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1.
Practical implications to contemplate when considering radical therapy for stage III non-small-cell lung cancer.
Storey, CL, Hanna, GG, Greystoke, A, ,
British journal of cancer. 2020;(Suppl 1):28-35
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Abstract
The type of patients with stage III non-small-cell lung cancer (NSCLC) selected for concurrent chemoradiotherapy (cCRT) varies between and within countries, with higher-volume centres treating patients with more co-morbidities and higher-stage disease. However, in spite of these disease characteristics, these patients have improved overall survival, suggesting that there are additional approaches that should be optimised and potentially standardised. This paper aims to review the current knowledge and best practices surrounding treatment for patients eligible for cCRT. Initially, this includes timely acquisition of the full diagnostic workup for the multidisciplinary team to comprehensively assess a patient for treatment, as well as imaging scans, patient history, lung function and genetic tests. Such information can provide prognostic information on how a patient will tolerate their cCRT regimen, and to perhaps limit the use of additional supportive care, such as steroids, which could impact on further treatments, such as immunotherapy. Furthermore, knowledge of the safety profile of individual double-platinum chemotherapy regimens and the technological advances in radiotherapy could aid in optimising patients for cCRT treatment, improving its efficacy whilst minimising its toxicities. Finally, providing patients with preparatory and ongoing support with input from dieticians, palliative care professionals, respiratory and care-of-the-elderly physicians during treatment may also help in more effective treatment delivery, allowing patients to achieve the maximum potential from their treatments.
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Pharmacological Ascorbate as a Means of Sensitizing Cancer Cells to Radio-Chemotherapy While Protecting Normal Tissue.
Schoenfeld, JD, Alexander, MS, Waldron, TJ, Sibenaller, ZA, Spitz, DR, Buettner, GR, Allen, BG, Cullen, JJ
Seminars in radiation oncology. 2019;(1):25-32
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Abstract
Chemoradiation has remained the standard of care treatment for many of the most aggressive cancers. However, despite effective toxicity to cancer cells, current chemoradiation regimens are limited in efficacy due to significant normal cell toxicity. Thus, efforts have been made to identify agents demonstrating selective toxicity, whereby treatments simultaneously sensitize cancer cells to protect normal cells from chemoradiation. Pharmacological ascorbate (intravenous infusions of vitamin C resulting in plasma ascorbate concentrations ≥20 mM; P-AscH-) has demonstrated selective toxicity in a variety of preclinical tumor models and is currently being assessed as an adjuvant to standard-of-care therapies in several early phase clinical trials. This review summarizes the most current preclinical and clinical data available demonstrating the multidimensional role of P-AscH- in cancer therapy including: selective toxicity to cancer cells via a hydrogen peroxide (H2O2)-mediated mechanism; action as a sensitizing agent of cancer cells to chemoradiation; a protectant of normal tissues exposed to chemoradiation; and its safety and tolerability in clinical trials.
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Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature.
Bozkurt, M, Antonoff, M, Jaramillo, S, Sagebiel, T, Murphy, MB
Journal of gastrointestinal cancer. 2019;(3):634-640
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Management of radiodermatitis associated with cetuximab in squamous cell carcinomas of the head and neck.
Villavicencio, M, Granados-García, M, Vilajosana, E, Domínguez-Cherit, J
International journal of dermatology. 2017;(6):602-609
Abstract
The objective of this review is to report to the medical community the most recent knowledge on prevention and management of dermatitis with the use of cetuximab simultaneously with radiotherapy in the treatment of squamous cell carcinomas of the head and neck. A review was conducted in PubMed of English language publications between 2010 and 2015. The search employed the terms 'skin toxicity', 'radiodermatitis', 'cetuximab', 'radiotherapy', and 'head and neck cancer'. Data related to the classification and management of dermatitis, associated with cetuximab with concomitant radiotherapy (n = 22), were critically reviewed. We conclude that dermatitis associated with bioradiotherapy is a predictable, treatable, and reversible event that does not affect administration of therapy or its clinical outcome when treated appropriately.
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Mesonephric adenocarcinoma of the vagina : Diagnosis and multimodal treatment of a rare tumor and analysis of worldwide experience.
