J Buon
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Metastatic cancer remains difficult to treat effectively and treatments are in most cases not curative despite significant side effects. Novel, targeted approaches such as gene therapy hold promise for the treatment of various tumor types. Among the most promising cancer gene therapy approaches are oncolytic adenoviruses, which are able to infect, replicate in and lyse tumor cells. ⋯ This review focuses on targeting strategies to improve tumor cell transduction and cancer cell selective replication. Strategies to improve antitumor efficacy by arming the virus with therapeutic transgenes are also discussed. Furthermore, an overview of the most important clinical approaches with oncolytic adenoviruses is given.
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Throughout the past two decades the efforts to improve the efficacy of treatment for locally advanced head and neck squamous cell carcinoma (HNSCC) have led to increased use of multimodality approaches combining surgery, radiotherapy (RT), and chemotherapy (CT). Conventional RT, a standard approach for locoregionally advanced disease, was associated with unsatisfactory results, thereby, a greater understanding of radiobiology led to the development of two classes of altered radiation fractionation schedules incorporating hyperfractionation (HF) and acceleration in the management of advanced HNSCC. Randomized controlled trials and meta-analyses demonstrated that for patients with locally advanced HNSCC major improvements in locoregional control (LRC) at high level of evidence can be achieved by accelerated fractionation (AF) and HF. ⋯ CCRT is now a standard treatment approach for patients with locally advanced HNSCC. CCRT has been also shown to allow organ preservation in almost two thirds of patients without affecting survival. Recently, strong evidence for an improved outcome for high-risk resected patients has been shown by the use of adjuvant CCRT.
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Surgery remains the primary curative treatment for patients who have early-stage non-small cell lung cancer (NSCLC). The proper use of surgical resection depends on a careful assessment of the extent of disease and the cardiopulmonary function. Because lung cancer is more common in patients who have chronic obstructive pulmonary disease (COPD), it is important to select carefully those patients who can safely undergo potentially curative therapy, thereby minimizing postoperative morbidity and mortality. This article discusses the preoperative pulmonary assessment for patient selection, the preparation of high-risk patients, special surgical considerations, and patient management in the immediate postoperative period.
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To determine reirradiation results of patients with recurrent non-metastatic non-small cell lung cancer (NSCLC). ⋯ In initially non-metastatic NSCLC patients, reirradiation can be a safe and effective treatment for palliation after recurrence. Large prospective studies are needed to confirm the safety, effectiveness and economical advantages of this modality.
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Review
The critically ill patient with cancer - indications for Intensive Care Unit admission and outcomes.
Critically ill cancer patients admitted to the Intensive Care Unit (ICU) have high mortality rates compared to noncancer patients. Yet, with suitable patient selection, improved ICU- and 6-month survival has been observed in these patients: admission of cancer patients to the ICU can no more be considered futile. As a general rule, patients with good performance status, who are at the initial phase of their malignant disease and with life-extending treatment options available, should be routinely admitted to the ICU, while patients being only in palliative care should not. When in doubt, an ICU trial with re-appraisal at 3-6 days may be the best policy, as the data available when ICU admission is considered, are not sufficient to identify patients who are likely to benefit from ICU management.