are common among younger patients and arise through progression from lower-grade astrocytomas. CDKN2A deletions, PTEN alterations, and EGFR amplification are more prevalent among de novo glioblastomas, whereas p53 mutations are more common among progressive glioblastomas. ⋯ The inactivation of the PTEN gene is found in approximately 30% to 40% of astrocytomas with chromosome 10 loss, and LOH pattern in the remaining astrocytomas strongly supports the presence of another yet unidentified tumor suppressor gene telomeric to PTEN. More than 80% of oligodendrogliomas exhibit LOH for 1 p and 19q alleles. Oligoastrocytomas with 1p/19q LOH are related to oligodendrogliomas, and those with p53 mutations are related to astrocytomas.
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Despite significant advances in medical imaging techniques and their routine preoperative use, real-time intraoperative information regarding anatomy remains of indisputable importance to neurosurgeons. Intraoperative displacement of the brain tissue caused by surgical retraction or the resection cavity itself, as well as shift caused by cerebrospinal fluid leakage, may result in alteration of the surgical anatomy of the lesion and surrounding structures. ⋯ Furthermore, interactive image guidance may decrease incision lengths, operating times, and postoperative morbidity. This review focuses on recent developments in neurosurgical navigational techniques that enable real-time anatomic visualization during brain tumor surgery.
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The role of radiation therapy in the management of breast cancer is well established. Questions remain, however, regarding: 1) which patients derive the most benefit from the addition of radiation in breast conservation for ductal carcinoma in situ (DCIS) and after mastectomy for node-positive invasive cancer; 2) what is the role of brachytherapy in the management of invasive disease, either as primary therapy or as a boost after external beam therapy; and 3) whether radiation fields can be modified given the low rates of local-regional recurrence reported after breast conserving therapy in patients receiving systemic therapy.