Adjuvant Treatments for Localized Advanced Gastric Cancer: Differences among Geographic Regions

2012 ◽  
pp. e31-e34
Author(s):  
Yoon-Koo Kang ◽  
Changhoon Yoo
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Standard Of Care ◽  
Current Standard ◽  
The West ◽  
The United Kingdom ◽  
Group B ◽  
Leukemia Group ◽  
Postoperative Chemoradiation

Overview: After much debate, adjuvant therapy has become the standard of care worldwide for resected localized gastric cancer. However, geographic differences exist in standard adjuvant treatments: postoperative chemoradiation in North America, perioperative chemotherapy in the United Kingdom, and postoperative chemotherapy in East Asia. Now that D2 gastrectomy has been recognized as the optimal surgery for localized gastric cancer in the West as well as in Asia, the standard adjuvant treatments used in the West may need to be reconsidered. One of the most important issues in adjuvant therapy for localized gastric cancer is how to improve the clinical outcomes of current standard treatments. Recent Cancer and Leukemia Group B (CALGB) and AMC studies suggest that simply intensifying chemotherapy by adding more agents or prolonging treatment duration is insufficient. However, new strategies like early initiation of chemotherapy and/or intraperitoneal chemotherapy may further improve the current standard adjuvant therapy. In the era of targeted therapy, the role of biologic agents for gastric cancer should also be explored in the adjuvant setting. With a deeper understanding of the molecular biology of gastric cancer, adjuvant therapy for patients with localized gastric cancer can be optimized and individualized.

scholarly journals Towards Personalization in the Curative Treatment of Gastric Cancer

2020 ◽  
Vol 10 ◽  
Author(s):  
Astrid E. Slagter ◽  
Marieke A. Vollebergh ◽  
Edwin P. M. Jansen ◽  
Johanna W. van Sandick ◽  
Annemieke Cats ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Molecular Characteristics ◽  
Perioperative Chemotherapy ◽  
Current Standard ◽  
Common Cancer ◽  
Resectable Gastric Cancer

Gastric cancer is the fifth most common cancer worldwide and has a high mortality rate. In the last decades, treatment strategy has shifted from an exclusive surgical approach to a multidisciplinary strategy. Treatment options for patients with resectable gastric cancer as recommended by different worldwide guidelines, include perioperative chemotherapy, pre- or postoperative chemoradiotherapy and postoperative chemotherapy. Although gastric cancer is a heterogeneous disease with respect to patient-, tumor-, and molecular characteristics, the current standard of care is still according to a one-size-fits-all approach. In this review, we discuss the background of the different treatment strategies in resectable gastric cancer including the current standard, the specific role of radiotherapy, and describe the current areas of research and potential strategies for personalization of therapy.

Adjuvant Therapy in Gastric Cancer

2005 ◽  
Vol 23 (25) ◽  
pp. 6220-6232 ◽  
Author(s):  
Lionel Lim ◽  
Michael Michael ◽  
G. Bruce Mann ◽  
Trevor Leong
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Standard Of Care ◽  
Current Status ◽  
Research Directions ◽  
Treatment Delivery ◽  
Significant Survival ◽  
Definitive Surgery ◽  
Radiation Planning

Gastric cancer has a poor prognosis. The majority of patients will relapse after definitive surgery, and 5-year survival after surgery remains poor. The role of adjuvant therapy in gastric cancer has been controversial given the lack of significant survival benefit in many randomized studies so far. The results of a large North American study (Gastrointestinal Cancer Intergroup Trial INT 0116) reported that postoperative chemoradiotherapy conferred a survival advantage compared with surgery alone, which has led to the regimen being adopted as a new standard of care. However, controversies still remain regarding surgical technique, the place of more effective and less toxic chemotherapy regimens, and the use of more modern radiation planning techniques to improve treatment delivery and outcome in the adjuvant and neoadjuvant setting. This article reviews the current status of the adjuvant treatment for gastric cancer including discussion on the research directions aimed at optimizing treatment efficacy. Issues such as the identification of patients who are more likely to benefit from adjuvant therapy are also addressed. Further clinical trials are needed to move towards better consensus and standardization of care.

