The RAPIDO trial tested a new experimental treatment for locally advanced rectal cancer that involved short-course radiotherapy followed by chemotherapy before surgery, compared to the standard treatment of long-course chemoradiotherapy followed by surgery and then chemotherapy. The results showed that the experimental treatment led to a lower rate of disease-related treatment failures and distant metastases, along with a doubled rate of pathologic complete responses, without increasing toxicities or compromising survival rates. This provides evidence that the experimental approach may be a new standard of care for high-risk locally advanced rectal cancer.
Total Nroadjuvant Therapy- Carcinoma RectumRohit Kabre
This document discusses management strategies for locally advanced rectal cancer. It summarizes that trimodality treatment with neoadjuvant chemoradiation and total mesorectal excision surgery is the standard of care, but has limitations including poor adjuvant chemotherapy compliance and high distant relapse rates. Newer approaches discussed include total neoadjuvant treatment without radiation, selective radiation sparing, non-operative management for patients with a clinical complete response, and the use of pathological and radiological tools to better assess tumor response to guide treatment. The document reviews evidence from ongoing clinical trials investigating these novel strategies.
1. SABR has emerged as an alternative to surgery for medically operable early-stage NSCLC based on case-control studies showing equivalence in outcomes.
2. Randomized trials are still needed to provide level 1 evidence of equivalence since residual differences remain between surgery and SABR cohorts in existing studies.
3. Ongoing trials such as STABLE-MATES, VALOR, and SABRTOOTH aim to address this evidence gap through randomized comparisons of SABR to surgery.
Gastroesophageal junction tumors present unique challenges due to their location between the esophagus and stomach. Siewert classification categorizes these tumors as type I, II, or III based on their epicenter location relative to the gastroesophageal junction. Type I and II tumors are typically treated with esophagectomy while type III tumors are treated with gastrectomy. Neoadjuvant chemotherapy or chemoradiation is commonly used to downstage locally advanced adenocarcinomas prior to surgery. Ongoing studies are evaluating the optimal multimodality treatment approaches for gastroesophageal junction tumors.
Radiation therapy is an important treatment for esophageal cancer. It can be used preoperatively to downstage tumors and improve resection rates, definitively for inoperable locally advanced cancers, or palliatively to relieve symptoms like difficulty swallowing. The document discusses optimal radiation targets, doses, and limits to nearby organs. Combined modality approaches using chemotherapy with radiation have significantly improved survival compared to radiation alone.
1. The document discusses treatment options and strategies for rectal cancer patients who achieve a clinical complete response after neoadjuvant chemoradiation therapy.
2. Key points discussed include patient selection criteria for active surveillance versus surgery, optimal timing of response assessment, and surveillance schedules for patients undergoing a watch-and-wait approach.
3. Studies presented showed that outcomes for complete responders managed non-operatively can be comparable to those having surgery, though local recurrence rates are higher with the non-operative approach. Strict patient selection and close surveillance are important.
SRS/SBRT experience at Maharaja Gandhi Cancer Hospital for the first 50 cases:
- SRS/SBRT uses precisely focused radiation beams to treat tumors with high doses in a single or few fractions while avoiding damage to surrounding tissue.
- Their experience includes cranial and extracranial tumors treated with SRS and SBRT such as brain metastases, meningiomas, pituitary tumors, and tumors in the liver, spine, and lymph nodes.
- Outcomes have been good with response seen on follow up imaging for various tumors including metabolic/structural resolution of treated lesions.
- The hospital is well equipped for SRS/SBRT with a dedicated machine, immobil
The RAPIDO trial tested a new experimental treatment for locally advanced rectal cancer that involved short-course radiotherapy followed by chemotherapy before surgery, compared to the standard treatment of long-course chemoradiotherapy followed by surgery and then chemotherapy. The results showed that the experimental treatment led to a lower rate of disease-related treatment failures and distant metastases, along with a doubled rate of pathologic complete responses, without increasing toxicities or compromising survival rates. This provides evidence that the experimental approach may be a new standard of care for high-risk locally advanced rectal cancer.
Total Nroadjuvant Therapy- Carcinoma RectumRohit Kabre
This document discusses management strategies for locally advanced rectal cancer. It summarizes that trimodality treatment with neoadjuvant chemoradiation and total mesorectal excision surgery is the standard of care, but has limitations including poor adjuvant chemotherapy compliance and high distant relapse rates. Newer approaches discussed include total neoadjuvant treatment without radiation, selective radiation sparing, non-operative management for patients with a clinical complete response, and the use of pathological and radiological tools to better assess tumor response to guide treatment. The document reviews evidence from ongoing clinical trials investigating these novel strategies.
1. SABR has emerged as an alternative to surgery for medically operable early-stage NSCLC based on case-control studies showing equivalence in outcomes.
2. Randomized trials are still needed to provide level 1 evidence of equivalence since residual differences remain between surgery and SABR cohorts in existing studies.
3. Ongoing trials such as STABLE-MATES, VALOR, and SABRTOOTH aim to address this evidence gap through randomized comparisons of SABR to surgery.
Gastroesophageal junction tumors present unique challenges due to their location between the esophagus and stomach. Siewert classification categorizes these tumors as type I, II, or III based on their epicenter location relative to the gastroesophageal junction. Type I and II tumors are typically treated with esophagectomy while type III tumors are treated with gastrectomy. Neoadjuvant chemotherapy or chemoradiation is commonly used to downstage locally advanced adenocarcinomas prior to surgery. Ongoing studies are evaluating the optimal multimodality treatment approaches for gastroesophageal junction tumors.
