Current treatment options in oncology
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Curr Treat Options Oncol · Jan 2016
ReviewFertility-Sparing Options in Young Women with Cervical Cancer.
Cervical cancer (CC) is the fourth most frequent tumor and the fourth most common cause of cancer death among women worldwide. Furthermore, more than 40 % of women with early CC are affected during reproductive age and wish to remain fertile. Thus, many patients demand a more conservative policy for managing these lesions in order to have an uneventful pregnancy in the near future. ⋯ Conization was the first fertility-sparing surgical procedure tested in stage IA1 CC. However, in recent decades, other strategies have been tested, particularly for more advanced tumors. The aim of this review is to analyze the main techniques performed in patients with CC who are eligible for fertility-sparing surgery, with particular attention paid to open questions and controversies.
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Curr Treat Options Oncol · Jul 2015
ReviewThe UZ Leuven Policy for Extended Adjuvant Anti-estrogen Therapy in Women With Early Estrogen Receptor-Positive Breast Cancer.
Opinion statement: Five years after adjuvant endocrine treatment for estrogen receptor (ER)-positive breast cancer, patients have a 2 to 20 % risk of metastatic relapse during the next 5 years. Extended adjuvant endocrine therapy seems to further lower this. In UZ Leuven, extended endocrine therapy is now discussed unless the tumor was a grade 1-2, pT1N0, ER-positive, progesterone receptor (PR)-positive, HER2-negative lesion. ⋯ Results from ongoing clinical trials will tell us whether in these cases prolonged AI use is better than tamoxifen so that therapy can be adapted. Benefit from extended adjuvant endocrine therapy is likely larger with better compliance and potential side effects of extended endocrine therapy need to be discussed. Therefore, when advising extended adjuvant endocrine treatment, a balance should always be made between relapse risk and treatment tolerance/compliance.
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Curr Treat Options Oncol · May 2015
ReviewSoft tissue sarcoma and radiation therapy advances, impact on toxicity.
Since adjuvant radiotherapy was introduced in the 1970s for soft tissue sarcoma (STS), sequential clinical trials characterized the toxicities induced by radiotherapy when given post-operatively and pre-operatively. Gradual technological advancements led to more precise radiotherapy delivery through intensity-modulated radiation therapy (IMRT) and more accurate targeting through image-guided radiotherapy (IGRT) to minimize normal tissues from high-dose irradiation. These improvements ultimately reduced the long-term toxicities from radiotherapy. ⋯ For STS originating from the retroperitoneum, if radiotherapy is recommended following multidisciplinary case discussion, pre-operative radiotherapy is preferred over post-operative radiotherapy. Post-operatively, normal radiosensitive organs fill the surgical cavity, which is the targeted volume of radiotherapy; hence, post-operative radiotherapy for retroperitoneal STS is associated with severe to fatal toxicities. Pre-operative radiotherapy has a more favorable toxicity profile as the retroperitoneal STS displaces, and thus spares, normal structures and organs from the high-dose irradiation volume.
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Curr Treat Options Oncol · Apr 2015
ReviewThe role of hyperthermic intraperitoneal intraoperative chemotherapy in ovarian cancer.
Epithelial ovarian cancer (EOC) is the fourth most common gynecologic cancer in Europe and is the leading cause of death among women with gynecologic malignancies. This is due to the fact that the majority of the patients are diagnosed with advanced stage disease. In these stages, extensive intraperitoneal metastases are often present, making therapy more difficult. ⋯ Currently, a total of 18 clinical trials are open and to answer the above-mentioned questions, it is adamant to complete these trials, especially the randomized phase III trials. Accrual is hampered by the fact that HIPEC is currently offered as standard treatment in some centers even though convincing evidence is not yet available. If these phase III trials show positive results in favor of HIPEC, subsequent trials comparing surgery and postoperative IP chemotherapy with surgery and HIPEC seem a logical next step.
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Curr Treat Options Oncol · Dec 2014
ReviewTherapeutic strategies for cancer treatment related peripheral neuropathies.
Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with multiple chemotherapeutic agents. CIPN may have a detrimental impact on patients' quality of life and functional ability, as well as result in chemotherapy dose reductions. Although symptoms of CIPN can improve with treatment completion, symptoms may persist. ⋯ Other agents with potential benefit for the treatment of established CIPN include gabapentinoids, venlafaxine, tricyclic antidepressants, and a topical gel consisting of the combination of amitriptyline, ketamine, and baclofen; none of these, however, has been proven to be helpful and ongoing/future studies may well show that they are not beneficial. The use of these agents is often based on their efficacy in the treatment of non-CIPN neuropathic pain, but this does not necessarily mean that they will be helpful for CIPN-related symptoms. Other nonpharmacologic interventions including acupuncture and Scrambler therapy are supported by positive preliminary data; however, further larger, placebo-controlled trial data are needed to confirm or refute their effectiveness.