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.
This document summarizes key findings from several clinical trials on the treatment of anal squamous cell carcinoma. The UKCCCR ACT I trial showed improved local control and colostomy-free survival with chemoradiation (CRT) compared to radiation alone. Subsequent trials found improved outcomes with mitomycin-C compared to 5-FU alone. The RTOG 98-11 and ACT II trials found no advantage to cisplatin over mitomycin-C in CRT or with maintenance chemotherapy. The current standard is CRT with 5-FU and mitomycin-C.
Role of radiation in benign conditionsPurvi Rathod
This document discusses the role of radiation therapy in treating various benign conditions. It provides indications for RT in benign tumors of the brain and head and neck such as meningiomas, pituitary adenomas, and craniopharyngiomas. It also discusses using RT to treat other benign conditions such as trigeminal neuralgia, hemangiomas, arteriovenous malformations, and Langerhans cell histiocytosis. Radiation therapy aims to control symptoms, provide pain relief, and achieve good local control of benign lesions with minimal side effects when used judiciously for the right indications.
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
Radiotherapy in hepatocellular carcinomasPratap Tiwari
External Radiotherapy in hepatocellular carcinomas (HCC). A brief summary of the guidelines statements on radiotherapy role in hepatocellular carcinoma (hcc).
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...Dr.Bhavin Vadodariya
1) The document summarizes key landmark trials in breast cancer surgery including the Halsted theory, Fisher theory, and results from NSABP B04, B06, and B17 trials which established breast conservation as a standard of care for early stage breast cancer.
2) It also discusses a trial evaluating cryoablation as a non-surgical option for small breast cancers and results showing 92% successful ablation with no residual disease after surgical resection.
3) Going forward, the document envisions more individualized and targeted breast cancer treatment based on genomic profiling of each tumor to identify markers and select the most appropriate targeted therapies or ablative procedures.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
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.
This document summarizes key findings from several clinical trials on the treatment of anal squamous cell carcinoma. The UKCCCR ACT I trial showed improved local control and colostomy-free survival with chemoradiation (CRT) compared to radiation alone. Subsequent trials found improved outcomes with mitomycin-C compared to 5-FU alone. The RTOG 98-11 and ACT II trials found no advantage to cisplatin over mitomycin-C in CRT or with maintenance chemotherapy. The current standard is CRT with 5-FU and mitomycin-C.
Role of radiation in benign conditionsPurvi Rathod
This document discusses the role of radiation therapy in treating various benign conditions. It provides indications for RT in benign tumors of the brain and head and neck such as meningiomas, pituitary adenomas, and craniopharyngiomas. It also discusses using RT to treat other benign conditions such as trigeminal neuralgia, hemangiomas, arteriovenous malformations, and Langerhans cell histiocytosis. Radiation therapy aims to control symptoms, provide pain relief, and achieve good local control of benign lesions with minimal side effects when used judiciously for the right indications.
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
Radiotherapy in hepatocellular carcinomasPratap Tiwari
External Radiotherapy in hepatocellular carcinomas (HCC). A brief summary of the guidelines statements on radiotherapy role in hepatocellular carcinoma (hcc).
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Landmark trials in breast Cancer surgery - NSABP 04,06,MILAN,EORTC 10853, ECO...Dr.Bhavin Vadodariya
1) The document summarizes key landmark trials in breast cancer surgery including the Halsted theory, Fisher theory, and results from NSABP B04, B06, and B17 trials which established breast conservation as a standard of care for early stage breast cancer.
2) It also discusses a trial evaluating cryoablation as a non-surgical option for small breast cancers and results showing 92% successful ablation with no residual disease after surgical resection.
3) Going forward, the document envisions more individualized and targeted breast cancer treatment based on genomic profiling of each tumor to identify markers and select the most appropriate targeted therapies or ablative procedures.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
This document discusses normal tissue tolerance doses from radiation therapy. It describes the formation of a task force to establish tolerance protocols, with an emphasis on partial volume effects. The earliest publication of tolerance doses is cited from 1972. 28 critical organ sites were included and considered in terms of dose, time factors, and partial volumes irradiated. The significance of these parameters and a quantitative model for normal tissue complication probability are provided. Limitations of the available data and ongoing areas of research are also outlined.
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.
This document summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
This document discusses management of prostate cancer through different treatment modalities including active surveillance, radical prostatectomy, radiation therapy, and hormonal therapy. It provides treatment recommendations based on cancer stage and risk level as well as 5-year outcomes. For low risk prostate cancer, active surveillance, radical prostatectomy, or radiation therapy are recommended depending on life expectancy. Radiation therapy techniques like 3D-CRT, IMRT, and brachytherapy are covered. Dose escalation studies showing improved outcomes with higher radiation doses are also summarized.
The document provides an overview of genomics in breast cancer and summarizes the Oncotype DX genomic assay. It discusses how the assay analyzes the expression levels of 21 genes in breast tumor tissue to provide a Recurrence Score that quantifies a patient's risk of recurrence and predicts who will benefit from chemotherapy. Clinical studies have shown the assay stratifies patients into low, intermediate, and high risk groups and identifies those unlikely to benefit from chemotherapy while high risk patients see significant reduction in recurrence with chemotherapy. The assay is recommended in clinical guidelines and widely covered by insurance.