Radiation therapy is an important treatment for esophageal cancer. It can be used preoperatively to downstage tumors and improve resection rates, definitively for inoperable locally advanced cancers, or palliatively to relieve symptoms like difficulty swallowing. The document discusses optimal radiation targets, doses, and limits to nearby organs. Combined modality approaches using chemotherapy with radiation have significantly improved survival compared to radiation alone.
1. The document discusses treatment options and strategies for rectal cancer patients who achieve a clinical complete response after neoadjuvant chemoradiation therapy.
2. Key points discussed include patient selection criteria for active surveillance versus surgery, optimal timing of response assessment, and surveillance schedules for patients undergoing a watch-and-wait approach.
3. Studies presented showed that outcomes for complete responders managed non-operatively can be comparable to those having surgery, though local recurrence rates are higher with the non-operative approach. Strict patient selection and close surveillance are important.
SRS/SBRT experience at Maharaja Gandhi Cancer Hospital for the first 50 cases:
- SRS/SBRT uses precisely focused radiation beams to treat tumors with high doses in a single or few fractions while avoiding damage to surrounding tissue.
- Their experience includes cranial and extracranial tumors treated with SRS and SBRT such as brain metastases, meningiomas, pituitary tumors, and tumors in the liver, spine, and lymph nodes.
- Outcomes have been good with response seen on follow up imaging for various tumors including metabolic/structural resolution of treated lesions.
- The hospital is well equipped for SRS/SBRT with a dedicated machine, immobil
This document provides an overview of radical radiotherapy for prostate cancer. It discusses the aims of radiotherapy to maximize dose to the tumor while minimizing dose to surrounding organs. External beam radiotherapy techniques like IMRT precisely shape radiation doses. Image guidance ensures accurate dose delivery. Hypofractionated schedules may improve outcomes while shortening treatment time. Brachytherapy can deliver a highly conformal dose but is best for localized disease. Overall the document outlines the key stages and techniques used in radiotherapy planning and treatment to effectively treat prostate cancer while limiting side effects.
1) Adjuvant chemoradiation improves local control for locally advanced rectal cancer compared to surgery alone based on multiple trials from the 1980s and 1990s.
2) Recent European trials have found no clear benefit of adjuvant chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer, with the exception of the QUASAR trial.
3) Adjuvant chemotherapy may be recommended after preoperative chemoradiation for mid-low rectal cancers with lymph node involvement (ypT3N+) or high rectal cancers with stage ypT2-3 based on trial results and expert guidelines.
Preoperative versus postoperative chemoradiotherapy for rectal cancerIsha Jaiswal
This clinical trial compared preoperative chemoradiotherapy to postoperative chemoradiotherapy for locally advanced rectal cancer. Over 800 patients were randomized to receive either preoperative or postoperative chemoradiotherapy followed by surgery. Results found that preoperative chemoradiotherapy resulted in more curative resections, less positive lymph nodes, and fewer protocol violations compared to postoperative chemoradiotherapy. After a median follow up of 45 months, there was no significant difference in overall survival between the two groups. However, preoperative chemoradiotherapy resulted in improved local control and tumor downstaging compared to postoperative chemoradiotherapy.
Total neoadjuvant therapy for rectal cancer 2016Mohamed Abdulla
1) Total neoadjuvant therapy, consisting of chemotherapy followed by chemoradiation and surgery, may improve outcomes for rectal cancer over the traditional approach.
2) Ongoing clinical trials are investigating selective use of radiation and whether radiation can be omitted from some neoadjuvant regimens based on risk factors and response.
3) Near total neoadjuvant therapy with upfront chemotherapy alone may achieve pathologic complete responses in a third of patients and warrants further exploration as an alternative to traditional chemoradiation.
Surgery is the cornerstone treatment for rectal cancer. Total mesorectal excision (TME) surgery has improved outcomes by removing the rectum and surrounding tissues in one piece. Local excision may be adequate for early stage T1N0 tumors with low-risk features, otherwise radical TME surgery is recommended. Neoadjuvant chemoradiation improves outcomes for more advanced T3/T4 or node-positive cancers by downstaging tumors. Laparoscopic surgery outcomes are similar to open surgery.
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Artery first approach For Pancreatic Head tumours by Dr Harsh Shah (www.gastr...Dr Harsh Shah
Artery first approach to Pancreatic head tumour. There are various approaches as described in this presentation. Pros & Cons of all approaches are discussed.
The document discusses intrabeam intraoperative radiotherapy (IORT) for breast cancer. It summarizes the TARGIT-A clinical trial which found IORT using the INTRABEAM system to be non-inferior to whole breast external beam radiotherapy for selected early-stage breast cancer patients. The INTRABEAM system delivers a targeted single fraction of low-energy X-rays directly to the tumor bed during lumpectomy surgery, shortening treatment time compared to the standard 5-6 weeks of external beam radiotherapy. The technique aims to sterilize the tumor bed while sparing surrounding healthy tissue from radiation exposure.
