principles of ­cancer treatment

... benefit One of the challenges of cancer treatment is to use the various treatment modalities alone and together in a fashion that maximizes the chances for patient benefit Cancer treatments are ... because of the accumulation of additional genetic lesions Elucidation of the mechanisms that regulate this "organ-like" behavior of tumors may provide additional clues to cancer control and treatment ... treatment has the potential to cause harm, and treatment may be given that produces toxicity with no benefit The therapeutic index of many interventions is quite narrow, and most treatments...

Ngày tải lên: 07/07/2014, 01:20

... lightmicroscopic inspection of a tumor for pattern of growth, degree of cellular atypia, invasiveness, and morphologic features that aid in the differential diagnosis, sufficient tissue is of value in searching ... incisional biopsy is the procedure of second choice A wedge of tissue is removed, and an effort is made to include the majority of the cross-sectional diameter of the tumor in the biopsy to minimize ... in the growth fraction and an increase in growth rate Principles of Cancer Surgery Surgery is used in cancer prevention, diagnosis, staging, treatment (for both localized and metastatic disease),...

Ngày tải lên: 07/07/2014, 01:20

... information for treatment planning and may determine the extent and nature of primary cancer treatment Treatment Surgery is the most effective means of treating cancer Today about 40% of cancer patients ... growth If resection of the primary lesion takes place in the presence of metastases, acceleration of metastatic growth may occur, perhaps based on the removal of a source of angiogenesis inhibitors ... benefits, including local control of tumor, preservation of organ function, debulking that permits subsequent therapy to work better, and staging information on extent of involvement Cancer surgery...

Ngày tải lên: 07/07/2014, 01:20

... impact on the patient's perception of successful therapy Plastic and reconstructive surgery can correct the effects of disfiguring primary treatment Principles of Radiation Therapy Physical Properties ... hits (Fig 81-2) Plotting the fraction of surviving cells against doses of x-rays or gamma radiation, the curve has a shoulder that reflects the cell's repair of sublethal damage, followed by a linear ... resistant to the biologic effects of radiation are not completely defined Figure 81-2 Shape of survival curve for mammalian cells exposed to radiation The fraction of cells surviving is plotted on...

Ngày tải lên: 07/07/2014, 01:20

... some fashion to a site of tumor Teletherapy is the most commonly used form of radiation therapy Radiation from any source decreases in intensity as a function of the square of the distance from ... the basis of the amount of radiation absorbed in the patient; it is not based on the amount of radiation generated by the machine The rad (radiation absorbed dose) is defined as 100 erg of energy ... three determinants: total absorbed dose, number of fractions, and time A frequent error is to omit the number of fractions and the duration of treatment This is analogous to saying that a runner...

Ngày tải lên: 07/07/2014, 01:20

... relief of bone pain from metastatic disease, control of brain metastases, reversal of spinal cord compression and superior vena caval obstruction, shrinkage of painful masses, and opening of threatened ... cases), and bone marrow toxicity Often these can be alleviated by interruption of treatment Chronic toxicities are more serious Radiation of the head and neck region often produces thyroid failure ... dimensional treatment planning permits the delivery of higher doses of radiation to the target volume without increasing complications in the transit volume Radiation therapy is a component of curative...

Ngày tải lên: 07/07/2014, 01:20

... evidence for the activity of the agent in assessing its value to the patient If cure is not possible, chemotherapy may be undertaken with the goal of palliating some aspect of the tumor's effect ... normal structures Patients treated with palliative intent should be aware of their diagnosis and the limitations of the proposed treatments, have access to supportive care, and have suitable "performance ... requiring treatment; PS2, symptoms requiring some treatment; PS3, disabling symptoms, but allowing ambulation for >50% of the day; PS4, ambulation

Ngày tải lên: 07/07/2014, 01:20

... consideration of surgery or primary radiation therapy should be given, as these treatment modalities may be curative as local treatments Chemotherapy may be employed after the failure of these modalities ... after the failure of these modalities to eradicate a local tumor or as part of multimodality approaches to offer primary treatment to a clinically localized tumor In this event, it can allow organ ... Chemotherapy agents may be used for the treatment of active, clinically apparent cancer Table 81-1, A lists those tumors considered curable by...

Ngày tải lên: 07/07/2014, 01:20

... Modulation of apoptosis by manipulation of signal transduction pathways has emerged as a basis for understanding the actions of drugs and designing new strategies to improve their use A general view of ... at least an increased time to further progression of disease Active efforts are being made to quantitate effects of anticancer agents on quality of life Cancer drug clinical trials conventionally ... conventionally use a toxicity grading scale where grade I toxicities not require treatment, grade II often require symptomatic treatment but are not life-threatening, grade III toxicities are potentially...

Ngày tải lên: 07/07/2014, 01:20

... novel mechanisms of action, combinations of drugs and targeted agents may maximize the chances of affecting critical pathways in the tumor Chemotherapeutic Agents Used for Cancer Treatment Table ... important in regulating cellular proliferation and the behavior of tumor cells in vitro, in vivo it is unclear whether all of the actions of chemotherapeutic agents to cause cell death can be attributed ... understanding of the relationship of cell death and cell survival mechanisms is needed Resistance to chemotherapy drugs has been postulated to arise either from cells not being in the appropriate phase of...

Ngày tải lên: 07/07/2014, 01:20

... 665 mg/m2 Diarrhea bid Prodrug 5FU due of to Hand-foot continuous; intratumoral syndrome 1250 mg/m metabolism bid weeks on/ off; 829 mg/m2 bid weeks on/ off + 60 mg/d leucovorin Cytosine arabinoside ... Carboplatin 365 mg/m2 Marrow platelets IV > WBCs q3–4 weeks Reduce dose according to CrCl: to AUC of 5–7 mg/mL Nausea as adjusted Renal (high dose) dose/(CrCl + 25)] for CrCl Oxaliplatin 130 mg/m2 ... Blue urine, Radiation sclerae, nails recall Indirect DNA-Interacting Agents Antimetaboli tes Deoxycoform Nausea mg/m2 ycin IV Excretes in urine Immunosuppressi every other on Reduce dose week for...