Accelerated partial breast irradiation (APBI) delivers radiation to only the portion of the breast at highest risk of recurrence rather than the whole breast. This allows radiation to be delivered in a significantly shortened period. Several techniques for APBI exist including brachytherapy using catheters implanted in the breast, balloon brachytherapy, and external beam radiotherapy. Ongoing clinical trials are evaluating outcomes and toxicities of APBI compared to whole breast irradiation in appropriately selected patients with early-stage breast cancer.
Hippocampal sparing whole brain radiation therapy- Making a case!VIMOJ JANARDANAN NAIR
- A 58-year-old female nurse presented with headache, nausea, and mental status changes. Imaging showed 3 brain metastases with no known primary site.
- She had a KPS of 90, age <60, controlled primary (pending further workup), and no extracranial mets, placing her in RPA class I and GPA group with a predicted median survival of 7.1-11.3 months.
- Treatment options included WBRT alone or WBRT with boost to reduce risk of neurocognitive toxicity based on the RTOG 0933 trial, which showed reduced memory decline with hippocampal avoidance. Patient selection focused on tumor types likely to benefit and survival duration to gain
CAN WE MARCH WITH MARCH META-ANALYSIS?Kanhu Charan
Altered fractionation radiotherapy, especially hyperfractionated radiotherapy, provides improved overall survival compared to conventional fractionation for head and neck cancers. The 2017 MARCH meta-analysis update, which included over 11,000 patients, confirmed the benefits of altered fractionation. Specifically, hyperfractionated radiotherapy resulted in an 8.1% absolute improvement in 5-year survival. Concurrent chemotherapy with conventional radiation was found to be better than altered fractionation alone, but hyperfractionated radiotherapy seems comparable to chemotherapy with standard radiation.
This document discusses radiation therapy options for prostate cancer. It notes that treatment depends on risk level: low risk may receive external beam radiation or seeds alone, intermediate risk should receive some external beam, and high risk should receive hormone therapy plus radiation. Newer techniques like IMRT and IGRT reduce side effects by more precisely targeting the prostate. Side effects of radiation include short term issues like urinary frequency and diarrhea as well as long term risks like radiation cystitis and impotence in some cases.
This document discusses the use of radiotherapy in the treatment of acute lymphoblastic leukemia (ALL). It provides an overview of ALL, including classification, risk groups, and treatment approaches involving induction, intensification, maintenance, and central nervous system prophylaxis. It then focuses on the role of radiotherapy, describing protocols for cranial irradiation to prevent central nervous system relapse, including dose schedules. It also discusses radiotherapy for meningeal leukemia at diagnosis, testicular irradiation, and total body irradiation used for bone marrow transplantation conditioning.
The document discusses the role of radiation therapy in treating oligometastatic prostate cancer, noting that radiation can potentially achieve durable responses or even cure in some cases when metastases are limited. It reviews definitions of oligometastatic prostate cancer, the rationale for local and metastasis-directed radiation therapy, clinical evidence from studies on the use of external beam radiation therapy and stereotactic body radiation therapy to treat the primary tumor and metastases, and outcomes from these studies including local control rates, progression-free survival, and overall survival. The document concludes that radiation therapy plays an important role in the treatment of oligometastatic prostate cancer.
1. Radiation therapy plays an important role in the treatment of Wilms tumor, especially for advanced or high-risk cases.
2. It is used preoperatively, postoperatively, and for metastatic disease to reduce the risk of recurrence.
3. The indications and techniques for radiation therapy depend on factors like tumor stage, histology, response to chemotherapy, and whether metastases are present. Precise radiation treatment planning is required to effectively target tumors while sparing healthy tissues.
Role of radiation in carcinoma rectum and colon Bharti Devnani
1. Radiation therapy has been shown to decrease rates of local recurrence in rectal cancer when used preoperatively or postoperatively.
2. Studies have demonstrated benefits of preoperative chemoradiation over postoperative chemoradiation, including lower rates of local recurrence, reduced toxicity, and increased rates of sphincter preservation.
3. Techniques such as prone positioning, abdominal compression, and bladder filling can help displace small bowel out of the radiation field and decrease toxicity.
This document discusses the management of early breast cancer. It covers workup including imaging and biopsy to determine tumor characteristics. Treatment options include breast conservation therapy with lumpectomy and radiotherapy or mastectomy with or without radiotherapy, depending on tumor size and other factors. It also discusses surgical management of the axilla including sentinel lymph node biopsy or axillary lymph node dissection. The role of chemotherapy, hormonal therapy and radiotherapy based on tumor biomarkers is summarized.
Role and Side effects of Ovarian Function Suppression in Breast CancerAjeet Gandhi
1) The document discusses the role and side effects of ovarian suppression therapy in premenopausal women receiving adjuvant treatment for hormone receptor positive breast cancer.
2) Key trials like SOFT and TEXT showed that the addition of ovarian suppression to tamoxifen or aromatase inhibitors improved disease-free survival rates and reduced the risk of breast cancer recurrence in premenopausal women compared to tamoxifen alone.