This document discusses the anatomy and surgical treatment options for rectal cancer. It describes the rectum and anal canal anatomically. There are three main types of surgery for rectal cancer - abdominoperineal resection (APR) for lower tumors, which results in a permanent colostomy, low anterior resection (LAR) for upper tumors, which aims to preserve the anus, and total mesorectal excision (TME), the gold standard technique which completely removes the rectum and surrounding tissue. TME results in lower recurrence rates than other approaches. Neoadjuvant chemoradiation is often used in addition to surgery to improve local control and reduce distant metastasis.
1. Neoadjuvant chemoradiotherapy (CTRT) followed by total mesorectal excision (TME) surgery has become the standard of care for locally advanced rectal cancer based on improved local control and survival outcomes compared to surgery or radiotherapy (RT) alone.
2. The addition of chemotherapy to neoadjuvant RT improves pathological complete response rates and local control compared to RT alone, though it also increases toxicity.
3. For patients who achieve a clinical complete response after neoadjuvant CTRT, a non-operative "watch and wait" approach may be considered given comparable oncologic outcomes when salvage surgery is performed for recurrences.
Technical Advances in radiotherapy for Lung (and liver) Cancerspa718
This document summarizes recent technical advances in radiotherapy for lung and liver cancer, including: 4DCT imaging to account for tumor motion; motion management techniques like gating and breath-holding; intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) to improve dose conformity; image-guided radiation therapy (IGRT) to reduce margins and enable adaptations; and proton therapy which may further reduce normal tissue dose due to its physical properties, though proton techniques are still evolving to address motion and anatomical changes. The document outlines the benefits and challenges of each technique through examples and studies.
This document discusses brachytherapy for breast cancer, including indications and treatment modalities. It notes that brachytherapy allows higher doses to be delivered to smaller target volumes, shortening treatment time and reducing tumor repopulation. Prospective randomized trials show lumpectomy with radiation improves local control over lumpectomy alone. Accelerated partial breast irradiation (APBI) delivers radiation to a limited region after breast-conserving surgery in 4-5 days instead of 3-7 weeks for whole breast irradiation (WBI), improving quality of life. Patient selection criteria for APBI are discussed. Brachytherapy is the most conformal radiation option, minimizing dose to normal tissues. Boost radiation after WBI improves local control and cos
HIPEC, or hyperthermic intraperitoneal chemotherapy, is a treatment for advanced cancers that have spread to the peritoneum. It involves delivering heated chemotherapy directly into the peritoneal cavity during cytoreductive surgery to remove any visible tumors. HIPEC aims to treat any remaining microscopic disease. Heating the chemotherapy to 41-42°C allows it to penetrate deeper tissues and more effectively kill cancer cells compared to normal intraperitoneal or intravenous chemotherapy alone. While HIPEC is effective, it is also associated with increased risks of complications due to the combined effects of surgery, chemotherapy, and localized hyperthermia.
Radiation Treatment of Rectal and Colon Cancer :: July 2017 #CRCWebinarFight Colorectal Cancer
Michael Bassetti, MD, Ph.D. from the University of Wisconsin Carbone Cancer Center discusses all you need to know about radiation. Dr. Bassetti will talk about what radiation treatment is, how it’s used for rectal and colon cancer patients, how to prepare for treatment, how to manage side effects and more.
NEOADJUVANT THERAPY IN PANCREATIC CANCER.pptxSujan Shrestha
1) Several studies provide evidence supporting the use of neoadjuvant therapy for resectable pancreatic cancer. The PREOPANC-1 trial found no survival benefit for neoadjuvant chemoradiotherapy compared to upfront surgery in resectable pancreatic cancer. However, the Prep-02/JSAP-05 and PACT-15 trials found significantly improved survival with neoadjuvant chemotherapy compared to upfront surgery.
2) Guidelines such as ESMO and NCCN provide classifications for resectability and recommend considering neoadjuvant therapy for resectable pancreatic cancer with certain high-risk features or comorbidities.
3) Potential advantages of neoadjuvant therapy include managing micro
This document summarizes key landmark clinical trials in breast cancer. It discusses trials related to prevention using tamoxifen and raloxifene, radiation therapy trials for DCIS and early stage breast cancer, breast-conserving therapy including accelerated whole-breast irradiation, neoadjuvant chemotherapy trials, and HER2 targeted neoadjuvant therapy trials. The trials demonstrated the effectiveness of tamoxifen and radiation therapy in breast cancer prevention and treatment, and showed that hypofractionated radiation regimens and partial breast irradiation are not inferior to standard radiation protocols. Neoadjuvant chemotherapy was found to increase breast-conserving surgery rates and pathologic complete response rates. Dual HER2 blockade neoadjuvant regim
This document discusses motion management techniques for lung cancer radiotherapy. It begins by explaining why motion management is important, as standard CT scans do not fully capture lung tumor motion. It then describes 4DCT and other methods for assessing tumor motion, as well as techniques like ITV, gating, tracking and breath-holding to control for motion. Specific examples of tracking systems like ExacTrac and Cyberknife are provided. Overall, the document provides an overview of the challenges of lung tumor motion and different strategies used to manage it in radiation treatment planning and delivery.
This document discusses locally advanced rectal cancer and options for individualizing treatment. It begins with an overview of anatomy, staging, evaluation, and current management strategies such as neoadjuvant chemoradiation therapy followed by surgery and adjuvant therapy. Prognostic factors and future directions including total neoadjuvant therapy and non-operative ("watch and wait") approaches are also mentioned. Clinical trials have shown that preoperative chemoradiation reduces local recurrence rates compared to postoperative chemoradiation or surgery alone.
