scholarly journals Advances in the curative management of oesophageal cancer

2021 ◽  
Author(s):  
Jarlath C. Bolger ◽  
Claire L. Donohoe ◽  
Maeve Lowery ◽  
John V. Reynolds
Keyword(s):  
Overall Survival ◽  
Oesophageal Cancer ◽  
Mortality Rates ◽  
Surgical Approaches ◽  
Combination Therapies ◽  
The West ◽  
Curative Intent ◽  
Treatment Pathway ◽  
The Past ◽  
New Knowledge

AbstractThe incidence of oesophageal cancer, in particular adenocarcinoma, has markedly increased over the last four decades with adenocarcinoma becoming the dominant subtype in the West, and mortality rates are high. Nevertheless, overall survival of patients with oesophageal cancer has doubled in the past 20 years, with earlier diagnosis and improved treatments benefiting those patients who can be treated with curative intent. Advances in endotherapy, surgical approaches, and multimodal and other combination therapies have been reported. New vistas have emerged in targeted therapies and immunotherapy, informed by new knowledge in genomics and molecular biology, which present opportunities for personalised cancer therapy and novel clinical trials. This review focuses exclusively on the curative intent treatment pathway, and highlights emerging advances.

scholarly journals O85: ENSURE: EUROPEAN INVESTIGATION OF SURVEILLANCE AFTER RESECTION FOR ESOPHAGEAL CANCER

2021 ◽  
Vol 108 (Supplement_1) ◽  
Keyword(s):  
Overall Survival ◽  
Pilot Study ◽  
Oesophageal Cancer ◽  
Research Question ◽  
Oncologic Outcome ◽  
Karolinska Institute ◽  
Curative Intent ◽  
Initial Recurrence ◽  
Recurrence Patterns

