The lancet oncology
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The lancet oncology · Jan 2013
Randomized Controlled Trial Multicenter StudyContinuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial.
Bevacizumab plus fluoropyrimidine-based chemotherapy is standard treatment for first-line and bevacizumab-naive second-line metastatic colorectal cancer. We assessed continued use of bevacizumab plus standard second-line chemotherapy in patients with metastatic colorectal cancer progressing after standard first-line bevacizumab-based treatment. ⋯ F Hoffmann-La Roche.
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The management of metastatic solid tumours has historically focused on systemic treatment given with palliative intent. However, radical surgical treatment of oligometastases is now common practice in some settings. The development of stereotactic body radiotherapy (SBRT), building on improvements in delivery achieved by intensity-modulated and image-guided radiotherapy, now allows delivery of ablative doses of radiation to extracranial sites. ⋯ Although complete cure might be possible in a few patients with oligometastases, the aim of SBRT in this setting is to achieve local control and delay progression, and thereby also postpone the need for further treatment. We review published work showing that SBRT offers durable local control and the potential for progression-free survival in non-liver, non-lung oligometastatic disease at a range of sites. However, to test whether SBRT really does improve progression-free survival, randomised trials will be essential.
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The lancet oncology · Jan 2013
Randomized Controlled Trial Multicenter StudyIntraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial.
Breast-conserving surgery for palpable breast cancer is associated with tumour-involved margins in up to 41% of cases and excessively large excision volumes. Ultrasound-guided surgery has the potential to resolve both of these problems, thereby improving surgical accuracy for palpable breast cancer. We aimed to compare ultrasound-guided surgery with the standard for palpable breast cancer-palpation-guided surgery-with respect to margin status and extent of healthy breast tissue resection. ⋯ Dutch Pink Ribbon Foundation, Osinga-Kluis Foundation, Toshiba Medical Systems.
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The lancet oncology · Jan 2013
The price of autonomy: should we offer individuals a choice of colorectal cancer screening strategies?
A difference between colorectal cancer screening and screening for most other types of cancer is that various screening methods are available. A choice between screening methods is common in the USA. Most European programmes currently offer a single screening method, since it is recommended that only screening strategies with sufficient evidence for a reduction in colorectal cancer mortality are introduced. ⋯ The availability of multiple effective screening options warrants deliberation on whether individuals should be given a choice between strategies. In this Personal View, we present arguments in favour and against offering a choice of screening strategies, together with the evidence substantiating these views. We also focus on screening invitees' autonomy, which is a crucial parameter in the debate.