Minerva chirurgica
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Neoadjuvant chemoradiotherapy followed by total mesorectal excision is currently the standard of care for locally advanced rectal cancers. However, this therapeutic approach does not take into account response to neoadjuvant treatment, which can go up to a pathologic complete response in 10-20% of the patients. Moreover, despite its efficacy in terms of local control and survival, radical surgery is associated with a significant risk of postoperative morbidity, anastomotic leakage, permanent stoma, impaired quality of life, bowel and genitourinary dysfunction. ⋯ But few high-quality studies are available and fears remain regarding oncologic results and reproducibility of published results. Before these strategies can be recommended, large prospective randomized studies are still needed. The aim of this review is to discuss these two options for organ preservation, based on the current literature, with a special focus on oncologic outcomes.
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Ductal carcinoma in situ (DCIS) is a non-invasive breast carcinoma that remains in the milk ducts. It is a poorly understood disease and its natural history is not well known. This is because once diagnosed, DCIS is usually treated. ⋯ Each group requires a different treatment, respectively: local excision of the tumor; local excision and radiotherapy; and mastectomy. The use of tamoxifen in the treatment of DCIS is still controversial, but research so far has encouraging results. Interesting developments have been made in the use of Her-2 pulsed dendritic cell vaccination before DCIS surgery.