Mueller, I, Kametriser, G, Jacobs, VR, Bogner, G, Staudach, A, Koch, H, Wolfrum-Ristau, P, Schausberger, C, Fischer, T, Sedlmayer, F
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2016;(9):668-71
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Abstract
BACKGROUND Mesonephric adenocarcinoma of the vagina is an extremely rare tumor of the female genital tract, with only a few cases reported so far worldwide. Consequently, there is no established standard treatment and limited knowledge about the prognosis and biologic behavior of vaginal mesonephric adenocarcinoma. METHODS This report documents a new case of vaginal mesonephric adenocarcinoma diagnosed in a 54-year-old woman, and analyzes this in the context of all previously published cases. RESULTS MRI demonstrated that the 2.5 × 1.8 cm tumor of the vaginal wall was invading urethra and bladder. Following surgical excision, histologic analysis determined mesonephric adenocarcinoma of the vagina, stage pT2 R1. In order to avoid the mutilating extended surgery which would be required to reach R0 and considerable impairment of quality of life, adjuvant radiochemotherapy was administered with external radiation and brachytherapy, including 5 cycles of cisplatin (40 mg/m²) for radiosensitization. After 4 years of continuous oncologic follow-up, the patient is alive and clinically free of disease. CONCLUSION In this case it was shown that adjuvant radiochemotherapy with radiation and brachytherapy was effective to manage the surgical R1 situation and maintain the patient's life quality. More published cases reports are needed to gradually substantiate optimal treatment strategies.
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Challenges and strategies on radioiodine treatment for differentiated thyroid carcinoma.
Cheng, L, Liu, M, Ruan, M, Chen, L
Hellenic journal of nuclear medicine. 2016;(1):23-32
Abstract
OBJECTIVE Radioiodine ((131)I) is considered an effective and low-risk therapeutic radionuclide for differentiated thyroid carcinoma (DTC); however, dilemmas exist in the optimization of indications, pre-treatment thyroid stimulating hormone (TSH) stimulation, dose decision, as well as in the treatment of (131)I-refractory disease. Refined strategies on (131)I treatment for DTC based on late evidence and novel insights are greatly needed. CONCLUSION The indications of (131)I ablation continue to be refined with a better understanding of the risks and benefits. For pre-treatment TSH stimulation, recombinant human thyrotropin presents a better choice as it improves the quality of life, but is indicated only for ablation of the thyroid remnant and follow-up. Decreased doses of (131)I seem to be more appropriate in patients without gross residual disease or metastases, but maximal doses are suggested in patients with advanced disease. Imaging procedures contributing to decision-making for patients with advanced DTC also continue to be modified. As for the (131)I-refractory disease, there is a trend to increase (131)I uptake and retention by using additional therapeutic agents like kinase inhibitors with encouraging results.
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Effects of honey use on the management of radio/chemotherapy-induced mucositis: a meta-analysis of randomized controlled trials.
Xu, JL, Xia, R, Sun, ZH, Sun, L, Min, X, Liu, C, Zhang, H, Zhu, YM
International journal of oral and maxillofacial surgery. 2016;(12):1618-1625
Abstract
This meta-analysis aimed to assess the prophylactic effects of honey use on the management of radio/chemotherapy-induced mucositis. PubMed, Cochrane Library, Science Direct, China National Knowledge Infrastructure (CNKI), VIP (Chinese scientific journal database), and China Biology Medicine (CBM) were searched for relevant articles without language restriction. Two reviewers searched and evaluated the related studies independently. Statistical analyses were performed using Stata 11.0, calculating the pooled risk ratio (RR) with the corresponding 95% confidence interval (CI). Begg's funnel plot was used together with Egger's test to detect publication bias. A total of seven randomized controlled trials were finally included. Quality assessment showed one article to have a low risk of bias, two to have a moderate risk, and four to have a high risk. Meta-analysis showed that, compared with blank control, honey treatment could reduce the incidence of oral mucositis after radio/chemotherapy (RR 0.35, 95% CI 0.18-0.70, P=0.003). No meta-analysis was applied for honey vs. lidocaine or honey vs. golden syrup. The sensitivity analysis showed no significant change when any one study was excluded. No obvious publication bias (honey vs. blank control) was detected. In conclusion, honey can effectively reduce the incidence of radio/chemotherapy-induced oral mucositis; however, further multi-centre randomized controlled trials are needed to support the current evidence.
