Friday, 22 March 2019

Spinal cord end

«In humans, the spinal cord stops growing in infancy and the end of the spinal cord is about the level of the third lumbar vertebra, or L3, at birth. Because the bones of the vertebral column continue to grow, by about 12 months of age, the end of the cord reaches its permanent position at the level of L1 or L2 (closer to the head). However, due to normal anatomical variations, the final cord end position may occur anywhere from T12 twelfth thoracic vertebra (T12) to L3.»
Bibliographic reference: En.m.wikipedia.org. (n.d.). Cauda equina. [online] Available at: https://en.m.wikipedia.org/wiki/Cauda_equina [Accessed 27 Mar. 2019].

Thursday, 21 March 2019

Hypopharynx

«The hypopharynx or laryngopharynx forms the most inferior portion of the pharynx, being the continuation of the oropharynx superiorly and both the larynx and esophagus inferiorly. The hypopharynx begins as the continuation of the oropharynx at the pharyngoepiglottic fold (which is at the level of the hyoid bone) superiorly, and extends inferiorly to the level of the inferior aspect of the cricoid cartilage, where it continues as the cervical esophagus. It is a mucosa-lined, muscular tube with its posterolateral walls formed by the inferior constrictor muscle and anterior wall by laryngeal cartilages. It forms part of the pharyngeal mucosal space.
The  boundaries are:
  • anteriorly: post-cricoid mucosa, posterior cricoarytenoid muscle;
  • posteriorly: mucosal wall, middle and inferior constrictor muscles;
  • superiorly: hyoid bone, glossoepiglottic and pharyngoepiglottic folds;
  • inferiorly: cricoid cartilage, cricopharyngeus muscle.
Three subsites of the hypopharynx are described, being pertinent to localize where squamous cell carcinoma arises:
  • pyriform sinus;
  • posterior wall;
  • post-cricoid region/pharyngo-esophageal junction: forms the anterior wall [1].»
«Embryologically, the larynx interjects into the hypopharynx anteriorly and is therefore considered a separate structure. Hypopharyngeal cancers are often named for their location, including pyriform sinus, lateral pharyngeal wall, posterior pharyngeal wall, or post-cricoid pharynx [2].»


Illustration of the pharynx:
Source: Commons.wikimedia.org. (n.d.). File:2411 Pharynx.jpg - Wikimedia Commons. [online] Available at: https://commons.wikimedia.org/wiki/File:2411_Pharynx.jpg [Accessed 21 Mar. 2019].

«The hypopharynx is the longest of the 3 segments of the pharynx. It is wide superiorly and progressively narrows toward the level of the cricopharyngeal muscle. It is bounded anteriorly by the posterior face of the cricoid cartilage. The parts of the hypopharynx that lie partly to each side of the larynx form the pyriform sinuses or fossae [2].»
Source: [2].

Source: [2].

Bibliographic references:
[1] Deng, F. and Knipe, H. (2018). Hypopharynx | Radiology Reference Article | Radiopaedia.org. [online] Radiopaedia.org. Available at: https://radiopaedia.org/articles/hypopharynx [Accessed 21 Mar. 2019].

[2] Quon, H. and Goldenberg, D. (2017). Hypopharyngeal Cancer: Overview, Clinical Presentation, Etiology and Risk Factors. [online] Emedicine.medscape.com. Available at: https://emedicine.medscape.com/article/1375268-overview [Accessed 21 Mar. 2019].

Thursday, 14 March 2019

Primary treatment

It is «the first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, primary treatment is the one accepted as the best treatment. If it doesn’t cure the disease or it causes severe side effects, other treatment may be added or used instead. Also called first-line therapy, induction therapy, and primary therapy.»
Bibliographic reference: National Cancer Institute. NCI Dictionary of Cancer Terms. Primary treatment. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/primary-treatment. Accessed 2019 Mar 14.

Monday, 11 March 2019

Cancer-related survival

It is the time from diagnosis of cancer, or the start of treatment for cancer, to the date of death related to primary cancer.
Bibliographic reference: Wu YC, et al. Long-term results of pathological stage I non-small cell lung cancer: validation of using the number of totally removed lymph nodes as a staging control. Eur J Cardiothorac Surg. 2003 Dec;24(6):994-1001. Available at: https://doi.org/10.1016/S1010-7940(03)00567-0.

Late side effects of radiotherapy

Toxicity typically occurring more than 3 months after treatment.
Bibliographic reference: Peach MS, et al. Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer. Prostate Cancer. 2015;2015:624736. Available at: https://doi.org/10.1155/2015/624736.