This document summarizes adjuvant chemotherapy for breast cancer. It discusses the rationale for adjuvant chemotherapy based on the Fisher hypothesis that breast cancer is a systemic disease at diagnosis. Evidence from large meta-analyses shows that adjuvant chemotherapy improves outcomes compared to no treatment or CMF chemotherapy alone. The addition of anthracyclines or taxanes to chemotherapy regimens provides further benefits. Molecular profiling tools can help select patients who will most benefit from chemotherapy based on tumor biology. Guidelines recommend chemotherapy for higher risk patient subgroups based on tumor characteristics and gene expression profiles.
This document discusses treatment approaches for locally advanced non-small cell lung cancer (NSCLC). It presents a case of stage IIIB NSCLC and reviews the history and evolution of combined modality therapy using chemotherapy and radiotherapy. Concurrent chemoradiotherapy is now the standard of care and research focuses on optimizing radiotherapy dose/fractionation and integrating targeted therapies and prophylactic cranial irradiation to further improve outcomes.
Caturelli E. Fegato Patologia Focale Maligna. ASMaD 2016Gianfranco Tammaro
DOTT. CATURELLI EUGENIO - Master ECM in Ecografia Internistica 2016 - Sabato 16 - 30 Gennaio e 13 Febbraio 2016 - Sala Congressi Fondazione Santa Lucia - Via Ardeatina n. 354 - ROMA
Sito ASMaD: http://www.asmad.net
This document provides an overview of radical radiotherapy for prostate cancer. It discusses the aims of radiotherapy to maximize dose to the tumor while minimizing dose to surrounding organs. External beam radiotherapy techniques like IMRT precisely shape radiation doses. Image guidance ensures accurate dose delivery. Hypofractionated schedules may improve outcomes while shortening treatment time. Brachytherapy can deliver a highly conformal dose but is best for localized disease. Overall the document outlines the key stages and techniques used in radiotherapy planning and treatment to effectively treat prostate cancer while limiting side effects.
1) Adjuvant chemoradiation improves local control for locally advanced rectal cancer compared to surgery alone based on multiple trials from the 1980s and 1990s.
2) Recent European trials have found no clear benefit of adjuvant chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer, with the exception of the QUASAR trial.
3) Adjuvant chemotherapy may be recommended after preoperative chemoradiation for mid-low rectal cancers with lymph node involvement (ypT3N+) or high rectal cancers with stage ypT2-3 based on trial results and expert guidelines.
Preoperative versus postoperative chemoradiotherapy for rectal cancerIsha Jaiswal
This clinical trial compared preoperative chemoradiotherapy to postoperative chemoradiotherapy for locally advanced rectal cancer. Over 800 patients were randomized to receive either preoperative or postoperative chemoradiotherapy followed by surgery. Results found that preoperative chemoradiotherapy resulted in more curative resections, less positive lymph nodes, and fewer protocol violations compared to postoperative chemoradiotherapy. After a median follow up of 45 months, there was no significant difference in overall survival between the two groups. However, preoperative chemoradiotherapy resulted in improved local control and tumor downstaging compared to postoperative chemoradiotherapy.
Total neoadjuvant therapy for rectal cancer 2016Mohamed Abdulla
1) Total neoadjuvant therapy, consisting of chemotherapy followed by chemoradiation and surgery, may improve outcomes for rectal cancer over the traditional approach.
2) Ongoing clinical trials are investigating selective use of radiation and whether radiation can be omitted from some neoadjuvant regimens based on risk factors and response.
3) Near total neoadjuvant therapy with upfront chemotherapy alone may achieve pathologic complete responses in a third of patients and warrants further exploration as an alternative to traditional chemoradiation.
Surgery is the cornerstone treatment for rectal cancer. Total mesorectal excision (TME) surgery has improved outcomes by removing the rectum and surrounding tissues in one piece. Local excision may be adequate for early stage T1N0 tumors with low-risk features, otherwise radical TME surgery is recommended. Neoadjuvant chemoradiation improves outcomes for more advanced T3/T4 or node-positive cancers by downstaging tumors. Laparoscopic surgery outcomes are similar to open surgery.
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Artery first approach For Pancreatic Head tumours by Dr Harsh Shah (www.gastr...Dr Harsh Shah
Artery first approach to Pancreatic head tumour. There are various approaches as described in this presentation. Pros & Cons of all approaches are discussed.
The document discusses intrabeam intraoperative radiotherapy (IORT) for breast cancer. It summarizes the TARGIT-A clinical trial which found IORT using the INTRABEAM system to be non-inferior to whole breast external beam radiotherapy for selected early-stage breast cancer patients. The INTRABEAM system delivers a targeted single fraction of low-energy X-rays directly to the tumor bed during lumpectomy surgery, shortening treatment time compared to the standard 5-6 weeks of external beam radiotherapy. The technique aims to sterilize the tumor bed while sparing surrounding healthy tissue from radiation exposure.
This document discusses the anatomy and surgical treatment options for rectal cancer. It describes the rectum and anal canal anatomically. There are three main types of surgery for rectal cancer - abdominoperineal resection (APR) for lower tumors, which results in a permanent colostomy, low anterior resection (LAR) for upper tumors, which aims to preserve the anus, and total mesorectal excision (TME), the gold standard technique which completely removes the rectum and surrounding tissue. TME results in lower recurrence rates than other approaches. Neoadjuvant chemoradiation is often used in addition to surgery to improve local control and reduce distant metastasis.
