Seminars in surgical oncology最新文献

{"title":"Perioperative radiotherapy for cancer of the esophagus.","authors":"F. Wenz, H. Mamon","doi":"10.1002/SSU.1014","DOIUrl":"https://doi.org/10.1002/SSU.1014","url":null,"abstract":"Carcinomas of the esophagus represent on average about 1% to 2% of all malignant tumors. The incidence shows extreme regional differences, reflecting the established environmental and acquired risk factors for cancer of the esophagus. There has been a major shift in tumor location and histology over the last decades, with the lower third/gastroesophageal junction becoming the most common location and adenocarcinoma the most common histology in white males. There has been a striking improvement in surgical resection rates and operative mortality; however, the curative potential of surgery is likely to be highest in early-stage disease. The poor prognosis for locally advanced tumors motivated the search for multimodal approaches to improve results. While neither perioperative radiotherapy nor perioperative chemotherapy alone have significantly improved survival rates, combined radiochemotherapy, used as neoadjuvant or definitive therapy, appears more promising. For patients with advanced tumors or extensive nodal involvement, first principles and extrapolation from other tumors of the gastrointestinal tract suggest that a combination of chemotherapy and radiation is likely to be of benefit, as compared to surgery alone. As this treatment is difficult to tolerate in the postoperative setting, neoadjuvant approaches have been emphasized. Although there are promising data, and preoperative chemoradiation is widely utilized, we do not consider the benefit of this approach to have been proven unequivocally. Future progress in the treatment of esophageal cancer may require that systemic therapy be improved to the point where occult metastatic disease can be controlled, enabling the local control provided by surgery and radiation to lead to improved survival.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"177 2","pages":"33-9"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/SSU.1014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72456408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative radiotherapy and concurrent radiochemotherapy in rectal cancer.","authors":"Claus Rödel, R. Sauer","doi":"10.1002/SSU.1011","DOIUrl":"https://doi.org/10.1002/SSU.1011","url":null,"abstract":"Combined modality treatment is the recommended standard adjuvant therapy for patients with locally advanced rectal cancer in the United States and Germany. During the last decade substantial progress has been made in treatment modalities, and surgical management currently includes a broad spectrum of operative procedures ranging from radical operations to innovative sphincter-preserving techniques. Specialized groups have reported excellent local control rates with total mesorectal excision (TME) alone. New and improved radiation techniques (conformal and intraoperative radiotherapy) and innovative schedules (protracted intravenous and chronomodulated infusion) and combinations (oxaliplatin and irinotecan) of chemotherapy may have the potential to further increase the therapeutic benefit of adjuvant treatment. Moreover, the basic issue of timing (pre- or postoperative) within a multimodal regimen is currently being addressed in prospective trials. Evidently there is a need to question the current monolithic approaches, which were established by studies conducted more than a decade ago. It is also under discussion whether to apply the same schedule of postoperative radiochemotherapy to all patients with stage II/III rectal cancer, or to give preoperative intensive short-course radiation according to the Swedish concept for all patients with resectable rectal cancer irrespective of tumor stage and treatment goal (e.g., sphincter preservation). This review discusses different irradiation settings in more recent and ongoing studies of perioperative radiotherapy for rectal cancer, and focuses on the issue of which patient should receive radiotherapy (if at all), and if so, how and when.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"1 1","pages":"3-12"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77302031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary role of modern brachytherapy techniques in the management of malignant thoracic tumors.","authors":"W. Harms, H. Becker, R. Krempien, M. Wannenmacher","doi":"10.1002/SSU.1017","DOIUrl":"https://doi.org/10.1002/SSU.1017","url":null,"abstract":"Sole brachytherapy for carcinoma of the lung is most often performed using high-dose-rate (HDR) remote afterloading equipment, which delivers the treatment within the tracheobronchial tree in an outpatient setting. It provides excellent, rapid palliation in advanced stages, and can also be used selectively for curative intent in early stages. In better-performance patients, fractionated external beam radiation therapy (EBRT) is preferred to brachytherapy as an initial treatment because it appears to provide a modest gain in survival, and more sustained palliation. In patients with centrally located tumors and limited extent of disease, the combination of external and endoluminal irradiation enables curative treatment options. Intraoperative brachytherapy may complement standard adjuvant treatment in incompletely resected, unresectable, or medically inoperable patients, and has the potential to improve local control in selected cases. Due to the rarity of the disease, the role of endoluminal