J Buon
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Comparative Study
Preoperative chemoradiotherapy improves local recurrence free survival in locally advanced rectal cancer.
Preoperative chemoradiotherapy (pre-CRT) followed by total mesorectal excision (TME) is the recommended therapy for patients with locally advanced rectal cancer (LARC). The primary aim of this study was to compare the rates of local and distant recurrence and overall survival (OS) in LARC patients who received pre-CRT vs postoperative (post) CRT. ⋯ Treatment of LARC with pre-CRT followed by surgery improved LRFS as compared to surgery followed by post-CRT, but failed to improve DRFS or OS in our patient population.
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To investigate the early and late toxicity of a hypofractionated radiotherapy (RT) schedule to treat muscle- invasive bladder cancer in relation to radiation parameters according to the organs at risk. ⋯ The performed hypofractionated schedule permitted delivery of an increased radiation dose without increased toxicity, and with a high probability of local control for elderly patients with low survival perspective.
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Historical Article
The treatment of melanoma at Westminster Hospital in the 20th century.
At Saint Dunstan's Coffee House in 1715 four London men met to form "A charitable proposal for Relieving the Poor and Needy and Other Distressed Persons". The proposal marked the beginnings of Westminster Hospital in London. ⋯ In the 20th century Westminster became a centre of tertiary referrals for cancer and under the leadership of Sir Stanford Cade and later of Gerald Westbury and Kenneth Newton the hospital pioneered the multidisciplinary management of malignant disease exemplified by the internationally- famous Wednesday afternoon clinics where the patients' best interests were discussed and served by a multitude of surgical and medical specialists. This paper focuses on the treatment of melanoma at Westminster Hospital in the 20th Century, placing in perspective the latest therapeutic developments based on the genetics of this cancer.
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Mutations that activate the PIK3CA oncogene and inhibit the tumor suppressor gene PTEN action are commonly found in breast tumors. Akt is a key activator of cell survival. p53 is frequently found mutated in human tumors, and mutant p53 protein actively contributes to tumorigenesis. In selected cases of breast cancer, trastuzumab (TZMB) is incorporated in the primary treatment in the adjuvant and metastatic settings. Many studies have reported that selected patients are resistant to TZMB due to the presence of p95 HER2 fragments. To address this, we analysed PTEN, Akt, MAPK, p53 and p95 expression in breast cancer patients treated with TZMB. ⋯ No statistically significant correlation between TZMB resistance and the expression of these biomarkers was noted. In patients with HER2-positive breast cancer that were treated with 4 dose-dense sequential cycles of doxorubicin and cyclophosphamide, followed by TZMB and paclitaxel combination therapy in the neodjuvant setting, p53 expression could predict complete response to chemotherapy.
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The therapeutic strategy for breast cancer with the use of targeted drugs is, at present, mainly focused on coping with HER2. Currently, lapatinib and trastuzumab are in widespread use. Virtually all completed and in progress clinical trials have demonstrated a significant enhancement in the rate of pathologic complete response (pCR), the primary endpoint in these studies, in cases of patients with HER2-positive breast cancer that received trastuzumab in the neoadjuvant setting. ⋯ Dual targeting approach with a combination of trastuzumab and lapatinib improved progression-free survival (PFS) as compared with lapatinib alone in patients with metastatic breast cancer who have not had a response to trastuzumab. The combination of pertuzumab plus trastuzumab plus docetaxel, as compared with placebo plus trastuzumab plus docetaxel, when used as first-line treatment for HER2-positive metastatic breast cancer, significantly prolonged PFS. Novel anti-HER2 targeted therapies are needed to utilise novel approaches to combat trastuzumab resistance.