Seminars in radiation oncology
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Lymphedema, defined as the abnormal accumulation of protein rich fluid dysfunction of the lymphatic system, is a common sequela of cancer therapy. The incidence is highest among patients who have undergone resection and irradiation of a lymph node bed. Recently, increased attention has been focused on the modification of anticancer therapies in an effort to minimize lymphatic compromise. ⋯ Their use as an isolated treatment modality is now rare. Reliance on pumps diminished with the recognition that they may exacerbate truncal and genital lymphedema, as well as injure peripheral lymphatics when applied at high pressures. Many noncompressive approaches, particularly the use of benzopyrone medications and liposuction, continue to be used abroad.
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Hormonal dependency of prostate cancer was first described in 1895 by White who showed the initial observation between castration and the treatment of prostatic disease in men with bladder outlet obstruction secondary to benign prostatic hypertrophy. Subsequently, in 1940 Huggins and Hodges demonstrated the association between normal and hyperplastic epithelium of canine prostate glands and adequate levels of circulating androgens. This pioneering work led extensive investigation of the role of androgens in both prostatic growth for benign and malignant disease. ⋯ Subsequently, a thorough review of the phase III trials performed to evaluate the potential role of hormonal manipulation in addition to radiation therapy in locally advanced adenocarcinoma of the prostate. Included in that discussion is a section on the potential toxicities of hormonal manipulation. Finally, the current recommendations for the use of hormonal manipulation combined with radiation therapy in locally advanced adenocarcinoma of the prostate is described.
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Most patients diagnosed with gastric cancer in the United States and the Western World will either present with advanced disease or have recurrence after surgery, requiring discussions of chemotherapy. The evolution of chemotherapy for gastric cancer has been mixed with excitement and disappointment. Multiple single-agent chemotherapies have been shown to be only modestly effective in advanced disease, and the search for the best combination of therapy has been difficult. ⋯ While newer, standard chemotherapeutics, including the taxanes and irinotecan, may offer modest additional benefits, each requires further examination in phase III trials. Among patients with curatively resected disease, postoperative chemoradiotherapy appears to improve overall survival significantly. As a greater understanding of the molecular basis of gastric cancer is gained, the inclusion of biologic-based therapies will hopefully advance our ability to treat patients with gastric cancer more effectively.
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Surgery remains an effective treatment for most histologic types of low- and intermediate-grade gliomas and is an important part of their initial management. Controversies nonetheless abound regarding the timing and goals of surgery for these gliomas. This article reviews surgical therapy of low- and intermediate-grade gliomas, paying special attention to new surgical techniques.
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Review
Protection of normal tissues from the cytotoxic effects of radiation therapy: focus on amifostine.
Evidence for the use of amifostine (Ethyol, ALZA Pharmaceuticals, Palo Alto, CA/US Bioscience, West Conshohocken, PA) as a radioprotectant has been gathered in a number of clinical trials conducted over the past decade. This report briefly reviews those trials, as well as highlights results of a recent phase II trial conducted to evaluate the efficacy of daily amifostine administration in reducing the incidence of radiation-induced esophagitis in patients with stage III non-small cell lung cancer. ⋯ There was a 60% objective response rate and 1-, 2-, and 3-year survival rates were 55%, 23%, and 23%, respectively. Thus, amifostine administration reduced radiation-induced toxicities without reducing antitumor efficacy.