3) The benefits of ovarian suppression were greater in women who remained premenopausal after chemotherapy and those with larger/node-positive tumors or higher grade disease. Common side effects included hot flashes and musculoskeletal symptoms.
1) Preoperative chemoradiotherapy improves local control rates and tumor downstaging for rectal cancer compared to postoperative chemoradiotherapy or radiotherapy alone.
2) The addition of chemotherapy to radiotherapy, whether in the preoperative or postoperative setting, improves local control and disease-free survival compared to radiotherapy alone.
3) For patients who achieve a clinical complete response after preoperative chemoradiotherapy, observation without surgery may be feasible, with local recurrence rates of approximately 30% that can often be successfully salvaged.
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.
This document discusses the management of Wilms tumor and the role of radiotherapy. It covers the epidemiology, molecular biology, clinical presentation, diagnostic workup, staging, pathology, treatment options according to NWTS and SIOP protocols, and long-term treatment outcomes from NWTS trials. Radiotherapy techniques for flank irradiation, whole abdominal irradiation, whole lung irradiation, and conformal planning are also described.
This document provides information on Wilms tumor (nephroblastoma), the most common malignant renal tumor of childhood. It discusses the epidemiology, genetics, clinical features, staging, histology, management including surgery, chemotherapy and radiation therapy. Key points include that Wilms tumor arises from nephrogenic rests, affects children aged 3-4 years, and is highly curable with multimodality treatment depending on stage, histology and other risk factors. Radiation therapy is an important component of treatment for local and metastatic disease. Ongoing clinical trials continue to refine risk-adapted therapies to improve survival while reducing long-term effects.
This document discusses normal tissue tolerance doses from radiation therapy. It describes the formation of a task force to establish tolerance protocols, with an emphasis on partial volume effects. The earliest publication of tolerance doses is cited from 1972. 28 critical organ sites were included and considered in terms of dose, time factors, and partial volumes irradiated. The significance of these parameters and a quantitative model for normal tissue complication probability are provided. Limitations of the available data and ongoing areas of research are also outlined.
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.
This document summarizes a panel discussion on oligometastatic disease. It defines oligometastatic disease as having a solitary or few detectable metastatic lesions confined to a single organ or more than one organ. There is ongoing debate around how many lesions constitute oligometastatic disease. The document discusses various theories on metastasis patterns and improving treatments like stereotactic radiosurgery that have led to reclassification of some metastatic tumors as oligometastatic. Ongoing trials are exploring more aggressive local treatment of oligometastatic lesions combined with systemic therapies to improve long-term survival.
This document discusses management of prostate cancer through different treatment modalities including active surveillance, radical prostatectomy, radiation therapy, and hormonal therapy. It provides treatment recommendations based on cancer stage and risk level as well as 5-year outcomes. For low risk prostate cancer, active surveillance, radical prostatectomy, or radiation therapy are recommended depending on life expectancy. Radiation therapy techniques like 3D-CRT, IMRT, and brachytherapy are covered. Dose escalation studies showing improved outcomes with higher radiation doses are also summarized.
The document provides an overview of genomics in breast cancer and summarizes the Oncotype DX genomic assay. It discusses how the assay analyzes the expression levels of 21 genes in breast tumor tissue to provide a Recurrence Score that quantifies a patient's risk of recurrence and predicts who will benefit from chemotherapy. Clinical studies have shown the assay stratifies patients into low, intermediate, and high risk groups and identifies those unlikely to benefit from chemotherapy while high risk patients see significant reduction in recurrence with chemotherapy. The assay is recommended in clinical guidelines and widely covered by insurance.
Accelerated partial breast irradiation (APBI) delivers radiation to only the portion of the breast at highest risk of recurrence rather than the whole breast. This allows radiation to be delivered in a significantly shortened period. Several techniques for APBI exist including brachytherapy using catheters implanted in the breast, balloon brachytherapy, and external beam radiotherapy. Ongoing clinical trials are evaluating outcomes and toxicities of APBI compared to whole breast irradiation in appropriately selected patients with early-stage breast cancer.
Hippocampal sparing whole brain radiation therapy- Making a case!VIMOJ JANARDANAN NAIR
- A 58-year-old female nurse presented with headache, nausea, and mental status changes. Imaging showed 3 brain metastases with no known primary site.
- She had a KPS of 90, age <60, controlled primary (pending further workup), and no extracranial mets, placing her in RPA class I and GPA group with a predicted median survival of 7.1-11.3 months.
- Treatment options included WBRT alone or WBRT with boost to reduce risk of neurocognitive toxicity based on the RTOG 0933 trial, which showed reduced memory decline with hippocampal avoidance. Patient selection focused on tumor types likely to benefit and survival duration to gain
CAN WE MARCH WITH MARCH META-ANALYSIS?Kanhu Charan
Altered fractionation radiotherapy, especially hyperfractionated radiotherapy, provides improved overall survival compared to conventional fractionation for head and neck cancers. The 2017 MARCH meta-analysis update, which included over 11,000 patients, confirmed the benefits of altered fractionation. Specifically, hyperfractionated radiotherapy resulted in an 8.1% absolute improvement in 5-year survival. Concurrent chemotherapy with conventional radiation was found to be better than altered fractionation alone, but hyperfractionated radiotherapy seems comparable to chemotherapy with standard radiation.