1. Neoadjuvant chemoradiotherapy (CTRT) followed by total mesorectal excision (TME) surgery has become the standard of care for locally advanced rectal cancer based on improved local control and survival outcomes compared to surgery or radiotherapy (RT) alone.
2. The addition of chemotherapy to neoadjuvant RT improves pathological complete response rates and local control compared to RT alone, though it also increases toxicity.
3. For patients who achieve a clinical complete response after neoadjuvant CTRT, a non-operative "watch and wait" approach may be considered given comparable oncologic outcomes when salvage surgery is performed for recurrences.
Technical Advances in radiotherapy for Lung (and liver) Cancerspa718
This document summarizes recent technical advances in radiotherapy for lung and liver cancer, including: 4DCT imaging to account for tumor motion; motion management techniques like gating and breath-holding; intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) to improve dose conformity; image-guided radiation therapy (IGRT) to reduce margins and enable adaptations; and proton therapy which may further reduce normal tissue dose due to its physical properties, though proton techniques are still evolving to address motion and anatomical changes. The document outlines the benefits and challenges of each technique through examples and studies.
This document discusses brachytherapy for breast cancer, including indications and treatment modalities. It notes that brachytherapy allows higher doses to be delivered to smaller target volumes, shortening treatment time and reducing tumor repopulation. Prospective randomized trials show lumpectomy with radiation improves local control over lumpectomy alone. Accelerated partial breast irradiation (APBI) delivers radiation to a limited region after breast-conserving surgery in 4-5 days instead of 3-7 weeks for whole breast irradiation (WBI), improving quality of life. Patient selection criteria for APBI are discussed. Brachytherapy is the most conformal radiation option, minimizing dose to normal tissues. Boost radiation after WBI improves local control and cos
HIPEC, or hyperthermic intraperitoneal chemotherapy, is a treatment for advanced cancers that have spread to the peritoneum. It involves delivering heated chemotherapy directly into the peritoneal cavity during cytoreductive surgery to remove any visible tumors. HIPEC aims to treat any remaining microscopic disease. Heating the chemotherapy to 41-42°C allows it to penetrate deeper tissues and more effectively kill cancer cells compared to normal intraperitoneal or intravenous chemotherapy alone. While HIPEC is effective, it is also associated with increased risks of complications due to the combined effects of surgery, chemotherapy, and localized hyperthermia.
Radiation Treatment of Rectal and Colon Cancer :: July 2017 #CRCWebinarFight Colorectal Cancer
Michael Bassetti, MD, Ph.D. from the University of Wisconsin Carbone Cancer Center discusses all you need to know about radiation. Dr. Bassetti will talk about what radiation treatment is, how it’s used for rectal and colon cancer patients, how to prepare for treatment, how to manage side effects and more.
NEOADJUVANT THERAPY IN PANCREATIC CANCER.pptxSujan Shrestha
1) Several studies provide evidence supporting the use of neoadjuvant therapy for resectable pancreatic cancer. The PREOPANC-1 trial found no survival benefit for neoadjuvant chemoradiotherapy compared to upfront surgery in resectable pancreatic cancer. However, the Prep-02/JSAP-05 and PACT-15 trials found significantly improved survival with neoadjuvant chemotherapy compared to upfront surgery.
2) Guidelines such as ESMO and NCCN provide classifications for resectability and recommend considering neoadjuvant therapy for resectable pancreatic cancer with certain high-risk features or comorbidities.
3) Potential advantages of neoadjuvant therapy include managing micro
This document summarizes key landmark clinical trials in breast cancer. It discusses trials related to prevention using tamoxifen and raloxifene, radiation therapy trials for DCIS and early stage breast cancer, breast-conserving therapy including accelerated whole-breast irradiation, neoadjuvant chemotherapy trials, and HER2 targeted neoadjuvant therapy trials. The trials demonstrated the effectiveness of tamoxifen and radiation therapy in breast cancer prevention and treatment, and showed that hypofractionated radiation regimens and partial breast irradiation are not inferior to standard radiation protocols. Neoadjuvant chemotherapy was found to increase breast-conserving surgery rates and pathologic complete response rates. Dual HER2 blockade neoadjuvant regim
This document discusses motion management techniques for lung cancer radiotherapy. It begins by explaining why motion management is important, as standard CT scans do not fully capture lung tumor motion. It then describes 4DCT and other methods for assessing tumor motion, as well as techniques like ITV, gating, tracking and breath-holding to control for motion. Specific examples of tracking systems like ExacTrac and Cyberknife are provided. Overall, the document provides an overview of the challenges of lung tumor motion and different strategies used to manage it in radiation treatment planning and delivery.
This document discusses locally advanced rectal cancer and options for individualizing treatment. It begins with an overview of anatomy, staging, evaluation, and current management strategies such as neoadjuvant chemoradiation therapy followed by surgery and adjuvant therapy. Prognostic factors and future directions including total neoadjuvant therapy and non-operative ("watch and wait") approaches are also mentioned. Clinical trials have shown that preoperative chemoradiation reduces local recurrence rates compared to postoperative chemoradiation or surgery alone.