Acute side effects of radiotherapy

Toxicity typically occurring within 3 months of treatment.
Bibliographic reference: Peach MS, et al. Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer. Prostate Cancer. 2015;2015:624736. Available at: https://doi.org/10.1155/2015/624736.

Saturday, 9 March 2019

Definitive treatment

«The treatment plan for a disease or disorder that has been chosen as the best one for a patient after all other choices have been considered [1]». It is «any therapy generally accepted as a specific cure of a disease [2]». It «is the first clinical intervention intended to manage a patient's disease, condition or injury and avoid further clinical interventions [3]». It is «a therapy that may be final, superior to others, curative, or all of those [4]». For example, definitive radiation is the «administration of radiation as a sole or first therapy, usually for cancer, with curative intent [5]».
Bibliographic references:
[1] National Cancer Institute. NCI Dictionary of Cancer Terms(n.d.). Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/definitive-treatment [Accessed 9 Mar. 2019].
[2] TheFreeDictionary.com. (n.d.). definitive treatment. [online] Available at: https://medical-dictionary.thefreedictionary.com/definitive+treatment [Accessed 9 Mar. 2019].
[3] Datadictionary.nhs.uk. (2018). Supporting Information: First Definitive Treatment. [online] Available at: https://www.datadictionary.nhs.uk/data_dictionary/nhs_business_definitions/f/first_definitive_treatment_de.asp?shownav=1 [Accessed 9 Mar. 2019].
[4] En.wikipedia.org. (2019). Therapy. [online] Available at: https://en.wikipedia.org/wiki/Therapy#Lines_of_therapy [Accessed 9 Mar. 2019].
[5] TheFreeDictionary.com. (n.d.). definitive radiation. [online] Available at: https://medical-dictionary.thefreedictionary.com/definitive+radiation [Accessed 9 Mar. 2019].

Wednesday, 30 January 2019

Friday, 28 December 2018

Imatinib

It «is a tyrosine-kinase inhibitor used in the treatment of multiple cancers. By preventing a tyrosine-kinase enzyme from phosphorylating subsequent proteins and initiating the signaling cascade necessary for cancer development, imatinib prevents the growth of, and leads to apoptosis in, cancer cells.»
Bibliographic reference: RadOncQuestions. Radoncquestions.com. https://www.radoncquestions.com. Published 2018. Accessed December 28, 2018.

Tuesday, 11 December 2018

Nocturnal polyuria

It is «the production of an abnormally large volume of urine during sleep, is the most important cause of nocturia and commonly defined as a nocturnal urine volume >33% of 24-hour urine volume in elderly patients or >20% in young patients [1].» «Nocturnal polyuria has to be suspected in patients with high-frequency and high-volume urine output that is excessive only at night [1,2].»
«Causes of nocturnal polyuria include a decrease in nocturnal urinary levels of arginine-vasopressin, an increase in atrial natriuretic peptide (e.g. patients with congestive heart failure, obstructive sleep apnoea), peripheral oedema (e.g. patients with venous insufficiency, congestive heart failure, liver failure, chronic kidney disease, nephrotic syndrome), excessive evening/nocturnal fluid intake, use of diuretics (at evening) [1,3].» «Uncontrolled diabetes insipidus/mellitus are potential causes of global polyuria [1,3].»
«Desmopressin (an antidiuretic) may be prescribed to decrease nocturia due to idiopathic nocturnal polyuria in men/women under the age of 65 [1,4]. A newer low-dose, gender-specific formulation of desmopressin is available and not limited to patients under the age of 65 [1,5].» «Antimuscarincs/α-blockers may be offered to men with nocturia associated with (storage) OAB (overactive bladder)/LUTS (lower urinary tract symptoms) [1,4]. However, therapies for OAB/LUTS do not treat nocturia due to nocturnal polyuria [1].» «If nocturia is suspected to be caused by a non-urological condition, the treating physician should consider to refer the patient to a specialist (offer shared care) [1,4].» «However, it should be noted that a first step in the management of nocturia consists of lifestyle modifications  (e.g. avoidance of caffeinated, alcoholic or carbonated beverages in the evening, reduced fluid intake in the evening, bladder emptying before going to be, weight loss) [1,4].
Bibliographic references:
[1] Pinpoint cases - Initial management of nocturia. Mirrors of medicine - PinPoint Cases. https://ppcp.mirrorsmed.org/case/cdombry4m54cg8c4kgws8ks0cs0c08k. Accessed December 16, 2018.
[2] Rees J, et al. Practical approaches to diagnosis and management of nocturia. Trends in Urology & Men's Health. March/April 2018. Available at https://wileymicrositebuilder.com/trends/wp-content/uploads/sites/13/2018/03/Nocturia_v2-lsw.pdf.
[3] Dani H, et alNocturia: aetiology and treatment in adults. Nat Rev Urol 2016;13:573-83. Available at: https://doi.org/10.1038/nrurol.2016.134.
[4] Gravas S, et al. EAU 2018 guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-the-Management-of-Non-neurogenic-Male-LUTS-2018-large-text.pdf.
[5] Juul KV, et alLow-dose desmopressin combined with serum sodium monitoring can prevent clinically significant hyponatraemia in patients treated for nocturia. BJU Int 2017;119:776-84. Available at: https://doi.org/10.1111/bju.13718.