This document discusses radiation therapy options for prostate cancer. It notes that treatment depends on risk level: low risk may receive external beam radiation or seeds alone, intermediate risk should receive some external beam, and high risk should receive hormone therapy plus radiation. Newer techniques like IMRT and IGRT reduce side effects by more precisely targeting the prostate. Side effects of radiation include short term issues like urinary frequency and diarrhea as well as long term risks like radiation cystitis and impotence in some cases.
This document discusses the use of radiotherapy in the treatment of acute lymphoblastic leukemia (ALL). It provides an overview of ALL, including classification, risk groups, and treatment approaches involving induction, intensification, maintenance, and central nervous system prophylaxis. It then focuses on the role of radiotherapy, describing protocols for cranial irradiation to prevent central nervous system relapse, including dose schedules. It also discusses radiotherapy for meningeal leukemia at diagnosis, testicular irradiation, and total body irradiation used for bone marrow transplantation conditioning.
The document discusses the role of radiation therapy in treating oligometastatic prostate cancer, noting that radiation can potentially achieve durable responses or even cure in some cases when metastases are limited. It reviews definitions of oligometastatic prostate cancer, the rationale for local and metastasis-directed radiation therapy, clinical evidence from studies on the use of external beam radiation therapy and stereotactic body radiation therapy to treat the primary tumor and metastases, and outcomes from these studies including local control rates, progression-free survival, and overall survival. The document concludes that radiation therapy plays an important role in the treatment of oligometastatic prostate cancer.
1. Radiation therapy plays an important role in the treatment of Wilms tumor, especially for advanced or high-risk cases.
2. It is used preoperatively, postoperatively, and for metastatic disease to reduce the risk of recurrence.
3. The indications and techniques for radiation therapy depend on factors like tumor stage, histology, response to chemotherapy, and whether metastases are present. Precise radiation treatment planning is required to effectively target tumors while sparing healthy tissues.
Role of radiation in carcinoma rectum and colon Bharti Devnani
1. Radiation therapy has been shown to decrease rates of local recurrence in rectal cancer when used preoperatively or postoperatively.
2. Studies have demonstrated benefits of preoperative chemoradiation over postoperative chemoradiation, including lower rates of local recurrence, reduced toxicity, and increased rates of sphincter preservation.
3. Techniques such as prone positioning, abdominal compression, and bladder filling can help displace small bowel out of the radiation field and decrease toxicity.
This document discusses the management of early breast cancer. It covers workup including imaging and biopsy to determine tumor characteristics. Treatment options include breast conservation therapy with lumpectomy and radiotherapy or mastectomy with or without radiotherapy, depending on tumor size and other factors. It also discusses surgical management of the axilla including sentinel lymph node biopsy or axillary lymph node dissection. The role of chemotherapy, hormonal therapy and radiotherapy based on tumor biomarkers is summarized.
Role and Side effects of Ovarian Function Suppression in Breast CancerAjeet Gandhi
1) The document discusses the role and side effects of ovarian suppression therapy in premenopausal women receiving adjuvant treatment for hormone receptor positive breast cancer.
2) Key trials like SOFT and TEXT showed that the addition of ovarian suppression to tamoxifen or aromatase inhibitors improved disease-free survival rates and reduced the risk of breast cancer recurrence in premenopausal women compared to tamoxifen alone.
3) The benefits of ovarian suppression were greater in women who remained premenopausal after chemotherapy and those with larger/node-positive tumors or higher grade disease. Common side effects included hot flashes and musculoskeletal symptoms.
1) Preoperative chemoradiotherapy improves local control rates and tumor downstaging for rectal cancer compared to postoperative chemoradiotherapy or radiotherapy alone.
2) The addition of chemotherapy to radiotherapy, whether in the preoperative or postoperative setting, improves local control and disease-free survival compared to radiotherapy alone.
3) For patients who achieve a clinical complete response after preoperative chemoradiotherapy, observation without surgery may be feasible, with local recurrence rates of approximately 30% that can often be successfully salvaged.
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.
This document discusses the management of Wilms tumor and the role of radiotherapy. It covers the epidemiology, molecular biology, clinical presentation, diagnostic workup, staging, pathology, treatment options according to NWTS and SIOP protocols, and long-term treatment outcomes from NWTS trials. Radiotherapy techniques for flank irradiation, whole abdominal irradiation, whole lung irradiation, and conformal planning are also described.
This document provides information on Wilms tumor (nephroblastoma), the most common malignant renal tumor of childhood. It discusses the epidemiology, genetics, clinical features, staging, histology, management including surgery, chemotherapy and radiation therapy. Key points include that Wilms tumor arises from nephrogenic rests, affects children aged 3-4 years, and is highly curable with multimodality treatment depending on stage, histology and other risk factors. Radiation therapy is an important component of treatment for local and metastatic disease. Ongoing clinical trials continue to refine risk-adapted therapies to improve survival while reducing long-term effects.
- Nephroblastoma, also known as Wilms tumor, is the most common renal malignancy in children under 5 years old.
- It accounts for 5-6% of all childhood cancers worldwide. Risk factors include genetic syndromes like WAGR or Beckwith-Wiedemann syndrome.