This document summarizes adjuvant chemotherapy for breast cancer. It discusses the rationale for adjuvant chemotherapy based on the Fisher hypothesis that breast cancer is a systemic disease at diagnosis. Evidence from large meta-analyses shows that adjuvant chemotherapy improves outcomes compared to no treatment or CMF chemotherapy alone. The addition of anthracyclines or taxanes to chemotherapy regimens provides further benefits. Molecular profiling tools can help select patients who will most benefit from chemotherapy based on tumor biology. Guidelines recommend chemotherapy for higher risk patient subgroups based on tumor characteristics and gene expression profiles.
This document discusses treatment approaches for locally advanced non-small cell lung cancer (NSCLC). It presents a case of stage IIIB NSCLC and reviews the history and evolution of combined modality therapy using chemotherapy and radiotherapy. Concurrent chemoradiotherapy is now the standard of care and research focuses on optimizing radiotherapy dose/fractionation and integrating targeted therapies and prophylactic cranial irradiation to further improve outcomes.
Caturelli E. Fegato Patologia Focale Maligna. ASMaD 2016Gianfranco Tammaro
DOTT. CATURELLI EUGENIO - Master ECM in Ecografia Internistica 2016 - Sabato 16 - 30 Gennaio e 13 Febbraio 2016 - Sala Congressi Fondazione Santa Lucia - Via Ardeatina n. 354 - ROMA
Sito ASMaD: http://www.asmad.net
Tiroide: chi decide quale intervento e per chi?ASMaD
Presentazione a cura del Dottor Bellotti Carlo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
Presa in carico del paziente con LMC e gestione della terapia a medio e lungo...ASMaD
This document discusses cardiovascular risk management from the perspective of a vascular surgeon. It summarizes the author's experience treating patients with chronic myeloid leukemia who developed vascular complications. The main points are:
1) Patients with chronic myeloid leukemia often have multi-level vascular disease involving the carotid, renal, mesenteric, and lower extremity arteries.
2) Endovascular interventions had high restenosis and failure rates, while open surgeries resulted in better mid-term patency but higher amputation rates.
3) An aggressive surgical approach along with intensive medical management and follow-up is needed for these high-risk patients due to their underlying disease and risk factors. A multidisciplinary team approach
I meccanismi del danno gastrico e la patologia H. Pylori correlataASMaD
Presentazione a cura del Dottor Vincenzo De Francesco - "Malattia da reflussogastroesofageo e infezione da Helicobacter Pylori: old topics?" - Roma 11/05/2019
Ph impedenziometria nella MRGE: quando, come e perchèASMaD
Presentazione a cura della Dottoressa Francesca Galeazzi - "Malattia da reflussogastroesofageo e infezione da Helicobacter Pylori: old topics?" - Roma 11/05/2019
This document discusses the classification of gastroesophageal reflux disease (GERD) and challenges in classifying patients. It notes that while some patients with typical GERD symptoms respond to treatment, they remain unclassified and may not actually have GERD. A single classification system based on symptoms and endoscopy does not capture all clinical conditions related to GERD. Patients who do not respond to PPIs should be referred to a gastroenterologist. Some GERD patients have significant esophageal motility issues. Those who do not respond to PPIs may require an esophageal biopsy. Some PPI responders actually have eosinophilic esophagitis. Some GERD patients have multiple gastrointestinal comor
Cambiamenti di popolazione e flussi migratori: cambiano anche le malattie met...ASMaD
Presentazione a cura della Dottoressa Migneco Maria Giuseppina - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
Tiroide: Integrazione tra elementi nutriacetici e farmacologia: utile o inutile?ASMaD
Presentazione a cura del Dottor Roberto Cesareo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
L'ecografia tiroidea: strumento cruciale nella gestione clinica?ASMaD
Presentazione a cura del Dottor Guglielmi Rinaldo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
Il chirurgo e la tiroide oggi un rapporto in crisi?ASMaD
Presentazione a cura del Dottor Luca Piantoni e del Dottor Francesco Pedicini - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
Presentazione a cura della Dottoressa Rosella Pasqualoni e del dottor Gregorio Reda - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
1. EUGENIO CATURELLIEUGENIO CATURELLI
Unità Operativa di GastroenterologiaUnità Operativa di Gastroenterologia
Ospedale “Belcolle” VITERBOOspedale “Belcolle” VITERBO
L’ECOGRAFIA OPERATIVAL’ECOGRAFIA OPERATIVA
2. ECOGRAFIA OPERATIVA
• DIAGNOSTICA
- biopsie e prelievi di materiali biologici
• TERAPEUTICA
- terapie ablative percutanee
- drenaggi di ascessi e raccolte
- trattamento delle cisti idatidee
3. BIOPSIA ECOGUIDATA
Lesioni benigne
• La diagnosi delle lesioni verosimilmente
benigne è quasi sempre posta mediante le
metodiche di immagine
• La biopsia viene eseguita nei casi dubbi
• La diagnosi differenziale tra adenoma
epatico e FNH non è basata sul prelievo
istologico
4. • La diagnosi di epatocarcinoma (HCC) si
ottiene nella gran parte dei casi con le
metodiche di immagine (TC, RM, CEUS)
• La biopsia viene eseguita nei casi dubbi
• La diagnosi di altre neoplasie (epatiche
secondarie, pancreatiche, spleniche,
linfonodali, ecc.) si avvale invece ancora
fondamentalmente della biopsia ecoguidata
BIOPSIA ECOGUIDATA
Lesioni maligne
5. BIOPSIA ECOGUIDATA SU LESIONI ADDOMINALI MALIGNE
neoplasia corpo pancreas linfoma ileale
linfoma splenico linfonodi addominali
6. METASTASI EPATICHE
INDICAZIONI DELLA BIOPSIA ECOGUIDATA
NEOPLASIA PRIMITIVA SCONOSCIUTA
DUBBIO CHE LA NEOPLASIA PRIMITIVA SIA
DIVERSA DA QUELLA NOTA
PAZIENTI CON DOPPIA NEOPLASIA
RICERCHE BIOMOLECOLARI E RECETTORIALI PER
INDIRIZZARE LA CHEMIOTERAPIA
MOLTI CENTRI ONCOLOGICI NON RITENGONO
GIUSTIFICATO UN TRATTAMENTO SENZA UNA
CONFERMA BIOPTICA DELLE METASTASI
LA BIOPSIA È GRAVATA DA SCARSE COMPLICANZE
ED HA UN’ELEVATA ACCURATEZZA DIAGNOSTICA
7. BIOPSIA ECOGUIDATA - TECNICA
• Uno o due operatori?