brachytherapy in the treatment regimen of tracheal neoplasms is not yet clearly defined. The risk of fatal bleeding after endoluminal brachytherapy appears to be correlated with tumor localization and fraction size, but in the majority of cases fatal bleeds are caused by progression of local disease. The use of a distanceable applicator provides a central positioning of the source, prevents the delivery of high-contact doses to the mucosa, and may reduce toxicity. The standard technique for interstitial brachytherapy after breast-conserving surgery and adjuvant EBRT is the use of low-dose-rate (LDR) brachytherapy, but it may also be applied by means of pulsed-dose-rate (PDR) or HDR techniques. Prospective trials comparing different boost techniques and indications are needed to define more precisely the subgroup of patients who are most suitable for interstitial brachytherapy. Reirradiation of chest wall local recurrences using brachytherapy molds is effective and provides a high local control rate with acceptable toxicity.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"20 1","pages":"57-65"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87257065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative radiotherapy of astrocytomas.","authors":"K. Herfarth, K. Herfarth, S. Gutwein, J. Debus, J. Debus","doi":"10.1002/SSU.1012","DOIUrl":"https://doi.org/10.1002/SSU.1012","url":null,"abstract":"Astrocytomas account for the majority of primary brain tumors. Low-grade tumors are slowly growing tumors with relatively long overall survival. However, a high percentage of these tumors transform to more malignant, high-grade tumors. High-grade gliomas (anaplastic astrocytomas and glioblastoma multiforme) have a poor prognosis. Treatment options are capable of prolonging the natural history of the disease, but the long-term survival is poor. This review discusses the different postoperative treatment options and the prognostic factors in low- and high-grade astrocytomas.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"50 1","pages":"13-23"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87797602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent developments in perioperative radiotherapy","authors":"M. Wannenmacher","doi":"10.1002/SSU.1010","DOIUrl":"https://doi.org/10.1002/SSU.1010","url":null,"abstract":"","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"20 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81835388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant treatment of brain metastases.","authors":"F. Lohr, A. Pirzkall, H. Hof, K. Fleckenstein, J. Debus, J. Debus","doi":"10.1002/SSU.1016","DOIUrl":"https://doi.org/10.1002/SSU.1016","url":null,"abstract":"With an incidence of 15/10(5) in the general population, brain metastases constitute a serious, debilitating complication in cancer patients. The majority of those patients suffer from more than one metastasis, but up to 30% to 40% present with a solitary lesion. Whole-brain radiotherapy (WBRT) extends median survival from 1 to 2 months for treatment with steroids only, to 4 to 6 months in most series. However, long-term survival (>1-2 years) is observed in up to 10% of patients with favorable prognostic factors, such as solitary lesions, good Karnofsky performance status, and absence of extracranial disease. For those patients, individually optimized treatment is worthwhile. For good-prognosis patients with controlled extracranial disease, surgery in combination with postoperative WBRT should be considered, especially when fast relief of symptoms is mandated. For surgically inaccessible solitary lesions below a size threshold of approximately 30 ccm, stereotactic radiosurgery (RS), although never compared to surgery in a randomized fashion, seems to yield comparable results and is the treatment of choice for more than one lesion in appropriately selected patients. Nevertheless, a number of questions concerning the optimal treatment regimens for brain metastases remain. These mainly concern the radiation dose, need for a combination of RS and WBRT, relative timing of different treatment modalities, and maximum number of brain metastases that can reasonably be treated with RS when long-term progression-free survival is the goal. However, RS is definitely an excellent option for salvage and palliation in patients with short life expectancy, as it is simultaneously noninvasive and cost-effective, with short hospitalization times.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"35 1","pages":"50-6"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90616864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of multimodal treatment in oropharynx, larynx, and hypopharynx cancer.","authors":"V. Rudat, M. Wannenmacher","doi":"10.1002/SSU.1018","DOIUrl":"https://doi.org/10.1002/SSU.1018","url":null,"abstract":"Due to recent advances in radiation fractionation, radiochemotherapy, and conservative surgical techniques, the concept of multimodal therapy in head and neck cancer is currently changing. The recently published RTOG Phase III trial 9003, with 1,113 patients accrued, showed that hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally-advanced head and neck cancer. Acute, but not late, toxicity was also increased. Three meta-analyses have suggested that the impact of chemotherapy in head and neck cancer is small but is highly associated with the timing of therapy. Concomitant administration of radiation therapy and chemotherapy led to an absolute benefit in 5-year survival of about 10%. This finding has been further