ISSN:8756-0437    

DOI:10.1002/ssu.2980090102

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractChemotherapy, as preliminary treatment before surgery and/or radiation for advanced squamous cell carcinoma of the head and neck, is no longer novel. In prospective trials to date, however, multiple agent induction chemotherapy has yet to demonstrate the initial presumptive promise of improved rates of cure. As an alternate goal, there has emerged a renewed attentiveness toward limiting treatment morbidity, several strategies for which may be considered. Extirpative, often radical, surgery on the primary site of disease usually represents the most significant threat to life quality. Various ways of limiting surgical morbidity will be considered by way of introduction. The trends of head and neck cancer treatment over the decades, leading into the era of induction chemotherapy and refined radiation techniques, will be described. At the combined Dana‐Farber/New England Deaconess Head and Neck Oncology Clinic, an experience with over 300 patients receiving induction chemotherapy for advanced head and neck cancer has been analyzed with an emphasis on the postulate of lessening the extent of surgery in appropriately selected patients. In a comparison between trials initiated in 1980 and 1987, improved complete response rates from 26 to 57% were documented. Survival rates were identical, but the use of planned primary site ablative surgery was decreased from 47 to 14%. While some increase in local failure has been noted in patients treated by primary site radiation alone, surgical salvage appeared to be more effective. The implication of these trends for patterns of failure and surgical salvage and data concerning the need for neck dissection in this group of patients will be briefly summarized. Other trials addressing organ‐preservation strategies will also be referenced and the dichotomy between survival‐based studies and morbidity‐limiting studies illustrated. Independent trends in radiation technique as a potential substitute for traditional surgical practice will be r

ISSN:8756-0437    

DOI:10.1002/ssu.2980090103

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractSquamous carcinoma of the esophagus is a disease with a poor prognosis which fortunately occurs seldom in the United States. Because patients present with more advanced disease here, surgical therapy has not equaled results reported from Asia. Although, claims of equality have appeared in the literature, radiation therapy alone has not been very effective for this disease. There are a myriad of small reports which extol a variety of combined approaches. Based upon a review of these series it is obvious that a Phase III trial is required to establish the best multimodality therapy for management of squamous carcinoma of the esophagus. Components of such a trial are reviewed and suggestions are made for design and reporting of such a trial.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090104

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractMultimodality therapy has not reproducibly improved the survival of patients with gastric adenocarcinoma. This is largely because the staging of disease has been imprecise and because the current regimens have only limited efficacy against advanced disease. Until staging is improved and active regimens are found, it will be difficult to identify synergism between surgery and other treatment modalities.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090105

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractCarcinoma of the pancreas has an especially grim prognosis. Only 1‐3% of patients survive for 5 years. Radical pancreaticoduodenectomy, especially for minimal disease, is currently the only chance for cure. While radiation therapy does not improve overall survival, it may improve local control following radical resection and decrease pain in locally advanced cancers. Although chemotherapy has led to significant improvements in survival in patients with locally advanced disease, the overall effect is small. When surgery, radiotherapy, and chemotherapy are administered to localized carcinomas in randomized, prospective trials, survival is significantly lengthened. Similar trials in locally advanced, unresectable pancreatic cancer also confirm the concept of synergistic interaction between therapies. Thus, pancreas carcinoma is one neoplasm where multimodality therapy has had a demonstrable, although small effec

ISSN:8756-0437    

DOI:10.1002/ssu.2980090106

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractAn emphasis on careful surgical staging of adenocarcinoma of the colon has improved the predictive value of tumor staging systems. As a result of improved staging and carefully conducted randomized clinical trials, adjuvant therapy of locally advanced colon cancer, based on 5‐fluorouracil chemotherapy, has been proven to substantially reduce recurrence rates and significantly increase overall survival for selected patients. Improved treatments and schedules are currently being studied in randomized trials and may increase the efficacy of this adjuvant therapy. Radiation therapy has not as yet been integrated into the adjuvant treatment of colon carcinoma. The application of a combined approach of surgery and chemotherapy in selected patients with liver metastases may also improve cure rates and long‐term survival. The developing understanding of molecular determinants for the biological behavior of these cancers will increase the opportunities to identify, on the one hand, those patients who will benefit from specific therapies, and, on the other hand, new therapeutic strategies and treatme

ISSN:8756-0437    

DOI:10.1002/ssu.2980090107

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractThe goals of the conservative management of adenocarcinoma of the distal rectum are to preserve rectal sphincter function and achieve excellent local tumor control. Multimodality therapy for more advanced disease suggests that these goals will be met by conservative surgery combined with radiation therapy and chemotherapy. Over 100 patients with T0‐3 N0‐1 lesions have been treated in prospective single institution trials with either local excision or anterior resection with coloanal anastomosis, usually combined with chemotherapy and radiotherapy. The typical criteria for local excision have been for lesions to be 4.0 cm or less, mobile, and not poorly differentiated or mucinous. Patients with larger or more advanced lesions may undergo anterior resection with coloanal anastomosis. Following resection, radiotherapy is delivered to the pelvis and tumor bed often with concomitant chemotherapy. The overall rate of local failure in the trials in which local excision is performed with postoperative chemoradiotherapy is 3% for TI lesions, 5% for T2 lesions, and 30% for T3 lesions with a median follow‐up of at least 25 months. Local failure in patients with a coloanal anastomosis is 9% overall. Salvage was successful in about half of the patients who failed locally. Importantly, nearly all patients remained continent. These institutional studies show that sphincter preservation can be used in patients who are objectively selected for this procedure. However, before this multimodality approach may be considered standard therapy the rate of local control must be confirmed in a large, Phase II, multicenter, prospective trial such as that now underway in many of the cooperative g

ISSN:8756-0437    

DOI:10.1002/ssu.2980090108

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractThe treatment of locally advanced rectal carcinoma is one of the more complicated problems in the management of colorectal carcinoma. More than any other site successful treatment requires a multimodality approach as surgery alone is frequently insufficient to completely eradicate all disease. This review focuses primarily on the management of patients who present without prior treatment and discusses the role of preoperative radiation therapy as well as intraoperative radiation therapy. Although much less gratifying, patients who present after failing previous therapy may also benefit from an aggressive multimodality approach.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090109

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractThe application of laparoscopy to the staging of solid abdominal tumors is reviewed. The current evidence support the use of laparoscopy particularly in hepatic tumors. There is evidence that the hospital length of stay for a patient with a nonresectable hepatic tumor can be reduced from 5.6 ± 0.4 days with a laparotomy to 1.5 ± 0.3 days with a laparoscopy. Where the palliative and bypass issues are not limiting, cases of pancreatic and gastric carcinoma also appear to benefit in having a staging laparoscopy before a formal laparotomy for resection. Current instrumentation does produce limits, but with future prospects of laparoscopic ultrasound, and tumor staining, staging laparoscopy will become an important diagnostic tool in surgical oncolog

ISSN:8756-0437    

DOI:10.1002/ssu.2980090110

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractMany surgical studies show a significant stratification of survival following resection of esophageal cancer based upon accurate pathologic staging. However, investigators are moving away from single modality therapy toward multimodality trials for the treatment of this disease. This presents a problem in staging of patients before therapy is begun. Chemotherapy and/or radiation therapy may alter the local tumor characteristics and nodal metastases, thus confounding evaluation of treatment results. Although CT scanning and transesophageal ultrasound help in assessing nodal status, they have not reached the precision necessary for study purposes. Pretherapy nodal staging using video‐assisted exploration may provide the same level of accuracy as mediastinoscopy does for lung cance

ISSN:8756-0437    

DOI:10.1002/ssu.2980090111

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY