Peas in the Pod: Systemic Therapy for Systemic Disease, Radiation for Local Disease

2021 ◽  
Vol 111 (2) ◽  
pp. 311
Author(s):  
William M. Mendenhall
Keyword(s):  
Systemic Therapy ◽  
Systemic Disease ◽  
Local Disease

Systemic Therapy of Salivary Gland Hypofunction

1987 ◽  
Vol 66 (2_suppl) ◽  
pp. 689-692 ◽  
Author(s):  
P. C. Fox
Keyword(s):  
Salivary Gland ◽  
Connective Tissue ◽  
Systemic Therapy ◽  
Systemic Disease ◽  
Objective Measures ◽  
Clinical Investigations ◽  
Number Of Patients ◽  
Salivary Function ◽  
Salivary Gland Hypofunction ◽  
Hydro Chloride

Salivary gland hypofunction occurs most often as a consequence of numerous drug therapies, anti-neoplastic treatments, or systemic disease. There are no universally accepted means of treating gland dysfunction and the resultant subjective xerostomia. A few studies have suggested that treatment of underlying inflammatory connective tissue disease will improve salivary performance in Sjögren's syndrome. Most of these reports, however, have either been limited to a small number of patients or have failed to include objective measures of salivary gland output. A larger body of literature deals with attempts using many different sialogogues to stimulate salivary function in a variety of conditions. Again, many studies have failed to document salivary improvement objectively. Recently, interest has focused on three drugs: bromhexine, anethole-trithione, and pilocarpine hydro-chloride. Studies with these agents are reviewed, and current clinical investigations with pilocarpine are presented in detail.

scholarly journals Survival After Surgery for Renal Cell Carcinoma Metastatic to the Spine: Impact of Modern Systemic Therapies on Outcomes

Neurosurgery ◽  
2020 ◽  
Author(s):  
Ganesh M Shankar ◽  
Laura A Van Beaver ◽  
Bryan D Choi ◽  
Muhamed Hadzipasic ◽  
Ahilan Sivaganesan ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
Systemic Disease ◽  
Cohort Analysis ◽  
Spinal Metastases ◽  
Immune Checkpoints ◽  
Metastatic Rcc ◽  
Systemic Therapies

Abstract BACKGROUND Modern medical management of metastatic renal cell carcinoma (RCC) includes therapies targeting tyrosine kinases, growth pathways (mammalian target of rapamycin (mTOR)), and immune checkpoints. OBJECTIVE To test our hypothesis that patients with spinal metastases would benefit from postoperative systemic therapy despite presenting with disease that, in many cases, was resistant to prior systemic therapy. METHODS This is an Institutional Review Board-approved clinical retrospective cohort analysis. A sample of adult patients with RCC metastatic to the spine who underwent operative intervention between January 2010 and December 2017 at 2 large academic medical centers was used in this study. RESULTS We identified 78 patients with metastatic RCC in whom instrumented stabilization was performed in 79% and postoperative stereotactic radiosurgery was performed in 41% of patients. Of patients presenting with weakness or myelopathy, 93% noted postoperative improvement and 78% reported improvement in radicular and axial paraspinal pain severity. Increased overall survival (OS) (913 d (95% CI: 633-1975 d, n = 49) vs 222 d (95% CI: 143-1005 d, n = 29), P = .003) following surgery was noted in patients who received postoperative systemic therapy a median of 80 d (interquartile range 48-227 d) following the surgical intervention. CONCLUSION Postoperative outcomes and palliation of symptoms for metastatic RCC without targeted therapies in this cohort are similar to those reported in earlier series prior to the adoption of these systemic therapies. We observed a significantly longer OS among patients who received modern systemic therapies postoperatively. These findings have implications for the preoperative evaluation of patients with systemic disease who may have been deemed poor surgical candidates prior to the availability of these systemic therapies.

scholarly journals Contemporary Review of Borderline Resectable Pancreatic Ductal Adenocarcinoma

2019 ◽  
Vol 8 (8) ◽  
pp. 1205 ◽  
Author(s):  
Bonds ◽  
Rocha
Keyword(s):  
Radiation Therapy ◽  
Systemic Therapy ◽  
Systemic Disease ◽  
Performance Status ◽  
Ductal Adenocarcinoma ◽  
Borderline Resectable ◽  
Disease Biology ◽  
Neoadjuvant Systemic Therapy ◽  
High Level ◽  
Patient Performance

Borderline resectable pancreatic adenocarcinoma (PDAC) presents challenges in definition and treatment. Many different definitions exist for this disease. Some are based on anatomy alone, while others include factors such as disease biology and patient performance status. Regardless of definition, evidence suggests that borderline resectable PDAC is a systemic disease at the time of diagnosis. There is high-level evidence to support the use of neoadjuvant systemic therapy in these cases. Evidence to support the use of radiation therapy is ongoing. There are ongoing trials investigating the available neoadjuvant therapies for borderline resectable PDAC that may provide clarity in the future.

