International advances in surgical oncology最新文献

Cancer of the pancreas remains a disease for which there is no satisfactory treatment. A specific population at risk and etiologic factors have not been clearly defined. The increased incidence in industralized countries over the past 30 to 40 years is not understood. Technological advances have permitted more frequent diagnosis at an early stage, but this has not influenced survival statistics. Clearly, there is a need for a reliable tumor marker that will allow diagnosis to be made even earlier. Radical surgery appears to have reached a plateau in terms of improving survival. Morbidity and mortality have decreased since pancreatoduodenectomy began to be widely used. This decrease is probably due to better pre- and postoperative surgical management than to major improvements in technique. More radical procedures have failed to demonstrate clearcut improvements in survival. Radiotherapy and chemotherapy are in the early stages of systematic exploration in treating pancreatic cancer. Most reports deal only with palliating advanced, nonresectable disease. The utility of radiotherapy and chemotherapy as adjuncts to surgery have not been defined.

This report covers the authors' experience during 19 years with patients at Buenos Aires Municipal School of Oral, Cervical, and Thyroid Surgery at Rawson Hospital; at the Municipal Hospital of Oncology; and in their private practice. During this period, 165 patients underwent surgery for thyroid cancer. An analysis is made of the surgical treatments chosen, the different histological types encountered, and the lymph node and radical neck dissections performed. The advantages and drawbacks of total thyroidectomy, as well as the survival rates, are commented upon.

Patients classified as having locally advanced breast cancer constitute a heterogeneous population of patients with variable prognoses among subgroups. Analysis of reported series has been complicated by the use of a wide variety of staging classifications and the inclusion by some (and not by others) of inflammatory carcinoma in reporting of end results. In spite of difficulties in this literature review, certain conclusions are possible: The 1983 AJCC-UICC staging system would appear to be a reasonable system for assuring comparability of results in future clinical trials. Although the precise frequency of LABC among series cannot be determined with certainty, this presentation probably constitutes less than 20% of series in the Western world. Recognizing that axillary lymph node status is the single most important prognostic variable in primary breast cancer, it has been reported that LABC with large local tumors are associated with neoplastic involvement of axillary lymph nodes in 65-80% of cases, thus connoting a poor prognosis. Patients with T3N0 lesions may constitute a subgroup of patients with relatively indolent (possibly receptor-positive) disease who might have a reasonably good prognosis compared with other variants of LABC, with approximately 75% to 82% of patients surviving five years with surgery alone. Surgery alone for the overall category of LABC is associated with a 20-31% ten-year survival rate, with local control varying from 50-75% in two reported series. Most radiation therapy (XRT) series deal with patients considered inoperable; hence five-year survival statistics in most series range between 10-20%. Selected radiation therapy series may yield results comparable to surgical series. Where reported, XRT has been associated with median survivals in the range of 25 months. Local control with XRT is likely a function of radiation dose, and the use of external beam or iridium implant boosts to the primary tumor mass for increased local control is worthy of continued study. The combination of XRT and mastectomy appears to be superior to either modality alone in terms of local control and survival, although this conclusion is based on analysis of retrospective studies. Combined modality therapy with systemic therapeutic modalities (hormonal and/or chemotherapy) plus the local modalities of surgery and radiation therapy appear promising. Prospective controlled trials using a uniformly accepted staging classification coupled with gathering of useful biological data (such as cytokinetic perturbation data, receptor information, marker studies, etc) should lead to improved treatment approaches in the future.