Paradox and Possibility

2021 ◽  
Author(s):  
Stuart Poyntz
Keyword(s):  
The United States ◽  
Media Technology ◽  
The West ◽  
The United Kingdom ◽  
Youth Cultures ◽  
Youth Media ◽  
Mass Reproduction ◽  
History Of ◽  
Cultural Texts

The history of youth and media culture can be examined by tracing the relationships between the production, representation, circulation, and consumption of media, technology, and cultural texts aimed at youth markets and audiences. The historical development of youth relates to larger socioeconomic, cultural, and political conditions, including the role of mass reproduction and changes in the conditions of distance that shape youth lives. Youth and mass media first melded together in the West, owing to developments in the United States and the United Kingdom. The histories of media and youth culture in other countries, however, capture differences in youth media relationships. In the contemporary period, the use of YouTube in the West and WeChat in China illuminates the globalization of youth cultures and the ongoing role of a central paradox integral to young people’s entanglements with media around the world: the key media structures that shape and contour youth lives are also the very sites where youth continue to navigate authentic meaning and experience and imagine their own futures.

scholarly journals Radiotherapy of glioblastoma 15 years after the landmark Stupp’s trial: more controversies than standards?

2018 ◽  
Vol 52 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Tomas Kazda ◽  
Adam Dziacky ◽  
Petr Burkon ◽  
Petr Pospisil ◽  
Marek Slavik ◽  
...  
Keyword(s):  
Concurrent Chemoradiotherapy ◽  
Standard Of Care ◽  
Primary Brain Tumor ◽  
Current Standard ◽  
Tumor Treating Fields ◽  
Integrated Boost ◽  
Hippocampal Sparing ◽  
New Treatment ◽  
Personalized Approach

Abstract Background The current standard of care of glioblastoma, the most common primary brain tumor in adults, has remained unchanged for over a decade. Nevertheless, some improvements in patient outcomes have occurred as a consequence of modern surgery, improved radiotherapy and up-to-date management of toxicity. Patients from control arms (receiving standard concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide) of recent clinical trials achieve better outcomes compared to the median survival of 14.6 months reported in Stupp’s landmark clinical trial in 2005. The approach to radiotherapy that emerged from Stupp’s trial, which continues to be a basis for the current standard of care, is no longer applicable and there is a need to develop updated guidelines for radiotherapy within the daily clinical practice that address or at least acknowledge existing controversies in the planning of radiotherapy. The goal of this review is to provoke critical thinking about potentially controversial aspects in the radiotherapy of glioblastoma, including among others the issue of target definitions, simultaneously integrated boost technique, and hippocampal sparing. Conclusions In conjunction with new treatment approaches such as tumor-treating fields (TTF) and immunotherapy, the role of adjuvant radiotherapy will be further defined. The personalized approach in daily radiotherapy practice is enabled with modern radiotherapy systems.

scholarly journals Radiomics for the Diagnosis and Differentiation of Pancreatic Cystic Lesions

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 505
Author(s):  
Jorge D. Machicado ◽  
Eugene J. Koay ◽  
Somashekar G. Krishna
Keyword(s):  
Predictive Accuracy ◽  
Quantitative Imaging ◽  
Standard Of Care ◽  
Small Sample ◽  
Cystic Lesions ◽  
Current Standard ◽  
Cross Sectional ◽  
Small Sample Sizes ◽  
Insight Into

Radiomics, also known as quantitative imaging or texture analysis, involves extracting a large number of features traditionally unmeasured in conventional radiological cross-sectional images and converting them into mathematical models. This review describes this approach and its use in the evaluation of pancreatic cystic lesions (PCLs). This discipline has the potential of more accurately assessing, classifying, risk stratifying, and guiding the management of PCLs. Existing studies have provided important insight into the role of radiomics in managing PCLs. Although these studies are limited by the use of retrospective design, single center data, and small sample sizes, radiomic features in combination with clinical data appear to be superior to the current standard of care in differentiating cyst type and in identifying mucinous PCLs with high-grade dysplasia. Combining radiomic features with other novel endoscopic diagnostics, including cyst fluid molecular analysis and confocal endomicroscopy, can potentially optimize the predictive accuracy of these models. There is a need for multicenter prospective studies to elucidate the role of radiomics in the management of PCLs.

scholarly journals Radiotherapy in the treatment of gastrointestinal stromal tumor

