Expert review of anticancer therapy
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Expert Rev Anticancer Ther · Nov 2009
ReviewCurrent developments in the radiotherapy approach to elderly and frail patients with glioblastoma multiforme.
The benefit of postoperative radiotherapy (RT) has been demonstrated in elderly patients aged 65 years or older with glioblastoma multiforme. Hypofractionated RT schedules can reduce the time and morbidity of treatment while maintaining comparable survival outcomes to lengthy conventional RT. ⋯ Given the guarded prognosis of the elderly and frail patients, quality of life and side effects of treatment should be closely examined. As more than half of cancers in the world occur in developing countries, hypofractionated RT could be better utilized as a cost-effective treatment for this group of patients.
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Expert Rev Anticancer Ther · Oct 2009
ReviewTreatment options for stage I non-small-cell lung carcinoma patients not suitable for lobectomy.
The standard of care for stage I non-small-cell lung carcinoma is generally accepted to be lobectomy. In patients who are deemed not to be candidates for lobectomy, various treatment strategies are available, including observation, sublobar resection, conventional fractionated radiotherapy, stereotactic body radiotherapy and radiofrequency ablation. However, there is no standardized, clearly established therapy to offer patients in this situation. While ongoing prospective trials will allow refinement of these techniques, the role of these treatment modalities warrants further investigation for this setting.
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Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in combination with chemotherapy is an established standard of treatment of limited-disease (LD) small-cell lung cancer (SCLC). Both types of radiotherapy increase 3-year survival by approximately 5%, as shown in the meta-analyses. There is some evidence that earlier commencement of thoracic radiotherapy for good performance status LD-SCLC patients results in better outcome. ⋯ The PCI in extensive-disease SCLC improves survival at the expense of worsening of short-term health-related quality of life. There is evidence that consolidation thoracic radiotherapy may be of value in extensive-disease SCLC. The recently initiated prospective trials may answer this question.
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Expert Rev Anticancer Ther · Oct 2009
ReviewChemotherapy for lung cancer: the state of the art in 2009.
Lung cancer remains the most common cause of cancer-related death among men and women worldwide. Incremental and significant advances in available systemic treatments, however, have taken place in the last decade to provide improved survival rates and better palliation for patients with non-small-cell and small-cell lung cancer. Superior imaging techniques have enabled the detection of early-stage disease and adjuvant chemotherapy has earned a place for select patients following resection of their tumors. ⋯ In concert with broader applicability of chemotherapy, translational studies have provided the rationale for using molecular markers to identify the patients most likely to benefit from biological and targeted therapies. This review will discuss the current role of chemotherapy in both early and advanced non-small-cell and small-cell lung cancer. Novel targeted systemic therapies and the appropriate selection of treatments for patients based on their tumors' molecular phenotypes and histologies will also be reviewed.