Current opinion in oncology
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The da Vinci robot has proved to be the most advanced surgical system in gynecology. In this review we evaluated the possibilities of applying robotic assistance to improve gynecological endoscopic oncological surgery. ⋯ Robotic surgery combines the advantages of open surgery and endoscopic surgery. In our opinion, robotic surgery may lead to better results than conventional laparoscopic surgery, particularly in the field of gynecological oncology. However, this opinion has yet to be confirmed by randomized studies.
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Morbidity and mortality related to malignancy are increasing in HIV-infected patients. We aim at reviewing the literature on recent changes in the incidence of AIDS-defining and non-AIDS-defining malignancies and the specific characteristics of the main cancers emerging in HIV-infected patients. ⋯ Prevention and screening management procedures need to be assessed on the basis of specific evidence-based studies in the HIV-infected population. Interventions, known to be efficacious in other populations, should systematically be used or adapted if necessary (alcohol and tobacco cessation programs and viral coinfection management). The respective role of HIV itself, immunosuppression, and antiretrovirals as pro-oncogenic factors need to be further examined.
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Delirium is a neuropsychiatric syndrome that occurs frequently in cancer patients, especially in those with advanced disease. Recognition and effective management of delirium is particularly important in supportive and palliative care, especially in view of the projected increase in the elderly population and the consequent potential for the number of patients both diagnosed and living longer with cancer to increase substantively. ⋯ Validated tools exist to assist in the assessment of delirium. Although our understanding of the pathogenesis of delirium has improved somewhat, there remains a compelling need to further elucidate the underlying pathophysiology, especially in relation to opioids and the other psychoactive medications that are used in supportive care. Further trials are needed, especially in patients with advanced disease to determine predictive models of reversibility, preventive strategies, outcomes, and to assess the role of antipsychotic and other medications in symptomatic management.
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The purpose of this review is to discuss recently published work on endpoints for early and advanced colorectal cancer, as well as the statistical approaches used to validate surrogate endpoints. ⋯ The search for surrogate endpoints will intensify over the coming years. In parallel, efforts to either standardize or extend the endpoints or both will improve the reliability and relevance of clinical trial results.
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Lymphatic mapping and sentinel lymph node biopsy have been established as definitive procedures for the staging of cutaneous melanoma. Large-scale studies that have been recently conducted and that are ongoing suggest a therapeutic role for lymphatic mapping/sentinel node biopsy in the management and prognosis of melanoma patients with early lymph node metastases. ⋯ There is increasing evidence for the efficacy of lymphatic mapping and sentinel lymph node biopsy in predicting prognosis, reducing the morbidity traditionally associated with regional lymph node dissection and increasing survival in subgroups of patients with cutaneous melanoma. Further study is needed to determine the role of the immune system in the spread of nodal metastases and the role of immunomodulatory therapy to prevent or possibly even reverse nodal metastases.