Rare Tumors ◽  
2011 ◽  
Vol 3 (4) ◽  
pp. 111-113 ◽  
Author(s):  
Christin A. Knowlton ◽  
Luther W. Brady ◽  
Rebecca C. Heintzelman
Keyword(s):  
Kinase Inhibitor ◽  
Standard Of Care ◽  
High Rate ◽  
Viable Option ◽  
Current Standard ◽  
Mesenchymal Tumors ◽  
Palliative Setting ◽  
Term Response

Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumors of the gastrointestinal tract. Up to one-third of GISTs are malignant with a high rate of metastasis. Surgical resection is the mainstay of care for patients with resectable disease. Imatinib mesylate, a selective tyrosine kinase inhibitor, is the current standard of care for GISTs that cannot be completely resected or in cases of metastatic GIST. Although often overlooked, radiation therapy is a viable option for select patients with GIST. We report the case of a patient with unresectable GIST who was treated with local radiotherapy and achieved long-term response. We also present a review of the literature regarding the use of radiotherapy in the treatment of GIST. GIST has been shown to be a radiosensitive tumor. Radiotherapy can offer long-term local control and should be considered in the adjuvant or palliative setting. The role of radiotherapy delivered concurrently with imatinib in the treatment of GIST may warrant further investigation.

scholarly journals Needleless Ablation of Osteoid Osteoma and Osteoblastoma: The Emergent Role of MRgFUS

2021 ◽  
Vol 11 (1) ◽  
pp. 128
Author(s):  
Flavia Cobianchi Bellisari ◽  
Pierpaolo Palumbo ◽  
Carlo Masciocchi ◽  
Carmine Zoccali ◽  
Antonio Barile ◽  
...  
Keyword(s):  
Osteoid Osteoma ◽  
Focused Ultrasound ◽  
Standard Of Care ◽  
Current Standard ◽  
Ultrasound Surgery ◽  
Focused Ultrasound Surgery ◽  
Poor Tolerance ◽  
Microscopic Features ◽  
Technical Details

Osteoblastoma (OB) and osteoid osteoma (OO) are benign bone-forming tumors, with nearly identical basic microscopic features. The main difference is dimension (OO has usually a nidus measuring <2 cm in diameter). In addition, OB is biologically more active than OO, with a tendency to grow in size. Historically, treatments have included surgical resection and analgesics, although invasiveness and poor tolerance have led to the current standard of care moving toward interventional radiology, where radiofrequency ablation (RFA) represents the most diffuse technique. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has recently emerged as another innovative alternative treatment, providing tumor ablation through a needleless and ionizing radiation-free modality. In addition, this technique has the ability to guarantee a very precise and controlled increase in temperature, delivering small amounts of energy that can accurately destroy only the lesion, avoiding healthy surrounding tissues. The present review focuses on MRgFUS as the less invasive, safe, effective, and durable treatment option for the management of osteoid osteoma and osteoblastoma, including a description of technical details, indications and outcomes.

scholarly journals Successful Treatment of Tumor-Induced Osteomalacia by Multidisciplinary Therapy with Radiation to Intracranial Fibromyxoid Tumor

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mariangela Massaccesi ◽  
Francesco Miccichè ◽  
Mario Rigante ◽  
Gianluigi Petrone ◽  
Elisabetta Lepre ◽  
...  
Keyword(s):  
Paraneoplastic Syndrome ◽  
Bone Fractures ◽  
External Beam Radiotherapy ◽  
Fibroblast Growth Factor 23 ◽  
Tumor Resection ◽  
Rare Condition ◽  
Standard Of Care ◽  
Tumor Control ◽  
Current Standard

Background. Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by protein fibroblast-growth-factor-23 (FGF-23) secreting tumors. Complete tumor resection is the current standard of care for TIO; however, some patients may develop tumor recurrence. Due to the rarity of this paraneoplastic syndrome, the role of radiotherapy is unclear. This case is worth reporting because it adds to our knowledge some insights about the potential role of radiotherapy in this rare condition. Case Presentation. After multidisciplinary consultation, in July 2015, postoperative adjuvant radiotherapy was offered to a 52-year-old man with a multiple recurrent ossifying fibromyxoid tumor in the right frontal sinus causing TIO. The patient had a history of multiple bone fractures and pain since more than 20 years. The tumor had been removed in 2003 for the first time. Subsequent endoscopic resections of the tumor had been performed for recurrences of TIO in May 2012, October 2013, and July 2015. Starting from October 2015, external beam radiotherapy was delivered with a volumetric modulated arc technique to the tumor bed with a daily dose of 2 Gy up to a total dose of 60 Gy. After five years from treatment, the patient is free from local tumor relapse, TIO progression, and radiation-induced side effects. Conclusions. Radiotherapy may provide long-term TIO remission and tumor control, thus being a treatment option in cases where surgery is unfeasible or unsuccessful.