Abstract   Presenting Author Email: [email protected] Research question Does intensive postoperative surveillance after planned curative resection for oesophageal cancer lead to increased detection of oligometastatic disease, facilitating increased use of tumor-directed therapy, hence improving overall survival? Background and aim Emerging data demonstrate long-term survival after salvage interventions for local or oligometastatic recurrence following planned curative resection for oesophageal cancer, providing rationale for postoperative surveillance. While meta-analyses confirm the survival benefit of chemotherapy (HR0.81, 0.71-0.92), and HER-2 directed therapy (HR0.75, 0.68-0.84) for patients with recurrent or metastatic oesophageal cancer, the effect of surveillance on oncologic outcome and health-related quality-of-life (HRQL) is unknown. There is currently no international consensus regarding the utility of surveillance following curative-intent treatment for oesophageal cancer, with divergent guidelines from ESMO, AUGIS and NCCN. A pilot study including 27 European centres (ENSURE-1) demonstrated wide variation in practice, with tumour markers, CT and PET-CT utilised in 4 (14.8%), 10 (37.0%) and 3 (11.1%), respectively. This multicenter collaborative project aims to determine the independent impact of intensive surveillance on recurrence patterns, oncologic outcome, and HRQL in survivorship, providing the first adequately powered study to address this critical research question. Patients A retrospective observational study of patients undergoing treatment with curative intent for oesophageal cancer at participating Centers from June 2009 to June 2015. Inclusion criteria 1. Age 18 years and above 2. Underwent surgery with curative intent for cTxNxM0 esophageal or esophagogastric junction (Siewert type I, II and III) cancer 3. Salvage surgery after failure of primary endoscopic or oncologic treatment will be included Exclusion criteria 1. Endoscopic therapy or definitive oncological treatment as sole therapy for esophageal cancer 2. Missing follow-up data Comparator Outcomes will be compared among patients managed with intensive surveillance (IS) compared with standard surveillance. IS will be defined as the routine use of CT/PET-CT for surveillance, at least annually, for at least the first three postoperative years. Each participating centre will be classified as undertaking IS or standard surveillance (SS) according to data submitted in the pilot study (ENSURE-1). Outcomes The primary endpoint of this study is: • Overall survival The secondary endpoints of this study are: • Disease-specific survival • Observed disease-free survival • HRQL o Prespecified EORTC QLQ-C30, QLQ-OG25 items • Recurrence patterns and treatment o Site of disease at initial recurrence o Oligometastatic disease at initial recurrence o Anastomotic disease at initial recurrence o Palliative chemotherapy, chemoradiation and radiation use o Treatment for oligometastatic and anastomotic recurrence (surgery, radiation, chemotherapy only) Study design Power calculation and sample size Power calculations are based on Sisic et al. demonstrating a 5% increase in 5-year overall survival with standardized follow-up in a propensity score matched analysis. Based on an initial feasibility survey of 18 Centers, current estimated number of cases per year for enrolled Centers is 885, therefore it is anticipated that the 5-year study period should capture approximately 4425 patients, of whom 31% undergo high intensity surveillance with cross-sectional imaging, with a minimum postoperative follow-up of 3 years. Using a log-rank analysis to detect a 5% difference in overall survival with sigma of 0.05, with 1371 of 4425 patients in the IS group, the study is powered to 90.4%, while accounting for a potential 20% exclusion rate, the study is powered to 83.1% with current enrolled Centers. Data collection and study definitions Where possible, data will be collected from prospectively maintained databases at participating Centers. Collected data will be entered into a standardized data collection spreadsheet “ENSURE Study - Datasheet” (attached). Variables will be coded at source by Co-Investigators according to standardized coding. Briefly, collected data will include: • Demographics • Co-morbidities and performance status • Histologic type • Tumor location • Clinical stage and grade • Pathologic stage, grade, treatment response and margins • Neoadjuvant therapy details • Operative details • Overall postoperative morbidity • Recurrence and associated treatment • Survival data • HRQOL o ENSURE database will be linked to include relevant HRQL data from a previous study (LASER) Registration The study has been registered on ClinicalTrials.gov (NCT03461341). Statistical Approach Data will be analyzed using SPSS® (v.23.0) software (SPSS, Chicago, IL, USA). For the multivariable analyses, all clinically relevant variables will be inputted into multivariable linear, logistic or Cox proportional hazards regression models. Team and infrastructure An international multidisciplinary collaborative team has been assembled via the Young Investigator Group of the European Society for Diseases of the Esophagus for the conduct of this study, with 27 centres signed up to participate in the pilot study to date. The study will be initiated from St. James's Hospital, Dublin, Ireland; the Karolinska Institute, Stockholm, Sweden; and Imperial College London, London, England. Steering committee: Jessie Elliott (Dublin), Fredrik Klevebro (Stockholm), Sheraz Markar (London), Lucas Goense (Utrecht), Melody Ni (London – statistician), Pernilla Lagergran (Stockholm – HRQL researcher) Supervisory committee: John V Reynolds (Dublin), Magnus Nilsson (Stockholm), George Hanna (London), Giovanni Zaninotto (Padova). Infrastructure: A dedicated biostatistician (Dr Melody Ni, Imperial College London) is a collaborator on the current project and will provide expertise with respect to design and data analysis. A researcher with expertise in HRQL assessment (Professor Pernilla Lagergren, Karolinska Institute) is also a named collaborator on the present project.

HPV-associated cervical diseases: screening, methods of examination, principles of treatment

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 6-8
Author(s):  
Vera N Prilepskaya
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Prevention ◽  
Mortality Rates ◽  
Diagnostic Methods ◽  
Screening Methods ◽  
The Past ◽  
Associated Diseases ◽  
Principles Of Treatment ◽  
Cervical Diseases

This article presents information about modern principles of diagnosis and treatment of HPV-associated diseases. Behind cervical cancer morbidity and mortality rates over the past 10 years increase significantly. Examination and observation of patients with human papillomavirus persistence of highly oncogenic types is important a link in cancer prevention. The article presents diagnostic methods, treatment of cervical diseases, as well as the possibility of pharmacotherapy in HPV-associated diseases.

