Seminars in oncology
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Seminars in oncology · Dec 2004
Clinical TrialSelective dose escalation of chemoradiotherapy for esophageal cancer: role of treatment intensification.
This ongoing phase II study is designed to assess the outcomes (survival and failure patterns) of therapy for localized esophageal cancer with conventional dose radiation (50.4 Gy) with concurrent continuous infusion 5-fluorouracil (5-FU) and weekly carboplatin/paclitaxel. Patients with less than complete response or partial response received dose escalation of radiation to 59.4 Gy with the same chemotherapy. This report details the results of the first 18 patients treated. ⋯ Grade 2/3 acute esophagitis was experienced by 89% and 39% of patients, respectively; 28% of patients developed esophageal strictures requiring dilatations. The combination of continuous-infusion 5-FU and weekly carboplatin/paclitaxel with selective radiation dose escalation yields promising results without surgery and adjuvant chemotherapy. The toxicities of therapy, while manageable, were significant.
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Seminars in oncology · Oct 2004
ReviewAdvances in neurosurgical technique in the current management of brain tumors.
Despite significant advances in anatomical and functional neuroimaging modalities (eg, magnetic resonance [MR] imaging [MRI], MR spectroscopy [MRS], diffusion and perfusion MR, functional MRI [fMRI], magnetic-source imaging [MSI], diffusion tensor imaging [DTI]) and neuronavigation techniques, intraoperatively obtained functional information remains of crucial importance to the neurosurgeon, especially when operating on tumors that are located in or adjacent to functional cortical sites and subcortical pathways. This article focuses on recent advances in the surgical management of of intracerebral tumors with special emphasis on intraoperative cortical and subcortical stimulation mapping methods, and the prognostic significance of surgery on patient outcome.
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Seminars in oncology · Dec 2003
ReviewTreating seizures in patients with brain tumors: Drug interactions between antiepileptic and chemotherapeutic agents.
Seizures are a common complication in patients with primary brain tumors or brain metastases that require treatment with antiepileptic drugs (AEDs). However, because many AEDs and chemotherapeutics share common metabolic pathways via the hepatic cytochrome P450 (CYP) isoenzymes, there is potential for drug interactions. Phenytoin, carbamazepine, and phenobarbital are potent enzyme-inducing AEDs (EIAEDs) that can cause a decrease in the serum concentration of chemotherapeutics, potentially compromising antitumor activity. ⋯ Interactions between these newer AEDs and chemotherapeutic agents have not been reported. In summary, the potential interactions between AEDs and chemotherapy should be anticipated and appropriate proactive adjustments implemented. Future studies will define the role of newer AEDs in the treatment of patients with primary brain tumors.