Annals of surgical oncology
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Despite decades of efforts by many investigators, systemic chemotherapy or hormone therapy have failed to demonstrate improved survival in patients with advanced hepatocellular carcinoma (HCC). On the basis of placebo-controlled, randomized phase III trials, sorafenib has shown improved survival benefits in advanced HCC and has set a new standard for future clinical trials. The successful clinical development of sorafenib in HCC has ushered in the era of molecularly targeted agents in this disease, which is discussed in this educational review. ⋯ Ongoing studies are evaluating the efficacy and tolerability of combining sorafenib with erlotinib and other targeted agents or chemotherapy. Many molecularly targeted agents that inhibit angiogenesis, epidermal growth factor receptor, and mammalian target of rapamycin are at different stages of clinical development in advanced HCC. Combining targeted agents that inhibit different pathways in hepatocarcinogenesis is an area of active investigation. Future research should continue to unravel the mechanism of hepatocarcinogenesis and to identify key relevant molecular targets for therapeutic intervention. Identification and validation of potential surrogate and predictive biomarkers holds promise to individualize patients' treatment to maximize clinical benefit and minimize the toxicity and cost of targeted agents. We hope that we will continue to improve the efficacy of systemic therapy in advanced HCC in the coming years.
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In patients with colorectal cancer peritoneal carcinomatosis (CRPC), only patients with a complete cytoreduction will benefit. The current selection criteria are ill-defined. The Peritoneal Surface Disease Severity (PSDS) staging was introduced as a basis of scoring patients into prognostic groups to improve patient selection. This study determines the impact on survival of the PSDS in a cohort of patients undergoing complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRPC. ⋯ In patients with CRPC who undergo a complete cytoreduction and HIPEC, the PSDS staging system has been demonstrated to be an important prognostic indicator. It appears that even with a complete cytoreduction and HIPEC, patients with PSDS stage IV do not benefit from treatment.
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Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. A simple guide for choosing the appropriate OPS procedure is not available. ⋯ OPS is the "third pathway" between standard BCS and mastectomy. The OPS classification and Atlas improves patient selection and allows a uniform approach for surgeons. It proposes a specific solution for different scenarios and helps improve breast conservation outcomes.