• Dispositivo di guida o tecnica “a mano
libera”?
• Prelievo citologico o istologico?
OGNUNO USA LA TECNICA
CHE GLI È PIÚ FAMILIARE
ISTOLOGICO!
11. 2012
Heimbach et al. Hepatology 2018; 67:358-380. AASLD guidelines for the treatment of HCC
12. • La scelta tra resezione e RFTA deve essere ritagliata sul singolo paziente
• La RFTA è preferibile nei pazienti con ipertensione portale severa e nei
tumori centroepatici
• La resezione è preferibile nei pazienti senza ipertensione portale, nei
tumori periferici e nei casi in cui la RFTA sia rischiosa o
presumibilmente poco efficace
• Nei pazienti cirrotici in classe A
di Child e nodulo di HCC singolo
< 3 cm, resezione e RFTA sono i
trattamenti di prima scelta
• Entrambe le terapie consentono
sopravvivenze a lungo termine e
tassi di recidiva neoplastica simili
ed eccellenti
13. EFFICACIA SUI NODULI NEOPLASTICI
ASSENZA DI DANNI SUL TESSUTO NON-
NEOPLASTICO CIRCOSTANTE
BASSO TASSO DI COMPLICAZIONI
SEMPLICITÀ E RIPETIBILITÀ (i pazienti
presentano spesso recidiva della malattia)
BASSI COSTI (se confrontati con le terapie
angiografiche e chirurgiche)
POSSIBILE SINERGIA CON ALTRE TERAPIE
RAZIONALE DELLE TERAPIE ABLATIVE
19. CONFRONTO TRA RF E MW
J Vasc Interv Radiol. 2016 May;27(5):631-8. doi:
10.1016/j.jvir.2016.01.136. Epub 2016 Mar 24.
Microwave versus Radiofrequency Ablation
Treatment for Hepatocellular Carcinoma: A
Comparison of Efficacy at a Single Center.
Potretzke TA1
, Ziemlewicz TJ2
, Hinshaw JL1
, Lubner
MG1
, Wells SA1
, Brace CL3
, Agarwal P4
, Lee FT Jr5
.
Abdom Imaging. 2015 Aug;40(6):1829-37. doi:
10.1007/s00261-015-0355-6.
Ablation therapy of hepatocellular carcinoma: a
comparative study between radiofrequency and
microwave ablation.
Vogl TJ1
, Farshid P, Naguib NN, Zangos S, Bodelle B,
Paul J, Mbalisike EC, Beeres M, Nour-Eldin NE.
J Vasc Interv Radiol. 2015 Mar;26(3):330-41. doi:
10.1016/j.jvir.2014.10.047. Epub 2014 Dec 18.
Comparison of combination therapies in the
management of hepatocellular carcinoma:
transarterial chemoembolization with
radiofrequency ablation versus microwave
ablation.
Ginsburg M1
, Zivin SP2
, Wroblewski K3
, Doshi T3
,
Vasnani RJ3
, Van Ha TG3
.
PLoS One. 2013 Oct 17;8(10):e76119. doi:
10.1371/journal.pone.0076119. eCollection 2013.
Therapeutic efficacy of percutaneous
radiofrequency ablation versus microwave
ablation for hepatocellular carcinoma.
Zhang L1
, Wang N, Shen Q, Cheng W, Qian GJ.