supported by recently published randomized prospective trials comparing concomitant radiochemotherapy with radiotherapy alone in advanced head and neck cancer. There is now clear evidence that radiochemotherapy provides a substantial and statistically significant improvement in survival and local-regional control, as compared to radiotherapy alone. Radiochemotherapy should be considered an accepted standard of care in cancers of the oropharynx, particularly for patients with locally-advanced disease who have a good performance status. Two randomized studies conducted by the Department of Veterans' Affairs and the EORTC, with a total of 534 patients accrued, showed that induction chemotherapy followed by radiotherapy of responders yields survival rates equal to those of total laryngectomy with postoperative radiotherapy. After 4 years, one-half to two-thirds of survivors of the chemotherapy arm retained a functional larynx. Larynx preservation using induction chemotherapy can now be regarded as feasible but still investigational. Current phase II studies show excellent larynx preservation rates using a primary concomitant radiochemotherapy with an altered fractionation regimen. More clinical and laboratory research is required to further evaluate the different treatment options of the multimodality concept, and to develop prognostic models that will allow individualization of the therapy.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"54 1","pages":"66-74"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83297096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative radiotherapy for gastrointestinal cancer.","authors":"T. Lehnert, M. Treiber, U. Tiefenbacher, C. Herfarth, M. Wannenmacher","doi":"10.1002/SSU.1015","DOIUrl":"https://doi.org/10.1002/SSU.1015","url":null,"abstract":"Local recurrence following potentially curative tumor resection is a major problem in patients with gastrointestinal cancer. To augment surgical excision and to avoid the disadvantages of external beam irradiation, intraoperative radiotherapy (IORT) has been applied to primary and recurrent gastrointestinal cancer, both with curative intent and for palliation. There is ample evidence that the combination of radical surgery and IORT can improve local control. Whether this eventually can translate into improved overall survival has not yet been studied in adequately powered randomized and controlled trials.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"41 1","pages":"40-9"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81272300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation of rectal function after low anterior resection with formation of a neorectum.","authors":"S. Brown, F. Seow-Choen","doi":"10.1002/SSU.8","DOIUrl":"https://doi.org/10.1002/SSU.8","url":null,"abstract":"Recent advances in surgery have enabled low rectal cancers to be resected, while at the same time restoring bowel continuity and preserving the anal sphincter. Although a permanent stoma is avoided and the operation is oncologically sound, function may be compromised. Many patients with a straight coloanal anstomosis suffer from urgency, incontinence, and bowel frequency-the so-called anterior resection syndrome. Over the last 15 years, surgical developments have aimed at improving function after restoration of bowel continuity, essentially by creating a neorectum. The best known and most widely practiced operation involves formation of a colonic J-pouch. The physiological and functional outcomes of the colonic J-pouch are discussed, along with controversies surrounding construction. Although a J-pouch improves some aspects of function, the results are not perfect. Alternatives to the colonic J-pouch are appraised, indicating future areas of development.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"103 1","pages":"376-85"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85801657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of local excision in the treatment of rectal cancer.","authors":"D. Rothenberger, J. García-Aguilar","doi":"10.1002/SSU.7","DOIUrl":"https://doi.org/10.1002/SSU.7","url":null,"abstract":"Local excision (LE) of properly selected rectal cancers can provide long-term survival, with minimal morbidity, negligible mortality, and excellent functional results. The role of LE has evolved over the past century. Initially, to avoid the excessive mortality of abdominal surgery, aggressive LE was performed to control the symptoms of rectal cancer. As abdominal surgery became safer, LE was restricted for use in palliation or high-risk patients. Better preoperative tumor staging resulted in an expanded role for LE, including curative-intent treatment of selected T(1-2) rectal cancers. Techniques for LE include snare polypectomy, transanal excision, transanal endoscopic microsurgery, and posterior approaches. The high local recurrence rate and compromised survival reported in modern series, despite efforts to properly select patients with cancers suitable for LE, have convinced the authors to restrict the use of curative-intent LE in good-risk patients only to the most favorable rectal cancers. Close follow-up after LE is critical, because radical surgical salvage is usually possible if recurrence is identified promptly. Whether adjuvant chemoradiation can expand the role of curative intent LE remains controversial.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"2012 1","pages":"367-75"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86425427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}