How Can Morbidity Be Minimized When Delivering Radiotherapy To A Patient With Rectal Cancer

The small benefits from the addition of SCPRT to TME surgery necessitate that additional toxicity from radiotherapy is minimized if the therapeutic ratio favors such treatment. In locally advanced and inoperable rectal cancer, it is also important to minimize the toxicity of combined chemo-radiotherapy followed by surgery. Patient selection and the radiotherapy technique employed are likely to be important factors in reducing acute and late radiation toxicity. A review of the toxic-ity seen in...

Pancreato Duodenal Carcinoids

Pancreatic carcinoids account for just over 1 of all cases (94), and exhibit a far higher metastatic rate than all other carcinoids apart from those arising in the ileo-cecal region (94). Five-year survival is extremely less (29 ) when compared to other sites of carcinoid tumors (2327,94). Since these tumors behave more like noncarcinoid pancreatic neuroendocrine tumors, the surgical management should therefore be analogous to that for exocrine pancreatic carcinoma (95). Lymph node metastases...

Lawrence D Wagman

Liver Tumor Program, Division of Surgery, City of Hope National Medical Center, Duarte, California, U.S.A. Palliation has been part of surgical practice since the dawn of medicine, yet the meaning of palliative surgery has evolved over time and varies from surgeon to surgeon. In the past, palliative surgery simply meant not curative. Today, we define palliative surgery as any operation that removes symptom(s) or impending symptom(s). Thus, a palliative operation that completely eradicates...

Cholangiocarcinoma Involving the Distal Bile Duct

Tumors of the lower bile duct are classified according to their anatomical location, although there may be considerable overlap. Mid-bile duct tumors arise below the confluence in the common bile duct between the upper border of the duodenum and the cystic duct distal bile duct tumors are those arising anywhere from the duodenum to the papilla of Vater (6). Tumors of the distal bile duct represent approximately 20 to 30 of all cholangiocarcinomas and 5 to 10 of all periampullary tumors...

Hepatic Arterial Infusion Chemotherapy as Second Line Treatment

Leonard et al. have recently reviewed the response rates and survival data from trials evaluating second-line chemotherapy after irinotecan or oxaliplatin failure. The response rates were generally less than 20 and median survival is around 10 months (85). For example, Tournigand et al. reported response rates of 15 with FOLFOX6 and 4 with FOLFIRI, respectively (86). As described above, HAI therapy when combined with newer cytotoxic agents has demonstrated encouraging second-line activity (up...

Intergroup 0116 Trial

The well-designed INT 0116 study reported by MacDonald in 2001, established postoperative chemoradiotherapy as the standard of care for patients with resectable gastric cancer (13). Patients who underwent a complete resection with negative margins were stratified according to tumor node metastases (TNM) staging and then randomized to surgery alone (275 patients) versus surgery plus adjuvant therapy (281 patients). The treatment protocol in the adjuvant arm consisted of chemotherapy beginning 20...

Neoadjuvant And Adjuvant Treatment For Esophageal Cancer

Surgery remains the standard approach in resectable esophageal cancer. Many patients still die from metastases or from locoregional relapse. This has resulted in an interest in combined therapeutic modalities. Attempts to improve cure rates through the use of systemic chemotherapy alone, radiotherapy alone, or the combination chemoradiotherapy have been extensively studied during the last 20 years. Over the last decade, the use of neoadjuvant (induction) protocols aiming at downsizing or...

Valrie Boige and David Malka

Gastrointestinal Tract Oncology Service, Gustave Roussy Institute, Villejuif, France Biliary tract neoplasms account for 1 to 2 of all cases of cancer, with only approximately 7000 cases presenting in the United States annually. They include intrahepatic, perihilar, and distal cholangiocarcinomas ( 20-25 , 50-60 , and 20-25 of cases, respectively), and gallbladder carcinomas, the more common of the two types (1). More than 95 of cases are adenocarcinomas, often well-differentiated and...

What Is The Role Of Radiotherapy In The Treatment Of Rectal Cancer And How Is This Role Influenced When Total

The investigation of the potential role of radiotherapy in rectal cancer was prompted by the unacceptable risk of local recurrence following conventional surgery when total excision of the mesorectum was not performed. This risk varied between 15 and 50 (1). In addition, when local recurrence occurred, it was associated with significant morbidity and was almost always fatal (1,2). Prior to the Dutch Total Mesorectal Excision (TME) trial which examined the role of short-course preoperative...