- Treatment involves surgical resection of the tumor followed by chemotherapy and sometimes radiation therapy. With a multidisciplinary approach, the 5-year survival rate is around 90%. Intensive follow-up is important after treatment to monitor for recurrence or late effects.
RCC- Staging and treatment of Renal Cell CarcinomaBe Akash Sah
This document discusses staging and treatment of renal cell carcinoma. It covers screening recommendations, risk factors, staging evaluations including imaging and biomarkers, prognostic factors like tumor size and grade, and treatment options for localized RCC including radical nephrectomy and partial nephrectomy. Pathologic stage is identified as the most important prognostic factor, with organ-confined disease having better outcomes than tumors involving adjacent structures or with lymph node or distant metastases.
Colon cancer is the most common type of cancer in developed Western nations. Risk factors include age, family history, and lifestyle. Genetic conditions like Lynch syndrome and familial adenomatous polyposis increase risk. Screening allows early detection of precancerous polyps. Staging involves TNM classification. Treatment depends on stage but commonly includes surgery with or without adjuvant chemotherapy or radiation. Prognosis depends on stage, grade, lymph node involvement and other high risk features. Long term surveillance is important after initial treatment.
Wilms tumor, or nephroblastoma, is a malignant kidney tumor that typically occurs in young children under 5 years old. It is the fifth most common pediatric cancer and is highly responsive to treatment, with a 90% survival rate. While the exact cause is unknown, genetic factors and abnormalities in genes like WT1 and WT2 may play a role in tumor development. Treatment involves surgery to remove the tumor, radiation therapy, and chemotherapy depending on the stage. Early detection and complete surgical removal of localized tumors results in high survival rates.
Stem Cell Transplantation in Hodgkin’s Lymphoma Past, Present and FutureAmir Abbas Hedayati Asl
Treatment for HL has improved significantly since the ABVD chemotherapeutic combination was invented over 30 years ago .
Despite using the same ABVD regimen in most patients treated in the first line, we now have a much better understanding of disease biology and the late side effects of therapy, and we have moved toward a personalized, risk-adapted approach.
This approach promises to deliver low toxicities and high cure rates for lower risk patients while reserving aggressive regimens for those high risk patients who really need them.
For the minority of patients who fail first-line therapy, novel drugs like the antibody-drug conjugate BV and immunotherapies with nivolumab and pembrolizumab have produced high response rates and durability of benefit.
Further research is needed to determine whether these novel drugs could make life better for both patients with HL who are undergoing treatment and for the growing cohort of HL survivors.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
Kidney transplant recipients have a 2-3x higher risk of developing cancer compared to the general population due to factors related to CKD, immunosuppression, and viral infections. Specific cancers like non-Hodgkin lymphoma, skin cancers, and cancers of the kidney and urinary tract are more common. Immunosuppression drugs like calcineurin inhibitors and mTOR inhibitors can influence cancer risk. Screening for cancers in kidney transplant patients requires individualization based on life expectancy and risks. Managing cancer often involves modifying immunosuppression to balance cancer treatment and risk of organ rejection.
Hepatoblastoma- Investigations and managementARJUN MANDADE
This document summarizes information about hepatoblastoma, a rare type of liver cancer that mostly affects young children. It discusses the history and terminology of hepatoblastoma. Key points include: hepatoblastoma typically affects children under 3 years old and accounts for about 1% of childhood cancers. Complete surgical resection is the main treatment when possible but less than 50% of patients are resectable at diagnosis. The addition of cisplatin-based chemotherapy has improved outcomes by increasing resectability. Prognosis remains suboptimal for patients with unresectable or metastatic disease after chemotherapy. Chemoembolization and liver transplantation are promising alternative treatments in these cases.
Gallbladder cancer is a relatively rare but aggressive form of cancer. The 5-year survival rate is only 20% overall but can reach 65% for localized cancers that are surgically resected. Risk factors include gallstone disease and gallbladder polyps. Symptoms often include pain, jaundice, weight loss and fatigue. Diagnosis involves blood tests, ultrasound, CT/MRI and biopsy. Surgical resection offers the best chance of cure for early stage disease while chemotherapy and radiation are used for advanced or metastatic cancers. Prognosis depends highly on stage, with 5-year survival rates of 100%, 65-80%, 30-70%, and less than 15% for stages I through IV, respectively.
This document discusses gastric cancer, including its epidemiology, risk factors, diagnosis, treatment, and outcomes. Some key points:
- Gastric cancer is the 4th most common cancer worldwide and the 15th most common in the US. Incidence has declined significantly over the last century.
- Risk factors include H. pylori infection, smoking, diet high in salted/smoked foods, and adenomatous polyps.
- Diagnosis is typically made via endoscopy with biopsy. Staging may involve endoscopic ultrasound, CT scan, or laparoscopy.
- Treatment is usually surgical resection with D1 or D2 lymph node dissection and chemotherapy/radiation. Total or
1. Small cell lung carcinoma is a highly aggressive malignancy associated with tobacco exposure. It is characterized pathologically by small, round, blue cells with scant cytoplasm and fine chromatin.
