Current opinion in oncology
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Despite major progress in the treatment of chemotherapy-induced emesis, nearly one third of patients undergoing cisplatin-based regimens still experience emesis within the first 24 hours of chemotherapy. An adequate treatment of delayed and anticipatory emesis remains to be determined. For highly emetogenic chemotherapy, the combination of ondansetron and dexamethasone is superior to dexamethasone alone and protects most patients. ⋯ This would suggest that, to reduce the cost of antiemetic therapy, ondansetron can be limited in case of failure of standard therapy. Delayed emesis remains poorly controlled with no difference between metoclopramide, dexamethasone, ondansetron, and placebo. Although some data suggest an improved efficacy when combining ondansetron with dexamethasone, convincing confirmatory studies are needed.
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Intensive care has been important in the treatment of cancer patients during the last decade. The main indications for admission to the intensive care unit are postoperative recovery, critical complications of cancer and its treatment, intensive anticancer treatment administration monitoring, and acute disease unrelated to the neoplastic disease or its treatment. Management of such cases must take into account the patient's fragility resulting from the presence of a severe chronic underlying disease with systemic effects. In the future, intensive care may play an important role in the development of oncology not only as supportive care for patients but also in the active development of new anticancer therapies.
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Clinically significant thyroid malignancies are relatively uncommon, although their prevalence in autopsy series ranges up to 11%. New data confirm an increased incidence of carcinoma in solitary thyroid nodules in younger patients and a greater likelihood for younger patients to present with metastatic disease. ⋯ Prophylactic neck dissection does not improve survival or lessen recurrence in differentiated thyroid cancers and may increase morbidity. It should, therefore, be reserved for the patient with clinically enlarged cervical nodes.