Patient and methods
Between January 2010 and July 2014, forty eight patients diagnosed as muscle invasive bladder cancer T2b-T4aN0M0 and not amenable or refuse radical cystectomy are enrolled in this prospective study. Eligibility criteria included, ECOG (Eastern Cooperative Oncology Group) performance status 0-2, haemoglobin> 10 gm/dl, white blood cells(WBC) > 3000/mm3, platelets > 100,000/mm3 ,creatinine clearance < 60 ml/min .Patients who received chemotherapy, radiotherapy or had prior history of malignancy were excluded from study. An approval of local ethics committee and an informed consent from all patients were obtained.
Neoadjuvant chemotherapy
All patients underwent routine laboratory and radiological work up for staging and assessment of performance status. Maximal TURBT was carried out for all patients followed by neoadjuvant chemotherapy within 1 week. Patients received carboplatin AUC on day 1 followed gemcitabine 1,000 mg/m2 on day 1 and 8 repeated every
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Late Radiation Morbidity Scoring Criteria were used to score toxicity according to The Radiation Therapy Oncology Group (RTOG)[8]. Toxicities were assessed in regular clinic visit every 2 weeks through treatment periodand monthly after ending of treatment
2-Outcome was evaluated at follow up cystoscopy and tumor site biopsy done after completion of all 6 cycles of radiotherapy .Response assessment according to response evaluation criteria in solid tumors (RECIST). Complete response (CR) was considered if complete regression of all evidence of tumors was achived while Partial response (PR)if there is an estimated decrease in tumors size of 50% or more. Stable disease (SD) was reporeted if less than 50%in tumor size or less than 25% of pretreatment tumor size was achievedwhile Progressive disease (PD) if there is more than 25% increase in pretreatment tumor size[9].
At today visit she is home alone. She is awake, alert and oriented. She states that she will be picked up by the bus to go to her radiation treatment. She reports that she continues to have neoplasm related pain in her shoulder and bladder. She describes
Wolchok does not name specific instruments used for measurements, discuss reliability in terms of type and size of reliability coefficients, or name specific control procedures. The success rates of the different types of treatments are determined by visible tumor growth difference after treatment is administered as well as overall survival. Wolchok also notes that measuring success among immunotherapy treatments can be difficult and take nearly double the time to see results than other treatment methods. Even in patients whose brain scans show tumor growth 12 weeks after the treatment has begun, the growth may be indicative of T cells and other immune cells flooding the tumor. Henceforth, the difficulty of determining success among patients being treated with immunotherapies is far more perplexing than patients who have undergone chemotherapy or
Though often effective, radiation therapy presents unique challenges with regard to early and late treatment toxicities, thought to develop as a response to vascular
The Median survival in Accelerated Phase was 18 months before imatinib. With imatinib, it is estimated to be more than 4 years.
Paradise Hills Medical Center’s radiation department, made a radiation overdose on 22 oncology patients. The error was attributed to a flaw in the radiation equipment
Follow up CT, MRI, or PET scans are employed to determine the size of the tumor, the extent of local invasion, and if distant metastasis has already occurred11. This is particularly important because, although all ATC cases are considered Stage IV cancers, the severity of metastasis dictates the course of treatment. Stage IVA cancers are limited to the thyroid and are often treated with surgical resection, if possible. This is followed by radiotherapy and chemotherapy9,11. For most patients, however, the cancer is unresectable. As such, clinicians typically shift their focus towards a combination of radiation therapy, chemotherapy, and palliative care to improve the quality of
The 3 patients with malignant GCT completed 4 courses of PEB chemotherapy. None of the patients had tumor recurrence. All the patients were alive during the last follow up. One patient who had residual disease was relieved of respiratory symptoms post surgery ans is under close follow up. Table 1 summarizes the management and outcomes of these patients with giant mediastinal GCTs.
