The lancet oncology
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The lancet oncology · Apr 2013
Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis.
Radiation therapy is an important component of cancer control programmes. The scarcity of radiation oncology resources in Africa is becoming more severe as cancer incidence increases in the continent. We did a longitudinal assessment of the status of radiation oncology resources in Africa to measure the extent of the problem and the effects of programmes designed to enhance radiation services in the continent. ⋯ These facilities are concentrated in the southern and northern states of the continent. Brachytherapy resources (high-dose rate or low-dose rate) were only available in 20 of the 52 African countries. Although progress has been made in the establishment of radiation oncology services in some countries, a large need still exists for basic radiation services, and much resource mobilisation is needed for services to keep pace with the burgeoning populations of many countries.
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Until recently, the Malawian capital of Lilongwe was without diagnostic pathology services, which left many patients with cancer facing serious diagnostic delays. Through collaboration with the University of North Carolina and other partners, a pathology laboratory was successfully established at Kamuzu Central Hospital in July, 2011, providing an essential foundation for cancer diagnosis and research in the country's largest city.
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Cancer is rapidly becoming a public health crisis in low-income and middle-income countries. In sub-Saharan Africa, patients often present with advanced disease. Little health-care infrastructure exists, and few personnel are available for the care of patients. ⋯ Poor access to surgical care is a major impediment to cancer care in sub-Saharan Africa. Additional obstacles include the cost of oncological care, poor infrastructure, and the scarcity of medical oncologists, pathologists, radiation oncologists, and other health-care workers who are needed for cancer care. We describe treatment options for patients with cancer in sub-Saharan Africa, with a focus on the role of surgery in relation to medical and radiation oncology, and argue that surgery must be included in public health efforts to improve cancer care in the region.
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The lancet oncology · Apr 2013
Randomized Controlled Trial Multicenter StudyCardiovascular outcomes in patients with locally advanced and metastatic prostate cancer treated with luteinising-hormone-releasing-hormone agonists or transdermal oestrogen: the randomised, phase 2 MRC PATCH trial (PR09).
Luteinising-hormone-releasing-hormone agonists (LHRHa) to treat prostate cancer are associated with long-term toxic effects, including osteoporosis. Use of parenteral oestrogen could avoid the long-term complications associated with LHRHa and the thromboembolic complications associated with oral oestrogen. ⋯ Cancer Research UK, MRC Clinical Trials Unit.
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The lancet oncology · Apr 2013
Characterisation of retinoblastomas without RB1 mutations: genomic, gene expression, and clinical studies.
Retinoblastoma is the childhood retinal cancer that defined tumour-suppressor genes. Previous work shows that mutation of both alleles of the RB1 retinoblastoma suppressor gene initiates disease. We aimed to characterise non-familial retinoblastoma tumours with no detectable RB1 mutations. ⋯ National Cancer Institute-National Institutes of Health, Canadian Institutes of Health Research, German Research Foundation, Canadian Retinoblastoma Society, Hyland Foundation, Toronto Netralaya and Doctors Lions Clubs, Ontario Ministry of Health and Long Term Care, UK-Essen, and Foundations Avanti-STR and KiKa.