Managing rivers for conservation and ecotourism in the Kruger National Park

1995 ◽  
Vol 32 (5-6) ◽  
pp. 227-233 ◽  
Author(s):  
F. J. Venter ◽  
A. R. Deacon
Keyword(s):  
National Park ◽  
Good Condition ◽  
Kruger National Park ◽  
Rapid Expansion ◽  
Natural Environments ◽  
The West ◽  
The Past ◽  
Management Actions ◽  
Flow Through ◽  
Three Rivers

Six major rivers flow through the Kruger National Park (KNP). All these rivers originate outside and to the west of the KNP and are highly utilized. They are crucially important for the conservation of the unique natural environments of the KNP. The human population growth in the Lowveld during the past two decades brought with it the rapid expansion of irrigation farming, exotic afforestation and land grazed by domestic stock, as well as the establishment of large towns, mines, dams and industries. Along with these developments came overgrazing, erosion, over-utilization and pollution of rivers, as well as clearing of indigenous forests from large areas outside the borders of the KNP. Over-utilization of the rivers which ultimately flow through the KNP poses one of the most serious challenges to the KNP's management. This paper gives the background to the development in the catchments and highlights the problems which these have caused for the KNP. Management actions which have been taken as well as their results are discussed and solutions to certain problems proposed. Three rivers, namely the Letaba, Olifants and Sabie are respectively described as examples of an over-utilized river, a polluted river and a river which is still in a fairly good condition.

The New Islamic State

2020 ◽  
Author(s):  
Farhad Khosrokhavar
Keyword(s):  
Middle East ◽  
Modern Society ◽  
Islamic State ◽  
Imagined Community ◽  
The West ◽  
Patriarchal Family ◽  
The Past ◽  
The World ◽  
The Creation

The creation of the Islamic State in Iraq and Sham (ISIS) changed the nature of jihadism worldwide. For a few years (2014–2017) it exemplified the destructive capacity of jihadism and created a new utopia aimed at restoring the past greatness and glory of the former caliphate. It also attracted tens of thousands of young wannabe combatants of faith (mujahids, those who make jihad) toward Syria and Iraq from more than 100 countries. Its utopia was dual: not only re-creating the caliphate that would spread Islam all over the world but also creating a cohesive, imagined community (the neo-umma) that would restore patriarchal family and put an end to the crisis of modern society through an inflexible interpretation of shari‘a (Islamic laws and commandments). To achieve these goals, ISIS diversified its approach. It focused, in the West, on the rancor of the Muslim migrants’ sons and daughters, on exoticism, and on an imaginary dream world and, in the Middle East, on tribes and the Sunni/Shi‘a divide, particularly in the Iraqi and Syrian societies.

scholarly journals Current Advancements and Novel Strategies in the Treatment of Metastatic Melanoma

2021 ◽  
Vol 20 ◽  
pp. 153473542199007
Author(s):  
Siddhartha Sood ◽  
Rahul Jayachandiran ◽  
Siyaram Pandey
Keyword(s):  
Metastatic Melanoma ◽  
Complementary Therapy ◽  
Natural Health Products ◽  
Combination Therapies ◽  
Natural Health ◽  
The Past ◽  
Health Products ◽  
Melanoma Treatment ◽  
New Research

Melanoma is the deadliest form of skin cancer in the world with a growing incidence in North America. Contemporary treatments for melanoma include surgical resection, chemotherapy, and radiotherapy. However, apart from resection in early melanoma, the prognosis of patients using these treatments is typically poor. In the past decade, there have been significant advancements in melanoma therapies. Immunotherapies such as ipilimumab and targeted therapies such as vemurafenib have emerged as a promising option for patients as seen in both scientific and clinical research. Furthermore, combination therapies are starting to be administered in the form of polychemotherapy, polyimmunotherapy, and biochemotherapy, of which some have shown promising outcomes in relative efficacy and safety due to their multiple targets. Alongside these treatments, new research has been conducted into the evidence-based use of natural health products (NHPs) and natural compounds (NCs) on melanoma which may provide a long-term and non-toxic form of complementary therapy. Nevertheless, there is a limited consolidation of the research conducted in emerging melanoma treatments which may be useful for researchers and clinicians. Thus, this review attempts to evaluate the therapeutic efficacy of current advancements in metastatic melanoma treatment by surveying new research into the molecular and cellular basis of treatments along with their clinical efficacy. In addition, this review aims to elucidate novel strategies that are currently being used and have the potential to be used in the future.