Chemo-Radiotherapy of Oligometastases of Colorectal Cancer With Pegylated Liposomal Mitomycin-C Prodrug (Promitil): Mechanistic Basis and Preliminary Clinical Experience

Chemo-Radiotherapy of Oligometastases of Colorectal Cancer With Pegylated Liposomal Mitomycin-C Prodrug (Promitil): Mechanistic Basis and Preliminary Clinical Experience: Hypo-fractionated radiotherapy and stereotactic body radiotherapy are viable options for treatment of oligometastases. A prodrug of mitomycin-C is under clinical testing as a pegylated liposomal formulation (Promitil) with an improved safety profile over mitomycin-C. Promitil was offered to two patients with oligometastases from colorectal cancer as radiosensitizer. Each derived durable clinical benefit from Promitil administered immediately prior to and following irradiation. Transient toxicity to normal tissues of moderate to severe degree was observed. Promitil appears to have potential clinical value in this setting.

Wednesday, 21 November 2018

Follow-up

«Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends [1]», «(...) in order to observe changes in health status or health-related variables [2]
Bibliographic references:

[1] National Cancer Institute. NCI Dictionary of Cancer Terms. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/follow-up. Accessed November 21, 2018.

[2] Last J. A Dictionary Of Epidemiology. 4th ed. Oxford: Oxford University Press; 2001:72.

Disease-free survival (DFS) or relapse-free survival (RFS)

«In cancer, the length of time after primary treatment for a cancer ends that the patient survives without any signs or symptoms of that cancer. In a clinical trial, measuring the DFS is one way to see how well a new treatment works.»
Bibliographic reference: National Cancer Institute. NCI Dictionary of Cancer Terms. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/dfs. Accessed November 21, 2018.

Tuesday, 20 November 2018

Overall survival (OS)

«The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive [1].» It is «the process of locating research subjects or patients to determine whether or not some outcome of interest has occurred [2].»  It includes any cause of death.
Bibliographic references:
[1] National Cancer Institute. NCI Dictionary of Cancer Terms. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/overall-survival. Accessed November 21, 2018.
[2] Everitt B, Skrondal A. The Cambridge Dictionary Of Statistics. 4th ed. Cambridge: Cambridge University Press; 2011:170.

Monday, 19 November 2018

Classification for long-term survival in oligometastatic patients treated with ablative radiotherapy

CI: confidence interval; OS: overall survival; #: number of.

CI: confidence interval; PFS: progression-free survival.

Bibliographic reference: Hong JC, et al. Classification for long-term survival in oligometastatic patients treated with ablative radiotherapy: A multi-institutional pooled analysis. PLoS One. 2018 Apr 12;13(4):e0195149. Available at: https://doi.org/10.1371/journal.pone.0195149.

Sunday, 21 October 2018

Oligometastatic disease

The oligometastatic disease is an intermediate state between locally advanced and disseminated or multimetastatic cancer [1]. It has been based on the number of detectable metastatic lesions in imaging exams, with the threshold varying between 3 and 10 lesions. Singh et al. [2] reported that a number of metastases limited to five lesions developed during follow-up after curative treatment of primary tumor was significantly associated to better 5-year survival (73% vs. 43% of patients with more than five metastases). Therefore, patients with oligometastatic disease are thought to have improved outcomes compared with those with multimetastatic cancer, with greater median survivals [3]. Until there is genomic or proteomic data that provide a biological component for the definition of oligometastatic disease, a clinical diagnosis based on up to 5 extra-pelvic lesions is reasonable [4]. Relapse may be local or distant. The molecular basis of oliometastases is that they can act like primary tumours and are able to seed and form new metastases [5].