2. Prognostic factors include stage, performance status, gender, and normal LDH levels. Staging workup involves imaging of the chest, abdomen, brain and bone as well as biopsy of suspicious lesions.
3. Treatment depends on stage - limited stage receives chemotherapy with thoracic radiation while extensive stage receives chemotherapy alone with consideration of prophylactic cranial irradiation for those who respond to initial treatment. The standard chemotherapy regimen is etoposide and platinum.
Management Guideline in Colorectal Cancer.pptxAtulGupta369
1. The document provides guidelines for the management of colorectal cancer including epidemiology, screening principles, diagnostic workup, treatment guidelines, and follow up principles.
2. Screening and surveillance recommendations are provided for average risk and high risk populations. Colonoscopy is the primary screening tool for average risk individuals beginning at age 50.
3. Treatment for localized colon cancer involves surgical resection with or without adjuvant chemotherapy depending on risk factors. Treatment for rectal cancer may involve neoadjuvant chemoradiation followed by surgery.
Wilms tumor, also known as nephroblastoma, is the most common renal tumor of childhood that arises from nephrogenic rests. It typically presents as an asymptomatic abdominal mass in children aged 2-5 years. Treatment involves surgical removal of the kidney along with chemotherapy based on tumor stage. While relapse can occur in 15-50% of cases depending on histology, overall survival rates for Wilms tumor now exceed 90% with multimodal therapy.
Seminoma testis is a relatively rare but common germ cell tumor in young men. It typically presents as a painless testicular swelling. Staging involves tumor markers, imaging and pathology. Stage I seminoma can be managed with surveillance, adjuvant chemotherapy or radiotherapy. Carboplatin is as effective as radiotherapy for stage I. For stage II, radiotherapy to retroperitoneum is standard but chemotherapy is also effective. Seminoma is highly curable with long term survival over 90% even with advanced stages. Careful follow up is needed long term.
Wilms tumor, also known as nephroblastoma, is the most common malignant renal tumor of childhood. It develops from embryonic kidney tissue and accounts for 6-7% of childhood cancers. The tumor is usually diagnosed before age 5 and may be detected via abdominal mass or hematuria. Staging involves imaging like CT or MRI to determine extent. Prognosis depends on histology and stage. Treatment typically involves nephrectomy followed by chemotherapy, with radiation sometimes used. Late effects can include growth issues, infertility, and second cancers. Long term follow up is important after treatment ends.
Seminar on acute lymphoblastic leukemia by Dr. Prachi KalraMAMC,Delhi
This document provides information about acute lymphoblastic leukemia (ALL):
- ALL is a cancer of the white blood cells that starts from immature lymphocytes in the bone marrow. It causes a buildup of abnormal lymphocytes that crowds out normal blood cell production.
- Symptoms include fever, bleeding, bone pain, swollen lymph nodes and organs, and neurological issues. Diagnosis involves blood tests, bone marrow biopsy, immunophenotyping and cytogenetic analysis.
- Treatment involves supportive care, induction chemotherapy to achieve remission, consolidation therapy to further reduce cancer cells, and long-term maintenance therapy to prevent relapse. Prognosis depends on risk factors like age and specific genetic abnormalities.
Hepatocellular carcinoma (HCC) is a primary malignancy of the liver and the third leading cause of cancer deaths worldwide. Risk factors include hepatitis and excessive alcohol use. Complete surgical resection or liver transplantation offers the best outcomes for eligible patients with early-stage HCC. For patients who cannot undergo surgery, radiofrequency ablation and chemoembolization provide good local control of small, localized tumors. Systemic therapies are minimally effective for HCC due to resistance, and palliation is the main goal for widespread disease. Long-term survival requires a multidisciplinary approach and close monitoring for recurrence.
This document discusses various clinical trials related to stomach cancer treatment. It summarizes that:
1) The D2 dissection surgery showed better local control and reduced gastric cancer deaths compared to D1 dissection.
2) Perioperative chemotherapy was found to be better than surgery alone in reducing tumor size and death rates based on the MAGIC trial.
3) The FLOT regimen showed improved survival over ECF/ECX as perioperative chemotherapy in locally advanced gastric cancer.
4) Postoperative chemotherapy provides a survival benefit compared to surgery alone based on meta-analysis results. The CLASSIC trial also showed improved outcomes with adjuvant capecitabine and oxaliplatin.
Three clinical trials comparing different treatments for oropharynx and larynx cancer were summarized:
1. RTOG 9003 found that hyperfractionated RT showed significantly improved OS and LRC compared to standard fractionation for advanced cancers. Acute toxicities were similar between arms.
2. GORTEC 9902 and the study by Brizel et al. found CCRT with altered fractionation like hyperfractionation or accelerated fractionation improved outcomes over RT alone.
3. RTOG 9501 and EORTC 22931 showed that for cancers with high-risk features, adjuvant chemoRT with cisplatin improved locoregional control and DFS compared to RT alone, with
The document discusses the management of oropharynx carcinoma. The goals of management are to maximize survival while minimizing morbidity given the site's involvement in speech, swallowing and airway. Management includes radiotherapy, chemotherapy and surgery. Radiotherapy techniques discussed include IMRT, hyperfractionation and concurrent chemoradiotherapy. Chemotherapy regimens used concurrently with radiotherapy include cisplatin or carboplatin with infusional 5-FU. Brachytherapy is also discussed as a boost technique for oropharynx carcinoma.