Ngày tải lên: 07/07/2014, 01:20

... Busulfan can cause profound myelosuppression, alopecia, and pulmonary toxicity but is relatively "lymphocyte sparing." Its routine use in treatment of CML has been curtailed in favor of imatinib (Gleevec)or ... that covalently modify bases in DNA This leads to cross-linkage of DNA strands or the appearance of breaks in DNA as a result of repair efforts "Broken" or cross-linked DNA is intrinsically unable ... body surface area or the presence of nephrectomy Several alkylating agents are less commonly used Nitrogen mustard (mechlorethamine) is the prototypic agent of this class, decomposing rapidly...

Ngày tải lên: 07/07/2014, 01:20

... incidence of anaphylaxis with early preparations of the drug has led to the practice of administering a test dose of 0.5– unit before the rest of the dose The most feared complication of bleomycin treatment ... responsive to treatment (e.g., glucocorticoids) The earliest indicator of an adverse effect is a decline in the DLCO, although cessation of drug immediately upon documentation of a decrease in ... cardiotoxicity in the form of atrial and ventricular dysrhythmias, but these are rarely of clinical significance In contrast, cumulative doses >550 mg/m are associated with a 10% incidence of chronic cardiomyopathy...

Ngày tải lên: 07/07/2014, 01:20

... particularly in the adjuvant treatment of breast cancer While chemotherapy-associated leukemia is generally of the acute myeloid type, APL arising in the setting of prior mitoxantrone treatment had the ... resealed lead to progress of the replication fork off the end of a DNA strand The DNA damage is a potent signal for induction of apoptosis Camptothecins promote the stabilization of the DNA linked to ... treatment of superficial transitional bladder carcinomas and, with radiation therapy, for curative treatment of anal carcinoma Mitoxantrone is a synthetic...

Ngày tải lên: 07/07/2014, 01:20

... motile and secretory processes occur Microtubules are composed of repeating noncovalent multimers of a heterodimer of α and subunits of the protein tubulin Vincristine binds to the tubulin dimer ... have useful activity in a variety of solid tumors, with limited nonmyelosuppressive toxicities 6Thioguanine and 6-mercaptopurine (6MP) are used in the treatment of acute lymphoid leukemia Although ... clotting function abnormalities Close monitoring of clotting functions should accompany use of asparaginase Paradoxically, owing to depletion of rapidly turning over anticoagulant factors, thromboses...

Ngày tải lên: 07/07/2014, 01:20

... approximately the same degree of activity in primary hormonal treatment of breast cancers that have elevated expression of estrogen receptor protein Estrogen is not used often owing to prominent cardiovascular ... adjuvant treatment of breast cancer in postmenopausal patients with estrogen receptor–positive tumors Letrozole treatment affords benefit following tamoxifen treatment Adverse effects of aromatase ... much more rarely, varying degrees of heart block These have not emerged as clinically significant in the majority of patients Docetaxel causes comparable degrees of myelosuppression and neuropathy...

Ngày tải lên: 07/07/2014, 01:20

... for discovery of the candidate drug is the a priori importance of the target in the biology of the tumor, rather than the initial detection of drug candidates based on the phenomenon of tumor cell ... relapse, notable response rates to withdrawal of tamoxifen itself or to subsequent addition of an aromatase inhibitor or progestin Likewise, initial treatment of prostate cancers with leuprolide plus ... These agents cause tonic stimulation of the LHRH receptor, with the loss of its normal pulsatile activation resulting in decreased output of LH by the anterior pituitary Therefore, as...

Ngày tải lên: 07/07/2014, 01:20

... superior to interferon plus chemotherapy in the initial treatment of the chronic phase of this disorder It has lesser activity in the blast phase of CML, where the cells may have acquired additional ... is an inhibitor of the proteasome, the multi-subunit assembly of protease activities responsible for the selective degradation of proteins important in regulating activation of transcription ... may persist after discontinuation of the drug The quality of response to imatinib enters into the decision about when to refer patients with CML for consideration of transplant approaches Nilotinib...

Ngày tải lên: 07/07/2014, 01:20

... risk of death is markedly increased Management of febrile neutropenia has conventionally included empirical coverage with antibiotics for the duration of neutropenia (Chap 82) Selection of antibiotics ... the MTD of the agent on a given schedule The normal kinetics of blood cell turnover influence the sequence and sensitivity of each of the formed elements Polymorphonuclear leukocytes (PMNs; t1/2 ... cytotoxic agents The nadir count of each cell type in response to classes of agents is characteristic Maximal neutropenia occurs 6–14 days after conventional doses of anthracyclines, antifolates,...

Ngày tải lên: 07/07/2014, 01:20

... use The American Society of Clinical Oncology has developed practice guidelines for the use of G-CSF and GM-CSF (Table 81-3) Table 81-3 Indications for the Clinical Use of G-CSF or GM-CSF Preventive ... Uses Afebrile neutropenic patients No evidence of benefit Febrile neutropenic patients No evidence of benefit May feel compelled to use in the face of clinical deterioration from sepsis, pneumonia, ... GM-CSF Preventive Uses With the first cycle of chemotherapy (so-called primary CSF administration) Not needed on a routine basis Use if the probability of febrile neutropenia is ≥20% Use if patient...

Ngày tải lên: 07/07/2014, 01:20