Endoscopic Septal Spur Resection

1993 ◽  
Vol 7 (5) ◽  
pp. 213-216 ◽  
Author(s):  
Donald C. Lanza ◽  
Deborah Farb Rosin ◽  
David W. Kennedy
Keyword(s):  
Surgical Technique ◽  
Endoscopic Sinus Surgery ◽  
Chronic Sinusitis ◽  
Sinus Surgery ◽  
Surgical Approaches ◽  
Postoperative Results ◽  
Valuable Alternative ◽  
Perioperative Morbidity ◽  
The Past ◽  
Septal Spur

A variety of surgical approaches exists for the management of nasal septal spurs in patients who undergo endoscopic sinus surgery (ESS). Treatment of septal spurs in the past has been frequently addressed by septoplasty which can result in increased bleeding and length of surgical procedure as well as mandate postoperative nasal packing. Individually each of these problems can jeopardize the success of endoscopic sinus surgery. An endoscopic approach, which targets the septal spur alone, can minimize perioperative morbidity. The purpose of this paper is to demonstrate the effectiveness of endoscopic septal spur resection (ESSR) for the management of significant septal spurs in 8 patients who underwent concurrent ESSR during ESS for chronic sinusitis. Surgical technique and postoperative results are discussed and suggest that ESSR is a valuable alternative to more traditional techniques.

Anti-Catholicism in Germany, Britain, and the United States: A Review and Critique of Recent Scholarship

2001 ◽  
Vol 70 (1) ◽  
pp. 98-131 ◽  
Author(s):  
Marjule Anne Drury
Keyword(s):  
Cultural Change ◽  
The United States ◽  
Turn Of The Century ◽  
Religious Culture ◽  
The West ◽  
The Past ◽  
Recent Scholarship ◽  
Race Ethnicity ◽  
Irish Question ◽  
Political Economic

The past two decades have seen an efflorescence of works exploring cultural anti-Catholicism in a variety of national contexts. But so far, historians have engaged in little comparative analysis. This article is a first step, examining recent historical literature on modern British and American anti-Catholicism, in order to trace the similarities and distinctiveness of the turn-of-the-century German case. Historians are most likely to be acquainted with American nativism, the German Kulturkampf, continental anticlericalism, and the problems of Catholic Emancipation and the Irish Question in Britain. Many of the themes and functions of anti-Catholic discourse in the West transcended national and temporal boundaries. In each case, the conceptualization of a Catholic ‘other’ is a testament to the tenacity of confessionalism in an age formerly characterized as one of inexorable secularization. Contemporary observers often agreed that religious culture—like history, race, ethnicity, geography, and local custom—played a role in the self-evident distinctiveness of peoples and nations, in their political forms, economic performance, and intellectual and artistic contributions. We will see how confessionalism remained a lens through which intellectuals and ordinary citizens, whether attached or estranged from religious commitments, viewed political, economic, and cultural change.

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S32-S41 ◽  
Author(s):  
Patrick P. Youssef ◽  
Albert Jess Schuette ◽  
C. Michael Cawley ◽  
Daniel L. Barrow
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Surgical Approaches ◽  
Dural Sinus ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

The Problem of Energy

2014 ◽  
Vol 31 (5) ◽  
pp. 3-20 ◽  
Author(s):  
John Urry
Keyword(s):  
Social Theory ◽  
21St Century ◽  
Fossil Fuel ◽  
Energy Systems ◽  
Social Thought ◽  
Human Intervention ◽  
The West ◽  
The Past ◽  
And Control ◽  
Global Growth

Energy forms and their extensive scale are remarkably significant for the ways that societies are organized. This article shows the importance of how societies are ‘energized’ and especially the global growth of ‘fossil fuel societies’. Much social thought remains oblivious to the energy revolution realized over the past two to three centuries which set the ‘West’ onto a distinct trajectory. Energy is troubling for social thought because different energy systems with their ‘lock-ins’ are not subject to simple human intervention and control. Analyses are provided here of different fossil fuel societies, of coal and oil, with the latter enabling the liquid, mobilized 20th century. Consideration is paid to the possibilities of reducing fossil fuel dependence but it is shown how unlikely such a ‘powering down’ will be. The author demonstrates how energy is a massive problem for social theory and for 21st-century societies. Developing post-carbon theory and especially practice is far away but is especially urgent.

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