Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
The Trial Assigning IndividuaLized Options for Treatment (Rx) -TAILORx,TAILORx clinical trial showed that most women with hormone receptor (HR)–positive, HER2-negative, axillary node–negative early-stage breast cancer and a mid-range score on a 21-tumor gene expression assay (Oncotype DX® Breast Recurrence Score) do not need chemotherapy after surgery
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
The Trial Assigning IndividuaLized Options for Treatment (Rx) -TAILORx,TAILORx clinical trial showed that most women with hormone receptor (HR)–positive, HER2-negative, axillary node–negative early-stage breast cancer and a mid-range score on a 21-tumor gene expression assay (Oncotype DX® Breast Recurrence Score) do not need chemotherapy after surgery
Cette présentation faite le 27 Avril 2017 à l'Hôpital Saint Joseph organisée par le Dr Vincent de Parades fait le point sur les nouvelles approches multidisciplinaires dans la prise en charge des cancers colorectaux en insistant sur la prise en charge de la maladie métastatique hépatique et de la carcinome péritonéale pour terminer sur les nouvelles approches par immunothérapie. Cette EPU a connu un large succès d'audience avec plus de 60 participants. Merci à toutes et tous.
Gastrointestinal stromal tumor, also called GIST is the most common mesenchymal tumor of GI tract. Over the years, the management of these tumors have evolved. This ppt shows the importance of mutation testing, wild type GIST, Newer drugs like avapritinib and ripretinib etc. Along with that it also shows Indian perspective and need of dedicated GIST clinics in India
Describes the emerging resistance of epithelial cancer of the ovary to current therapies and the role of PARP inhibitors in the management in view of the recent drug approvals.
Management of MSI High Solid Tumors and the impact of adding Immunotherapy upon improving survival outcome and response rate. Colorectal and Non Colorectal tumors.
Prostate cancer the androgenic fortified dogmaMohamed Abdulla
It describes the androgenic nature of prostate cancer and the androgenic axis should be tackled in all phases of prostate cancer. Also a special emphasis on recent data on management of metastatic hormone sensitive prostate cancer.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Liver limited Metastatic Colorectal Cancer. Case Presentation
1. Liver Limited mCRC
“Real Life Problems & Solutions”
Mohamed Abdulla M.D.
Prof. of Clinical Oncology
Cairo University
NEMROCK 20TH Annual Meeting
Ritz Carlton Hotel – Cairo
29/03/2017
2. Member of Advisory Board, Consultant, and Speaker for:
• Amgen, Astellas, AstraZeneca, Hoffman la Roche, Janssen Cilag,
Merck Serono, Novartis, Pfizer, Mundipharma, MSD, Eli Lilly.
• The content of this presentation does not relate to any product of a
commercial interest
Speaker Disclosures:
3. Colon Cancer:
Basic Facts & Figures:
• 2nd & 3rd most common cancers in females and males.
• 9% of cancer related deaths.
• 90% occurring around the age of 40 – 50 years.
• OAS for entire patients = 65%.
• Metastatic disease: 5-year OAS = 10%.
• Organ limited metastatic disease (Metastatectomy):
5-year OAS > 40%
• Median survival of metastatic disease > 35 months.
• Improved OAS with exposure to all available drugs
guided by predictive markers to improve outcome
through drug sequencing.
• Unified global treatment algorhytm is still controversial.
5. mCRC with LLD: Key Players
Systemic
Therapies Alone
Cures 1 – 2%
of Patients
Surgery
Alone
Cures > 30%
of Patients
Don’t Miss Surgical Intervention
The Race Toward More Responses
6. Results of Hepatic Resection for Patients
with mCRC:
Survival (%)
Author (year) No. Patients Mortality,% Median Survival 1-year 5-year
Hughes et al (86) 607 --- --- --- 33
Gayowski et al (94) 204 0 33 mo 91 32
Scheele et al (95) 469 4 40 mo 83 39
Fong et al (95) 577 4 40 mo 85 35
Jamison et al (97) 280 4 33 mo 84 27
Fong et al (99)
Choti et al (02)
Pawlik et al (05)
1001
226
557
3
1
1
42 mo
46 mo
74 mo
---
96
97
36
40
58
Hughes KS, et al. Surgery. 1986;100(2):278-284. Gayowski TJ, et al. Surgery. 1994;116(4):703-710. Scheele J, et al. World J Surg. 1995;19(1):59-71. Fong Y, et
al. Ann Surg. 1995;222(4):426-434.; Jamison RL, et al. Arch Surg. 1997;132:505–510. Fong Y, et al. Ann Surg 1999;230:309-318; Choti MA, et al. Ann Surg.