Source: [6]

Bibliographic references:
[1] Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995 Jan;13(1):8-10. Available at: https://doi.org/10.1200/JCO.1995.13.1.8.
[2] Singh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, et al. Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol Biol Phys. 2004 Jan 1;58(1):3-10. Available at: https://doi.org/10.1016/S0360-3016(03)01442-1.
[3] Tree AC, Khoo VS, Eeles RA, Ahmed M, Dearnaley DP, Hawkins MA, et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol. 2013 Jan;14(1):e28-37. Available at: https://doi.org/10.1016/S1470-2045(12)70510-7.
[4] Tosoian JJ, Gorin MA, Ross AE, Pienta KJ, Tran PT, Schaeffer EM. Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations. Nat Rev Urol. 2017 Jan;14(1):15-25. Available at: https://doi.org/10.1038/nrurol.2016.175.
[5] Gundem G, Van Loo P, Kremeyer B, Alexandrov LB, Tubio JMC, Papaemmanuil E, et al. The evolutionary history of lethal metastatic prostate cancer. Nature. 2015 Apr 16;520(7547):353-357. Available at: https://doi.org/10.1038/nature14347.
[6] Alongi F. Radioterapia nella malattia metastatica: indicazioni nel 2018?. Presentation presented at the: 2018; NSCLC: avanzato: quali novità nel 2018? II Congresso Nazionale, Negrar, Verona, Italy. Available at: http://web2.sacrocuore.it/oncologia/Negrar_30_ottobre_2018/Alongi.pdf. Accessed November 24, 2018.

Oligoprogressive

The oligoprogressive phase is a relapsed phase of oligometastatic cancer after a cytoreductive treatment [1]. It «refers to disease progression at a limited number of anatomic sites, with continued response or stable disease at other sites of disease [2].» It can also be related «to patients with stage IV disease who are receiving active systemic therapy that is controlling most of the disease in the body but a small number of sites show disease progression [2].» «Oligoprogression refers to the clinical scenario where a few metastases progress, whereas all other metastases are stable or responding to a systemic therapy strategy. Unlike the oligometastatic state, there can be diffuse metastatic disease, therefore there is no upper limit about how many metastases a patient has. The key point is that with the exception of a few growing tumours, the majority of other tumours are not progressing [3].»

Source: [4]

Bibliographic references:
[1] Alongi F, Mazzola R, Figlia V, Guckenberger M. Stereotactic body radiotherapy for lung oligometastases: Literature review according to PICO criteria. Tumori. 2018 Jun;104(3):148-156. Available at:https://doi.org/10.1177/0300891618766820.
[2] Kim C, Hoang CD, Kesarwala AH, et al. Role of Local Ablative Therapy in Patients with Oligometastatic and Oligoprogressive Non-Small Cell Lung Cancer. J Thorac Oncol. 2017 Feb;12(2):179-193. Available at: https://doi.org/10.1016/j.jtho.2016.10.012.
[3] Cheung P. Stereotactic body radiotherapy for oligoprogressive cancer. Br J Radiol. 2016 Oct;89(1066):20160251. Available at: https://doi.org/10.1259/bjr.20160251.
[4] Alongi F. Radioterapia nella malattia metastatica: indicazioni nel 2018?. Presentation presented at the: 2018; NSCLC: avanzato: quali novità nel 2018? II Congresso Nazionale, Negrar, Verona, Italy. Available at: http://web2.sacrocuore.it/oncologia/Negrar_30_ottobre_2018/Alongi.pdf. Accessed November 24, 2018.

Oligorecurrent

The oligorecurrent phase is a relapsed phase of oligometastatic cancer [1]. «The conditions of oligorecurrence has a primary site of the cancer controlled, meaning that all gross recurrent or metastatic sites could be treated using local therapy [2].»
«Schema 1 shows one distant metastasis/recurrence with a primary lesion. Schema 2 shows two distant metastases/recurrences with a primary lesion.»
Source: [2].


«Schema 1 shows one distant metastasis/recurrence with a controlled primary lesion. Schema 2 shows two distant metastases/recurrences with a controlled primary lesion. The biggest difference between oligometastases and oligo-recurrences lies in the uncontrolled or controlled primary lesion. Oligo-recurrence requires a controlled primary lesion.»
Source: [2].


Source: [3]

Bibliographic reference:
[1] Alongi F, Mazzola R, Figlia V, Guckenberger M. Stereotactic body radiotherapy for lung oligometastases: Literature review according to PICO criteria. Tumori. 2018 Jun;104(3):148-156. Available at: https://doi.org/10.1177/0300891618766820.
[2] Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol. 2010 Feb;40(2):107-11. Available at: https://doi.org/10.1093/jjco/hyp167.
[3] Alongi F. Radioterapia nella malattia metastatica: indicazioni nel 2018?. Presentation presented at the: 2018; NSCLC: avanzato: quali novità nel 2018? II Congresso Nazionale, Negrar, Verona, Italy. Available at: http://web2.sacrocuore.it/oncologia/Negrar_30_ottobre_2018/Alongi.pdf. Accessed November 24, 2018.