The lancet oncology
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The lancet oncology · Jul 2006
ReviewReassessment of the role of induction chemotherapy for head and neck cancer.
Head and neck cancers are a complex group of diseases defined by variations in histological features, anatomical location, and cause. Once the realm of surgeons and radiation oncologists, the treatment of locally advanced disease now involves medical oncologists. Major developments include primary chemoradiotherapy for unresectable disease and organ preservation, the addition of chemotherapy to adjuvant radiotherapy, improvement in surgical and radiation techniques, and biological therapies. ⋯ Given this shift in site of recurrence, therapeutic strategies to suppress distant metastases may be the next goal for further improvement of survival. One approach that merits reassessment is the use of induction chemotherapy in the setting of locally advanced disease--both resectable and unresectable. In this review we summarise data for the use of induction chemotherapy to define better which patients will likely benefit from this approach now and which questions are important in the design of future clinical trials.
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The lancet oncology · Jun 2006
Randomized Controlled Trial Comparative StudyImmediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy.
Appropriate timing of androgen deprivation treatment (ADT) for prostate cancer is controversial. Our aim was to determine whether immediate ADT extends survival in men with node-positive prostate cancer who have undergone radical prostatectomy and pelvic lymphadenectomy compared with those who received ADT only once disease progressed. ⋯ Early ADT benefits patients with nodal metastases who have undergone prostatectomy and lymphadenectomy, compared with those who receive deferred treatment. The beneficial effects of early ADT, rather than an imbalance in risk factors, are likely to explain the differences in outcomes between treatments.
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The lancet oncology · Jun 2006
Randomized Controlled TrialEffect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial.
Standard curative schedules of radiotherapy to the breast deliver 25 fractions of 2.0 Gy over 5 weeks. In a randomised trial, we tested whether fewer, larger fractions were at least as safe and as effective as standard regimens. In this analysis, we assessed the long-term results of tumour control in the same population. ⋯ Breast cancer tissue is probably just as sensitive to fraction size as dose-limiting healthy tissues. If this finding is confirmed, radiotherapy schedules can be greatly simplified by the delivery of fewer, larger fractions without compromising effectiveness or safety, and possibly improving both.