Local or regionally recurrent carcinoma of the breast: results of therapy in 121 patients.

1983 ◽  
Vol 1 (6) ◽  
pp. 400-405 ◽  
Author(s):  
T M Beck ◽  
N E Hart ◽  
D A Woodard ◽  
C E Smith
Keyword(s):  
Overall Survival ◽  
Surgical Management ◽  
Systemic Therapy ◽  
Residual Disease ◽  
Systemic Disease ◽  
Disease Free Survival ◽  
Local Therapy ◽  
Surgical Removal ◽  
Carcinoma Of The Breast ◽  
Disease Free

Local or regional recurrence after primary surgical management for carcinoma of the breast was retrospectively evaluated by presenting stage and management in 121 patients. None had evidence of systemic disease. Management consisted of surgical removal only in 11 patients, removal followed by irradiation in 25, biopsy only followed by irradiation in 43, hormonal therapy after biopsy in 30, and chemotherapy after biopsy in 12. Mean and median follow-up for all patients was 46.9 and 31.5 months, respectively. Patients experiencing a recurrence within 24 months of primary surgical management experienced the worst overall and disease-free survival. The group of 42 patients with residual disease who received systemic therapy after biopsy had improved disease-free and overall survival at 5 years in comparison to the group of 43 patients who received local therapy after biopsy (p less than or equal to 0.05). Radiation therapy produced more frequent and durable control of local disease than did systemic therapy. Patients who had a complete response to applied therapy had significant improvement in overall survival.

scholarly journals Pancreatic Adenocarcinoma: Treating a Systemic Disease With Systemic Therapy

2014 ◽  
Vol 106 (3) ◽  
pp. dju011-dju011 ◽  
Author(s):  
D. P. Sohal ◽  
R. M. Walsh ◽  
R. K. Ramanathan ◽  
A. A. Khorana
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Systemic Therapy ◽  
Systemic Disease

scholarly journals Psoriasis is a systemic disease: A proposed approach for inflammation scale calculation

2021 ◽  
Vol 12 (4) ◽  
pp. 381-386
Author(s):  
Abdulghani Mohamed Alsamarai ◽  
Amina Hamed Ahmed Alobaidii
Keyword(s):  
Skin Disease ◽  
Large Scale ◽  
Troponin I ◽  
Systemic Disease ◽  
Local Skin ◽  
Lipoprotein A ◽  
Local Disease ◽  
Significant Difference ◽  
Hs Crp ◽  
D Dimer

Background: Psoriasis is a skin disease affecting 2.3% of the Iraqi population and begins as a local disease with subsequent systemic comorbidities. Aim: The aim was to clarify whether psoriasis is a local or systemic disease. Materials and Methods: A total of 211 subjects with psoriasis and 163 sex- and age-matched controls were included in the study. Serum adiponectin, interleukin-6, interleukin-8, interleukin-10 (IL-10), interleukin-23 (IL-23), interleukin-18 (IL-18), paraoxonase, lipoprotein (a), osteopontin, chemerin, tumor necrosis factor-a (TNF-a), high-sensitivity C- reactive protein (hs-CRP), bilirubin, D-dimer, and creatinine were determined using commercial kits. Results: There was no significant difference in the mean age and BMI between psoriasis and the control groups. However, there was significantly higher mean serum values of IL-6, IL-8, IL-10, IL-23, lipoprotein (a), chemerin, TNF-a, hs-CRP, osteopontin, D-dimer, troponin I, creatinine, bilirubin, and platelet counts in psoriatic patients than in the controls. Meanwhile, the serum mean values of adiponectin, paraoxonase, and cortisol were significantly lower in psoriasis subjects than in the controls. The mathematical model was proposed to clarify whether psoriasis is a systemic or local disease. The application of the model to our data of biomarkers indicated the presence of systemic inflammation in psoriasis. Conclusion: The present study finding suggests that psoriasis is a systemic disease rather than a local skin disease. However, there is a need for the application of the model in a large-scale study.