Nessuna differenza tra RF e MW per l’ottenimento di
necrosi completa, per la persistenza di malattia dopo la
prima ablazione, per il tasso di recidiva locale, per la
sopravvivenza complessiva
< 50 mm < 20 mm
< 25 mm
20. • Temperature tissutali maggiori
(>150°C)
• Tempo di ablazione più breve
• Riscaldamento del tessuto
indipendente dalla conduttività
termica tissutale
• Rapido riscaldamento tissutale che
riduce il problema della dispersione
di calore, permettendo di trattare
lesioni poste vicino ai vasi
• Maggiore fragilità dell’estremità
dell’antenna
• Costi più elevati
• Maggiore potenza (potenziale
maggiore danno vascolare)
• Tecnologia in evoluzione
• Minore esperienza
VANTAGGI E SVANTAGGI DELLE MW RISPETTO ALLA RF
MW - VANTAGGI MW - SVANTAGGI
21. La tecnica ablativa attualmente più diffusa è la RF:
• più dati clinici disponibili
• più facile da usare / più riproducibile
• migliore marketing
Negli ultimi 2 anni i notevoli sviluppi tecnologici
riguardanti l’ablazione mediante MW lasciano
intravedere un superamento della RF nel prossimo
futuro
22. Limiti della termoablazione dell’HCCLimiti della termoablazione dell’HCC
Rischio di complicazioni: lesioni sottocapsulari, o
adiacenti ai dotti biliari principali o alle anse
intestinali, o difficili da raggiungere
Rischio di insuccesso: lesioni > 3 cm; lesioni poste
vicino ai grossi vasi (dispersione del calore);
lesioni infiltranti
Circa il 10-25% dei noduli singoli di HCC non possonoCirca il 10-25% dei noduli singoli di HCC non possono
essere trattati mediante la RFessere trattati mediante la RF
23. I noduli satelliti sono di solito localizzati in prossimità
della lesione principale (entro 5 mm dal margine)
È così essenziale ottenere un volume di necrosi
significativamente più esteso del nodulo originale
Il punto cruciale: la necrosi completa e il margine di
sicurezza libero da neoplasia
27. Perché le terapie ablative percutanee per
l’HCC possono trovare maggiore spazio?
• La chirurgia (OLT/resezione) può essere
offerta a una minoranza di pazienti cirrotici
con HCC (5-25%)
• Esiste un altissimo tasso di recidiva dell’HCC
dopo resezione (70-100% a 5 anni)
…e lo stesso vale per le metastasi epatiche
28. • Alcool etilico sterile
• Aghi sottili (21 G) spinali o dedicati
• Più sedute o un’unica seduta, a seconda
della tolleranza del paziente
• Quantità di alcool da iniettare
corrispondente al volume del nodulo
• Anestesia locale
• Fattibilità in pazienti ambulatoriali
ALCOLIZZAZIONE PERCUTANEA ECOGUIDATA
(Percutaneous Ethanol Injection – PEI)
CARATTERISTICHE
ei
d
d
30. Lesioni non trattabili con RF a causa del rischio di
complicazioni o di insuccesso
Pazienti con severa coagulopatia (gli aghi usati per
la PEI sono più sottili e meno traumatici)
Rifinitura della necrosi di lesioni trattate
parzialmente con altre metodiche
Trattamento-ponte in attesa di trapianto epatico
Rischio di insuccesso: lesioni > 2 cm; lesioni non capsulate
o infiltranti; imprevedibilità della perfusione della lesione
ALCOLIZZAZIONE PERCUTANEA ECOGUIDATA
INDICAZIONI
31. Fattori che riducono l’efficacia della PEI su HCC
Persistenza periferica Setti intra-lesionali
Noduli satellitiInvasione extracapsulare
32. TERAPIA “PERSONALIZZATA” DELL’HCC
L’ESTREMA ETEROGENEITÀ NELLA
PRESENTAZIONE DELL’HCC IN CIRROSI
PONE IL MEDICO DI FRONTE A NUMEROSE
OPZIONI TERAPEUTICHE
SOLO LA COLLABORAZIONE TRA I VARI
SPECIALISTI (INTERNISTA, CHIRURGO,
RADIOLOGO INTERVENTISTA) PUÒ
INDIRIZZARE VERSO L’APPROCCIO
TERAPEUTICO (EVENTUALMENTE
MULTIMODALE) PIÚ ADEGUATO PER IL
SINGOLO PAZIENTE
33. È considerato attualmente il trattamento di prima
scelta
Consente non solo di eliminare la raccolta purulenta,
ma anche di ottenere materiale per l’esame
colturale
Deve essere sempre accompagnato da una congrua
terapia antibiotica
Può essere rimosso circa 48 ore dopo che la portata si
è esaurita
DRENAGGIO PERCUTANEO ECOGUIDATO
DEGLI ASCESSI EPATICI
39. È considerato attualmente una valida alternativa
all’intervento chirurgico (e secondo molti
costituisce il trattamento di prima scelta)
Le cisti idatidee devono essere sempre trattate
quando sono vitali, in quanto possono diffondersi
o andare incontro a complicazioni (infezione,
rottura con shock anafilattico)
TRATTAMENTO PERCUTANEO ECOGUIDATO
DELLE CISTI IDATIDEE
La parte vitale di una cisti idatidea è quella a contenuto liquido
41. • Puntura con ago sottile
• Aspirazione del liquido
idatideo
• Iniezione di alcool etilico
95% sterile (volume
equivalente a quello del
liquido idatideo aspirato)
• Ri-aspirazione dell’alcool
dopo circa 20 minuti
ALCOLIZZAZIONE ECOGUIDATA DELLE CISTI
IDATIDEE
(Puncture, Aspiration, Injection, Re-aspiration – PAIR)
47. • Puntura con ago sottile
• Aspirazione del liquido idatideo
• Iniezione di alcool etilico 95% sterile (volume
equivalente a quello del liquido idatideo aspirato)
• L’alcool non viene ri-aspirato, ma lasciato in situ
• La procedura viene ripetuta dopo 3-7 giorni
(D-PAI - Double PAI)
ALCOLIZZAZIONE ECOGUIDATA DELLE CISTI
IDATIDEE
(Puncture, Aspiration, Injection – PAI)