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The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients.
Bishop, S, Reed, WM
Journal of medical radiation sciences. 2015;(4):267-76
Abstract
Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side-effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.
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Recombinant human thyrotropin versus thyroid hormone withdrawal in radioiodine remnant ablation for differentiated thyroid cancer: a meta-analysis.
Fu, H, Ma, C, Tang, L, Wu, F, Liu, B, Wang, H
The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of.... 2015;(1):121-8
Abstract
AIM: We aim to assess the effects of recombinant human thyrotropin (rhTSH) versus thyroid hormone withdrawal (THW), and rhTSH-aided low doses (1.11 GBq and 1.85 GBq) versus high dose (3.7 GBq) of radioiodine in the residual ablation for differentiated thyroid cancer (DTC). METHODS Studies were obtained from computerized searches of MEDLINE, EMBASE, the Cochrane Library (all until September 2012). Randomized controlled trials were included. RESULTS Altogether 1325 patients with DTC participated in seven trials for residual ablation. Overall, studies had a low risk of bias. We found no statistically significant differences between rhTSH and THW treatment in terms of successful ablation rate (OR 0.87, 95% CI 0.56 to 1.37, P=0.56) but significant benefits in health-related quality of life (mean difference 3.59, 95% CI 2.81 to 4.37, P<0.00001), adverse events during and after ablation (OR 0.57, 95% CI 0.44 to 0.73, P<0.00001), radiation exposure to blood and bone marrow (mean difference -0.01, 95% CI -0.02 to -0.01, P<0.00001). In addition, no significant difference was found in the successful ablation rate between the low dose (1.11 GBq and 1.85 GBq) and high dose (3.7 GBq) of radioiodine aided by rhTSH (OR 0.85, 95% CI 0.49 to 1.47, P=0.56). There were no deaths and no serious adverse effects in DTC patients treated with either rhTSH or THW, maximum follow-up was 12 months. None of the included trials investigated secondary malignancies or economic outcomes. CONCLUSION rhTSH is as effective as THW on radioiodine thyroid remnant ablation with significant benefits on health-related quality of life, adverse effects during and after ablation, decreased whole body radiation exposure. The lower radioiodine doses are as effective as high doses for remnant ablation under rhTSH stimulation.
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Dental demineralization and caries in patients with head and neck cancer.
Deng, J, Jackson, L, Epstein, JB, Migliorati, CA, Murphy, BA
Oral oncology. 2015;(9):824-31
Abstract
Concurrent chemoradiation (CCR) therapy is a standard treatment for patients with locally advanced head and neck cancer (HNC). It is well documented that CCR causes profound acute and late toxicities. Xerostomia (the symptom of dry mouth) and hyposalivation (decreased salivary flow) are among the most common treatment side effects in this cohort of patients during and following treatment. They are the result of radiation-induced damage to the salivary glands. Patients with chronic hyposalivation are at risk for demineralization and dental cavitation (dental caries), often presenting as a severe form of rapidly developing decay that results in loss of dentition. Usual post-radiation oral care which includes the use of fluoride, may decrease, but does not eliminate dental caries associated with radiation-induced hyposalivation. The authors conducted a narrative literature review regarding dental caries in HNC population based on MEDLINE, PubMed, CLNAHL, Cochrane database, EMBASE, and PsycINFO from 1985 to 2014. Primary search terms included head and/or neck cancer, dental caries, dental decay, risk factor, physical symptom, physical sequellea, body image, quality of life, measurement, assessment, cost, prevention, and treatment. The authors also reviewed information from National Institute of Dental and Craniofacial Research (NIDCR), American Dental Association (ADA), and other related healthcare professional association web sites. This literature review focuses on critical issues related to dental caries in patients with HNC: potential mechanisms and contributing factors, clinical assessment, physical sequellea, negative impact on body image and quality of life, potential preventative strategies, and recommendations for practice and research in this area.