scholarly journals Monoclonal gammopathies of undetermined significance and smoldering myeloma

2020 ◽  
Vol 51 (4) ◽  
pp. 193-202
Author(s):  
Artur Jurczyszyn ◽  
Ruth Hutch ◽  
Anna Waszczuk-Gajda ◽  
Anna Suska ◽  
Katarzyna Krzanowska ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cell ◽  
Standard Of Care ◽  
Current Standard ◽  
Malignant Plasma Cell ◽  
Plasma Cell Disorder ◽  
Smoldering Myeloma ◽  
Cell Disorder ◽  
Undetermined Significance

AbstractMonoclonal gammopathy of undetermined significance (MGUS) is a clonal plasma cell disorder implicated as a precursor of multiple myeloma (MM), while smoldering multiple myeloma (SMM) is a malignant plasma cell disorder without evidence of a myeloma-defining event(s) (MDE). This is a review article of both disorders outlining their current definition and management according to the current standard of care. We focus on the pathogenesis of MM and the role of MGUS and SMM in the development of active MM. MGUS is a benign disorder and, subsequently, is followed by observation. In contrast, for SMM, although the current standard of care is “watch and wait”, this paper will explore the circumstances in which treatment should be considered to prevent MDE.

A phase III randomized study comparing perioperative nivolumab vs. observation in patients with localized renal cell carcinoma undergoing nephrectomy (PROSPER RCC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS4596-TPS4596 ◽  
Author(s):  
Lauren Christine Harshman ◽  
Maneka Puligandla ◽  
Naomi B. Haas ◽  
Mohamad Allaf ◽  
Charles G. Drake ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Clinical Stage ◽  
Expression Patterns ◽  
Correct Diagnosis ◽  
Randomized Study ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Phase Iii ◽  
Current Standard ◽  
Absolute Increase

TPS4596 Background: The anti-PD-1 antibody nivolumab (nivo) improves overall survival (OS) in metastatic treatment refractory RCC and is generally tolerable. In 2017, there is no standard adjuvant therapy proven to increase OS over surgery alone in non-metastatic (M0) disease. Mouse solid tumor models have revealed an OS benefit with a short course of neoadjuvant PD-1 blockade compared to adjuvant therapy. Two ongoing phase 2 studies of perioperative nivo in RCC patients (pts) have shown preliminary feasibility and safety with no surgical delays or complications. The PROSPER RCC trial will examine if the addition of perioperative nivo to radical or partial nephrectomy can improve clinical outcomes in pts with locally advanced RCC. With the goal of increasing cure and recurrence-free survival (RFS) rates in M0 RCC, we propose a three-pronged, multidisciplinary approach of presurgical priming with nivo followed by resection and adjuvant PD-1 blockade. Methods: Tumorbiopsy prior to randomization is mandatory to ensure the correct diagnosis and will permit unparalleled correlative science in this global, randomized, unblinded, phase 3 National Clinical Trials Network study. 766 pts with clinical stage ≥T2 or any node positive M0 RCC of any histology will be enrolled. The study arm will receive nivo 240mg IV for 2 doses prior to surgery followed by nivo adjuvantly for 9 months (q2 wks x 3 mo followed by q4 wks x 6 mo). The control arm will undergo the current standard of care: surgical resection followed by observation. Pts are stratified by clinical T stage, node positivity, and histology. There is 84.2% power to detect a 14.4% absolute increase in the primary endpoint of RFS from the ASSURE historical control of 55.8% to 70.2% at 5 yrs (HR 0.70). The study is also powered to detect a significant OS benefit (HR 0.67). Key safety, feasibility, and quality of life endpoints are incorporated. PROSPER RCC exemplifies team science with a host of planned correlative work to investigate the significance of the baseline immune milieu and changes after neoadjuvant priming and to identify predictive gene expression patterns. Additional collaborations are welcomed.

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