The document discusses the anatomy and histology of the endometrium, the lining of the uterus. It then covers endometrial cancer, including risk factors, common presentations, workup involving endometrial biopsy and imaging, and staging. Treatment is discussed for each stage, with surgery being primary treatment and adjuvant therapy depending on grade, myometrial invasion, and other pathological factors. Sentinel lymph node biopsy and recent advances are also mentioned.
1) A cell survival curve shows the relationship between the proportion of cells surviving and the radiation dose or dose of a cell-killing agent. It is used to assess the biological effectiveness of radiation.
2) Radiation can kill cells through direct damage, free radical injury, apoptosis, mitotic death, bystander effects, autophagy, and senescence. The mechanism of cell death influences whether the survival curve is linear or has a shoulder.
3) Factors that influence the cell survival curve include linear energy transfer (LET), cell cycle stage, intrinsic radiosensitivity, genetic factors, and fractionation of radiation doses. Higher LET radiation and apoptosis result in a more linear curve, while lower LET
Hyperthermia involves heating tumor tissue above normal body temperature to damage and kill cancer cells. It has been used experimentally for thousands of years to treat tumors. Effects are due to protein damage within cells. Hyperthermia can enhance the effects of radiation therapy by making tumor cells more sensitive. Temperature and exposure time determine cell death in a predictable way. Factors like pH, oxygen levels, and cell cycle stage influence response. Temperature is monitored and thermal dose is calculated to determine treatment effectiveness. Hyperthermia shows promise for improving cancer treatments when combined with other therapies.
The document discusses the anatomy, histology, staging, and workup of esophageal cancer. It describes the esophagus as a hollow muscular tube connecting the pharynx to the stomach. Esophageal cancer most often presents with dysphagia and can spread through lymphatic channels or directly invade nearby structures. Staging involves endoscopy, endoscopic ultrasound, CT, and PET scans to determine the depth of invasion and presence of metastases.
This document summarizes the anatomy, pathology, and epidemiology of breast cancer. It discusses the embryology, gross anatomy, histology, and molecular classification of the breast. It also describes the epidemiology of breast cancer, noting key risk factors like family history, age, reproductive history, hormone exposure, radiation exposure, BMI, physical activity, and diet. Screening and management of breast cancer is available at various levels of healthcare centers in India.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. INTRODUCTION
• current cure rate of >90%.
• highly curable childhood neoplasm
• most common malignant renal tumor of childhood
• 3 and 4 years of age
• sporadic or hereditary tumors or in the setting of
specific genetic disorder
3. • WT1, which is a tumor suppressor gene at
chromosome 11p13
• play a specific role in glomerular and gonadal
development,WAGR syndrome, Denys-Drash
syndrome
• Beckwith Wiedemann syndrome maps to
chromosome 11p15.5; this locus is also referred to
as WT2.
4. • loss of heterozygosity (LOH) at 16q and 1p have
higher relapse and mortality rates.
• A novel WT suppressor gene on the X chromosome,
WTX
• Anaplastic tumors have shown changes on 17p
consistent with TP53 deletion and specific genomic
loss or underexpression on 4q and 14q and focal
gain of MYCN.1
5. • WT1 mutation and 11p15 LOH were significant
predictors of relapse in VLRWTs.
• gain of 1q is a promising biomarker for patients
with favorable histology
• Other molecular aberrations associated with
poorer outcomes included MYCN gain and TP53
loss
6. PATHOLOGY
• Histologically, WT reflects the development of the
normal kidney, consisting of three components,
blastemal, epithelial (tubules), and stromal elements, in
varying proportions
• Nephrogenic rests consist of embryonal nephroblastic
tissue and are found in 35% of kidneys with unilateral
WT and in nearly 100% of kidneys with bilateral WT
(BWT).
• greatest clinical significance in WT is anaplasia.
Anaplasia may be focal (FA) or diffuse (DA)
• distribution of anaplastic cells
7. CLINICAL FEATURES
• healthy child in whom abdominal swelling
• A smooth, firm, nontender massGross hematuria
occurs in as many as 25%
• hypertensive, malaise or fever
• anemia from haematuria
8. Work up
• Malignant childhood lesions of the kidney, neuroblastoma, and
benign conditions such as hydronephrosis, polycystic disease, and
splenomegaly in left-sided tumor
• USG -A specific advantage of ultrasonography is its ability to
assess vessels for flow and tumor thrombus with duplex and color
Doppler
• Abdominal CT scans can demonstrate gross extrarenal spread,
lymph node involvement, liver metastases, and the status of the
opposite kidney
• MRI -identifying renal origin and vascular extension of the tumor.
• Plain chest radiography and chest CT are also essential because
asymptomatic pulmonary metastases are common
15. Timing of RT
• a delay of ≥10 days after surgery was associated with a significantly higher
abdominal relapse rate, particularly among patients with UH tumors
• D’Angio GJ, Evans AE, Breslow NE, et al. The treatment of Wilms’ tumor:
results of the National Wilms’ Tumor Study. Cancer 1976;38:633–646.