Usually, radiation therapy is treated by neoadjuvant, adjuvant or definitive treatment with systemic therapy. Around 20% to 80 % of the patients with cancer received radiation therapy through the way of their treatment (de Gonzalez et al., 2011). In this treatment the radiation is usually given along with chemotherapy, which is recognized as chemoradiation or chemoradiotherapy. The Duke University conducts investigational study of neoadjuvant radiation therapy in 96 resectable patients. Everyday patients who received 50.4 Gy dose of radiotherapy are combined with 5-FU-based chemotherapy. After this patients were then surgically findout if there was no evidence of metastatic disease and less mortality. Overall survival (OS) and median survival was (28%:23 months) respectively (Spitz et al., 1997; White and Tyler, 2004). In 1980’s The Gastro-intestinal Tumor Study Group (GITSG) conducted randomized study in purpose of adjuvant chemoradiotherapy in resected pancreatic cancer. After R0 resection 49 patients were treated with chemorediotherapy for evaluation of adjuvant
For some people with bladder cancer, treatment can remove or destroy the cancer. Completing treatment can be exciting and stressful. When cancer comes back after treatment it is called recurrence. For other people, bladder cancer may never go away completely. They may get regular treatments including chemotherapy or radiation therapy. If you’ve completed treatment, your doctor will still want to monitor you closely. The doctor may want to do a series of exams at each visit. If cancer does come back, treatment will depend on the location of the cancer and what treatments you’ve had before. It may be surgery, radiation therapy, chemotherapy, or some combination of
respectively [1]. Treatment with imatinib mesylate (Gleevec; Novartis), a receptor tyrosine kinase inhibitor, is reportedly effective in patients with metastatic GIST [6,7], and adjuvant imatinib treatment prolongs both survival and the time to metastasis [8]. Estimation of the postoperative risk of metastasis becomes more important in the management
For patients with (m RCC), the prognosis is extremely poor, which makes the occurrence of (m RCC) a serious problem for oncologic health care around the world.
Radiation therapy can be used anywhere in the body to treat any kind of cancer. Depending on what type of radiation therapy, it can have some side effects. The most common ones include fatigue, hair loss near the treated area, and skin darkening in the area exposed to a beam of radiation. ("Radiation Therapy for Cancer,” 1) There are also safety concerns that patients have when they are treated with radiation therapy. Many people that receive radiation therapy treatment, worry about exposing family and love ones to radiation, as well as the side effects. Radiation effects on the normal tissues are divided into acute and chronic effects (Schreiber). Acute effects occur during the course of therapy and during the post therapy period (approximately 2-3 weeks after the completion of a course of irradiation) (Schreiber).
Patients with functional or anatomical bladder abnormalities often undergo surgical procedures to correct these abnormalities and assist them with urine elimination. These procedures are often followed by the creation of urinary diversions, which serve to re-route urine (Hinkle and Cheever, 2014). Urinary diversions can either be continent; whereby a portion of the intestine is used to create a new reservoir for urine, or incontinent; whereby urine is drained through a stoma created in the abdominal wall and collected in an external pouch. In patients with muscle-invasive bladder cancer, a cystectomy is the gold standard for treatment, followed by a urinary diversion such as an intestinal conduit, a continent cutaneous diversion or an orthoptic neobladder (Asgari et al, 2013; Merandy, 2016).
Breast cancer is very common among the women. Nowadays, the number of patient survive from breast cancer have increased due to the early detection. However, the treatments of the breast cancer become difficult in pregnant mother as it need to consider the life of foetus. The doctor must provide the best treatments to maximize the chances of mother and also foetus survival. Besides, any potential risk against the foetus such as morphological and functional defect must not be neglect. Adjuvant chemotherapy has been found to be an important role in surviving the women suffer from early stage of breast cancer but not pregnant mother with breast cancer. Delay and modification adjuvant chemotherapy may ensure the healthier infants birth and also
At one month assessment, 189 (37%) achieved a partial response and had ambulatory physical state suited for further curative-dose radiotherapy. The main acute toxicity of palliative radiotherapy was patchy oro-pharyngeal mucositis and dermatitis. Median overall survival was 200 days. One hundred fifty three patients who went on to receive further curative dose had significantly overall survival of 400