scholarly journals Systemic therapy of MSCs in bone regeneration: a systematic review and meta-analysis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Jingfei Fu ◽  
Yanxue Wang ◽  
Yiyang Jiang ◽  
Juan Du ◽  
Junji Xu ◽  
...  
Keyword(s):  
Bone Formation ◽  
Bone Regeneration ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Meta Analysis ◽  
Systemic Disease ◽  
Bone Diseases ◽  
Original Research ◽  
Mineral Density ◽  
Systemic Application

Abstract Objectives Over the past decades, many studies focused on mesenchymal stem cells (MSCs) therapy for bone regeneration. Due to the efficiency of topical application has been widely dicussed and systemic application was also a feasible way for new bone formation, the aim of this study was to systematically review systemic therapy of MSCs for bone regeneration in pre-clinical studies. Methods The article search was conducted in PubMed and Embase databases. Original research articles that assessed potential effect of systemic application of MSCs for bone regeneration in vivo were selected and evaluated in this review, according to eligibility criteria. The efficacy of MSC systemic treatment was analyzed by random effects meta-analysis, and the outcomes were expressed in standard mean difference (SMD) and its 95% confidence interval. Subgroup analyses were conducted on animal species and gender, MSCs types, frequency and time of injection, and bone diseases. Results Twenty-three articles were selected in this review, of which 21 were included in meta-analysis. The results showed that systemic therapy increased bone mineral density (SMD 3.02 [1.84, 4.20]), bone volume to tissue volume ratio (2.10 [1.16, 3.03]), and the percentage of new bone area (7.03 [2.10, 11.96]). Bone loss caused by systemic disease tended to produce a better response to systemic treatment (p=0.05 in BMD, p=0.03 in BV/TV). Conclusion This study concluded that systemic therapy of MSCs promotes bone regeneration in preclinical experiments. These results provided important information for the systemic application of MSCs as a potential application of bone formation in further animal experiments.

scholarly journals Locoregional management of in-transit metastasis in melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline

2020 ◽  
Vol 27 (3) ◽  
Author(s):  
F. C. Wright ◽  
S. Kellett ◽  
N. J. Look Hong ◽  
A. Y. Sun ◽  
T. P. Hanna ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Cancer Care ◽  
Carbon Dioxide Laser ◽  
Systemic Disease ◽  
Interleukin 2 ◽  
Surgical Excision ◽  
Case Conference ◽  
Complete Surgical Excision ◽  
First Choice ◽  
In Transit

Objective The purpose of this guideline is to provide guidance on appropriate management of satellite and in-transit metastases (ITM) from melanoma.   Methods The guideline was developed by the Program in Evidence-Based Care (PEBC) of Ontario Health (Cancer Care Ontario) and the Melanoma Disease Site Group (DSG). Recommendations were drafted by the Working Group based on a systematic review of publications in MEDLINE and Embase. The document underwent patient and caregiver-specific consultation and was circulated to the Melanoma DSG and the PEBC Report Approval Panel for internal review; the revised document underwent external review.   Recommendations Minimal ITM were defined as lesions in a location with limited spread (generally 1 to 4 lesions); lesions are generally superficial, often clustered together, and surgically resectable. Moderate disease was defined as > 5 lesions covering a wider area or when new in-transit lesions develop rapidly (over weeks). Maximal disease was defined as large-volume disease with multiple (more than 15 to 20) 2-3 cm nodules or subcutaneous or deeper lesions over a wide area.   1. In patients presenting with minimal ITM, complete surgical excision with negative pathological margins is recommended. In addition to complete surgical resection, adjuvant treatment may be considered. 2. In patients presenting with moderate, unresectable ITM consider using the following approach for localized treatment: intralesional interleukin-2 or talimogene laherparepvec as first choice, topical diphenylcyclopropenone as second choice, or radiation therapy as third choice. There is insufficient evidence to recommend intralesional bacille Calmette-Guerin or carbon dioxide laser ablation outside of a research setting. 3. In patients presenting with maximal ITM confined to an extremity, isolated limb perfusion, isolated limb infusion, or systemic therapy may be considered. In extremely select cases, amputation could be considered as a final option in patients without systemic disease after discussion at a multidisciplinary case conference. 4. In cases where local, regional, or surgical treatments for ITM may be ineffective, unable to be performed, or if a patient has systemic metastases at the same time, systemic therapy may be considered.

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