• . D’Angio GJ, Tefft M, Breslow NE, et al. Radiation therapy of Wilms’ tumor:
results according to dose, field, postoperative timing and histology.Int J Radiat
Oncol Biol Phys 1978;4:769–780.
• Thomas PRM, Tefft M, Compaan PJ, et al. Results of two radiotherapy
randomizations in the third National Wilms’ Tumor Study (NWTS-3). Cancer
1991;68:1703–1707.
Thomas PRM, Tefft M, Farewell VT, et al. Abdominal relapses in the Second
National Wilms’ Tumor Study patients. J Clin Oncol 1984;2:1098– 1101.ccording
• For the COG protocols, it is recommended that RT be given preferably by day 9
but no later than day 14 after surgery.
23. Bilateral wilms
• The current COG protocol (AREN0534) recommends earlier
biopsies or resection of nonresponsive tumors so that
ineffective therapies for patients with DA could be avoided.
• This study will intensify chemotherapy upfront (three drugs),
require second-look surgery at 6 weeks and definitive surgery
at 12 weeks, and recommend chemotherapy based on
histologic response after definitive surgery.
• RT is indicated for stage III FH tumors, stage I to III UH
tumors, or when chemotherapy and several surgeries do not
result in complete tumor resection with negative margins.
• Unlike in unilateral WT, the performance of a tumor biopsy or
the use of chemotherapy before definitive surgery is not an
indication for flank RT in BWT.
25. • NWTS (National Wilms Tumor Study Group)/ US
approach:
• Primary surgery
• Confirms pathological diagnosis
• Adjuvant treatment based on surgical staging
• Additional prognostic implication of surgical pathology
• SIOP (International Society of Paediatric Oncology /
/European approach: –
• Pre-operative chemotherapy approach
• Reduced spillage
• Tumor downstaging and improved surgical resectability
• Potentially avoids or reduces intensity of adjuvant therapy
26. • UK Children’s Cancer Study Group, UKW3
randomized trial:
Immediate nephrectomy vs Preoperative
Chemotherapy –
Improved stage distribution with preop Approach –
20% reduced use of radiotherapy or doxorubicin –
Similar event-free and overall survival and
distribution
27. • NWTS 1 (1969-74): – Post-operative RT not needed for stage I kids < 2
years age treated with AMD, but needed for older kids
• – Combined AMD and VCR better than either drug alone in stage II/ III
• NWTS 2 (1974-78): – ADR and VCR x 6 months may suffice for older
stage I kids, thereby avoiding RT – Adriamycin needed for stage II or
more
• NWTS 3 (1979-85): – 10 weeks AMD + VCR is sufficient (not 6 months)
in stage I, Favorable histol. (FH)
• – No RT needed for stage II, FH – 10 Gy equivalent to 20 Gy for stage
III, FH
• NWTS 4 (1986-94): – No RT randomizations in the study – Single dose
pulse intensive chemotherapy reduces hematological toxicity and
costs (compared to standard course 5 day course)
• NWTS 5 (1995-2002): – Identified LoH 16 q and 1p as negative
prognostic factor – Addition of etoposide improved outcomes in stage
II or more
28.
29. • Recently completed COG renal protocols: –
AREN0532 - Very Low, Low & Standard Risk FH
Wilms –
• AREN0533 - Higher Risk FH Wilms – st III FH w/ LOH
or st IV FH
• Key RT study question: evaluated omission of lung
RT for patients with CR in lung to 6 weeks of chemo
& without LOH of 1p & 16q
• AREN0534 - Bilateral Wilms –
• AREN0321 - High Risk Renal Tumors (WT w/
anaplasia, clear cell sarcoma of kidney,malignant
rhabdoid tumor, renal cell carcinoma)
39. Side Effects of Treatment
• • Acute: –
• Loose stools
• Nausea
• Fatigue
• Long term: –
1. Bowel adhesions –
2. Infertility (females > males) or future pregnancy complications •
3. Greater in females treated with whole abdomen with both ovaries and uterus in the field.
4. Scoliosis/vertebral body foreshortening
5. Hypertension - Secondary to fibrosis of contralateral renal artery
6. Renal failure (low incidence if treating flank)
7. CHF – risk is ~4% in patients receiving adriamycin1
8. Liver failure (chemotherapy associated)
9. 2nd malignancy (1.6% cumulative risk)
40. End stage renal disease
• The 20-year cumulative incidence of end-stage
renal disease among WT survivors after unilateral
nephrectomy on NWTS protocols was 74% for
children with Denys-Drash syndrome, 36% for
children with WAGR syndrome, 7% for children
with genitourinary anomalies, and 0.6% for
patients with none of these conditions.
41. Second malignant neoplasm
• 15-year cumulative risk of second malignant neoplasm
(SMN) was 1.6%. The risk of developing a lymphoma or
leukemia was 0.4% at 8 years, after which no cases
occurred later
• 73% of solid tumors arose within a previous RT
• the British Cancer Survivor Study__ the cumulative
incidence of a second primary neoplasm at 30, 40, and
50 years of age was 2%, 7%, and 12%, respectively
• In another NWTS report, female survivors who received
WLI had nearly a 15% risk of developing invasive breast
cancer by age 40 years