2002;235(6):759-766; Pawlik TM, et al. Ann Surg. 2005;241(5):715-722.
16. ~30% of patients
Sidedness
~70% of patients
Median OS
>38 months!
• Over 10 months more than bev + CT
(FIRE-3)
• 7 months more than bev + CT (CALGB
80405)
• 7 month more than CT (crystal)
Bad prognosis
regardless of
therapy
Small sample size ,
premature data
LEFT RIGHT
17.
18. Personal History
• Mrs. MAN 34 years old Female
• Married with 2 children
• No special Habits of Medical History
• No Past history of Medical Importance
• Family History:
– Grandmother: Colon Cancer
– Aunt: Breast Cancer
19. Initial Presentation
• Right Hypochondria pain of 3 months duration
(intermittent, dull aching)
• Associated Change in Bowel Habits (Diarrhea)
• No other System symptoms
• Sought medical advice with her family doctor,
received medical treatment with no improvement
of the symptoms
• Abdominal U/S: Hepatomegaly with hepatic
focal lesion.
20. Baseline Multi-slice CT of Abdomen & Pelvis
+ Panel of Tumor Markers
• Liver is enlarged in size & shows a large hypodense mass with
lobular margin measuring 15.7 x 13.8 x 12.5 cm seen within right
lobe of liver.
– The mass shows heterogeneous enhancement with peripheral to
central filling seen in delayed scan taken up to 20 minutes suggest
possibility of benign mass possibly hemangioma.
• The rest of the study is unremarkable.
CA 19-9 452
CEA 143.7
AFP 2.44
CA 125 24.37
21. Baseline MRI Abdomen & Pelvis
• Large heterogeneous soft tissue signal intensity lesion noted in the
right liver lobe
– Mainly segment VI and VII
– Measuring 11 x 11.1 x 14.2 cm
– Low signal intensity on T1 and relatively heterogeneous high signal
intensity at T2 weighted images with central necrosis
– Compressing the right portal vein and causing expansion of the
inferior liver capsule indenting the upper pole of the right kidney.
• Post contrast images showed early capsular enhancement with
heterogeneous enhancement on delayed images.
• Multiple adjacent peripheral satellite nodules.
22. Whole body PET/CT
Review of PET, CT and fused images
• Metabolically active FDG avid circumferential mural thickening of
the splenic flexure of the colon measures about 5 cm in its
maximum diameter with SUV max 22.7
• Large hepatic focal lesion is involving the right lobe (mainly at
segments V, VI, VII and VIII) it shows peripheral active FDG uptake
with central breaking down, the mass measures about 15.6 x 12.7 x
10.3 cm in its maximum dimensions with SUV max 21.5
• Other 2 small sized metabolically active hepatic focal lesions are
seen at segments II & VII, the larger measures about 1.4 cm with
SUV max 3.7
• No other metabolically active lesions.
23. Colonoscopy
• Cauliflower mass at 40cm from the anal verge at the
sigmoid descending colon junction causing
complete obstruction of the lumen extending for 5
cm , biopsies are taken for histopathology.
• Passage with extreme difficulty to the rest of the
colon revealed no other abnormality to the cecum
Adenocarcinoma grade II possibly arise on top of high villous
adenoma
Somatic mutation in codon 12 of the KRAS
oncogene was detected in the assayed sample.
24. Baseline Physical Examination
• PS: 1
• Within Normal Vital Signs & Lab Values
• Unremarkable General Examination
• Right lobe Hepatomegaly of 2 fingers below Costal
margin, extremely tender.
• Weight: 61 Kgs
• Height: 165 cm
• BSA: 1.67 m2
25. Q1: Intention of Treatment?
1. Cure?
2. Palliation?
• Young age with perfect PS & adequate organ
functions.
• Neither extra-hepatic visceral nor nodal disease.
• Left sided lesion.
• Neither hepatic nor associated systemic comorbid
disease.
• No life threatening warning signs Not obstructed.
27. Initial Management
• Curative Intent: aiming for possible
resectability
• Started CapeOX
• Bevacizumab added later after RAS analysis
• Good Tolerance
28. BEVACIZUMAB & Liver Mets …
IT IS SAFE … but wait al least 5 weeks
• D’Angelica ASO 2007, Reddy JACS 2008, Gruenberger JCO
2008, Kesmodel JCO 2008, Wicherts BJS 2011, …
PROTECTS AGAINST SINUSOIDAL OBSTR.
• Ribero Cancer 2007, Klinger EJSO 2009
IMPROVES PATHOLOGIC RESPONSE
• Ribero Cancer 2007, Blazer JCO 2008, Klinger ASO 2010,
Wicherts BJS 2011
29. CT Abdomen & Pelvis “1st Interval Assessment”
• It showed Regressive Course (but was still
beyond resectability)
• Patent homogeneously enhancing portal vein as
well as its main branches.