Liver Resection Vs Transplantation For Hepatocellular Carcinoma

Liver transplantation is the optimal treatment for HCC because it provides the widest possible resection margins for the cancer, removes the underlying cirrhotic liver tissue that is at risk for the development of de novo HCC, and restores normal hepatic function (41). With the refinement of the selection criteria mentioned in the previous section, several studies have shown TABLE 1 Proposed Criteria for Selection of Hepatocellular Carcinoma Candidates for Liver Transplantation Criteria for...

Methylene Blue Dye Color Variation Esophageal Cancer

There has been an improvement in the outcome of surgical resection for esophageal carcinoma in recent years (1). In a review of publications of esophagectomy performed during the decade 1990-2000, the overall mortality from surgery was 6.7 , compared with 13 for the period 1980-1988 (2). Overall five-year survival for those undergoing resection currently ranges from 23 for Western series to 30.5 for Eastern patients (2). This may be in part due to better selection of cases through more accurate...

Surgery For Residual And Recurrent Anal Squamouscell Carcinoma

Previous studies on the outcomes of salvage surgery after initial CRT for anal SCCa are retrospective, and the majority of these are small. Residual disease has been determined by positive biopsy less than six months following the end of treatment. Recurrence is usually determined by positive biopsy more than six months after cessation of treatment. Some information on salvage surgery after CRT can be gleaned from studies reporting the overall experience of single institutions in treating anal...

Contributors

Arciero Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A. Stephen Attwood Department of Upper GI Surgery, North Tyneside General Hospital, North Shields, U.K. Dimitra G. Barabouti James H. Quillen VA Medical Center, Mountain Home, Tennessee, U.S.A. Hugh Barr Cranfield Health, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, U.K. Johanna Bendell Division of Oncology and Transplantation, Duke University Medical Center, Durham, North Carolina, U.S.A. Val rie Boige...

Hepatic Reserve

In general, patients considered for hepatic resection for colorectal metastases do not have viral hepatitis or cirrhosis. Thus, a good rule of thumb is that such resections can be performed safely if two segments of functional liver can be preserved. Some clinicians will rely on volumetric assessment radiologically for patient selection 25 . It is generally accepted that if greater than 20 functional residual liver can be preserved, a liver resection can be performed safely. The only TABLE 1...

Preoperative Evaluation and Assessment of Resectability

Cholangiocarcinoma And Surgery

Evaluation of patients with hilar cholangiocarcinoma is principally an assessment of resecta-bility, since resection is the only effective therapy. First and foremost, the surgeon must assess the patient's general condition and fitness for operation, which usually includes partial hepatectomy. The presence of significant comorbid conditions, chronic liver disease, and or portal hypertension generally precludes resection. In these patients, biliary drainage is the most appropriate intervention,...

Surgery For Inguinal Lymph Node Disease

Radiation Therapy Groins

Inguinal lymph nodes are usually included in the RT field when anal SCCa patients are treated with CRT. Lee et al. reported on the University of Florida experience with elective inguinal lymph node RT in 164 patients with pelvic malignancies at risk for inguinal nodal metastases 30 . Primary sites included the anal canal, distal rectum, and the distal genitourinary GU tract. In 148 patients, both groins were clinically negative 16 patients had unilateral clinical lymphadenopa-thy. The authors...

References

Cancer statistics, 2005. CA Cancer J Clin 2005 55 10-30. 2. Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas-616 patients results, outcomes, and prognostic indicators. J Gastrointest Surg 2000 4 567-579. 3. Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 1997 21 195-200. 4. Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and...

Results Of The Eortc-gtcct Phase Iii Trial Of Irradiation Vs Irradiation And Cddp In Inoperable Esophageal Cancer

1 Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998 339 27 1979-1984. 2. Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer a randomised controlled trial. Lancet 2002 359 9319 1727-1733. 3. Wang C, Ding T, Chang L. A randomized clinical study of preoperative chemotherapy for esophageal carcinoma. Zhonghua...

M0 M0 M0 M0 M0

The Japanese Research Society for Gastric Cancer JRSGC took a quite different approach to staging and classification, and set out a detailed set of clinical rules to accurately describe gastric cancer in 1963. They have published multiple subsequent editions of their initial set of rules, and in 1998 published their second English edition, based on the thirteenth Japanese edition 19 . The position within the stomach of the primary tumor is assigned to three locations C-area proximal stomach...