• Unremarkable Rest of the study
• After Discussions with the surgeon: We decided
to continue further
30. CT Abdomen & Pelvis “2nd Interval Assessment”
• Compared to the last CT study dated 16/06/2016 the
current study shows no appreciable changes of the
size.
• Enlarged liver showing diffuse homogeneous reduction
of its parenchymal CT attenuation denoting fatty
infiltration.
• Patent homogeneously enhancing portal vein as well as its main branches.
No biliary radicle dilatation.
• Unremarkable Rest of the study
• A PET CT was requested to better estimate the
situation
31. Pre-operative PET Assessment
• Marked regression in size and metabolic activity in the previously
described neoplastic lesion in the splenic flexure, currently
measures 2cm with SUVmax~3.3. (previously 22)
• Moderate regression in size and marked regression in metabolic
activity of the old right hepatic lobe deposit that currently
measures 11 Cm in its maximum diameter with SUVmax~5.9. (was
21)
• Similar regression of the other two FDG avid HFLs with current
SUVmax~4.8.
• The rest of the body is free with no newly developed FDG avid
metastasis.
32. Q3: Further Steps of Management?
1. Continue on more treatment sessions to
increase response rate?
2. Surgical Resection of both primary and
Secondaries?
3. Surgical resection of liver disease only?
33. Trial Resection
Dead / Total
No resection
Dead / Total
Hazard Ratio HR [95% CI]
Favors resection Favors no resection
Overall effect P<.0001
… what about RESECTION of PRIMARY ?
Faron M, et al. J Clin Oncol. 2012;30(15S): Abstract 3507.
FFCD 9601 130 / 146 60 / 60 0.5 [ 0.4 , 0.7 ]
FFCD 2000-05 138 / 168 123 / 140 0.6 [ 0.4 , 0.7 ]
ACCORD 13 24 / 59 24 / 37 0.6 [ 0.3 , 1.1 ]
ML16987 58 / 105 74 / 95 0.6 [ 0.4 , 0.8 ]
Total 350 / 478 281 / 332 0.6 [ 0.5 , 0.7 ]
Heterogeneity P = .87
0 0.5 1 1.5
34. Underwent Operation
• Segmental colectomy
– INFILTRATING ADENOCARCINOMA, GRADE II, ON TOP OF TUBULO-VILLOUS
ADENOMA WITH HIGH GRADE DYSPLASIA, No lymphovascular invasion. No
Necosis.
– WITH POSITIVE LYMPH NODE METASTASIS [L.N 1/9],
– STAGE B1, T2 N1, FREE COLONIC SURGICAL MARGINS.
• Right hepatic lobectomy
– METASTATIC ADENOCARCINOMA, GRADE II, LIKELY OF COLONIC ORIGIN, FREE
SURGICAL MARGINS. Extensive Necrosis.
• Left hepatic lobe lesion Excision biopsy
– CAVERNOUS HEMANGIOMA, MARKED STEATOSIS.
Smooth postoperative period and discharged on day 8 P.O.
35. Multivariate analysis revealed
that independent predictors of
pathologic response* were:
• CEA <5 ng/mL
• tumor size <3 cm,
• FP + OXA + BEVACIZUMAB
*assessed by the proportion of
residual cancer cells
Blazer DG III, et al. J Clin Oncol. 2008;26(33):5344-5351.
36. During Follow Up:
• Asymptomatic, infrequent abdominal cramps.
• Dropping liver enzyme profile (3 folds P.O.)
• Improving appetite & regain of normal activity.
• Follow up US:
– Status post-operative showing 3 focal metastatic
lesions implicating the residual left lobe.
– Minimal residual abdominal and pelvic ascetic
peritoneal fluid smearing (Reactionary).
37. MRI Abdomen
• 2 focal hepatic lesions at segments IV and
junction between II & III measuring 11 x 9 mm &
31 x 20 mm.
• Both appear of low T1 signal intensity that
become brighter in T2 images.
• They show no contrast enhancement with the
larger exhibiting some marginal enhancement.
38. Q: Further Actions to Be Taken:
1. Start salvage systemic treatment?
2. Re-operate?
3. Closed ablative procedures?
39. The Need for Second Hepatectomy:
Adam R, et al. The Oncologist. 2012;17:1225-1239
40. Re-operation & Follow up Descision
• 9 Focal Lesions
– RFA
– Excision of the largest (Same pathology)
• Shifted to FOLFIRI + Bevacizumab