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Kristiansand, Norway

Glynne-Jones R.,Center for Cancer Treatment
Hematology/oncology clinics of North America | Year: 2012

The primary aim of anal cancer treatment is loco-regional control with preservation of anal function. Phase III trials consistently demonstrate radiotherapy with concurrent 5FU and mitomycin (MMC) chemoradiation is the standard of care for anal cancer. Salvage surgery is associated with considerable morbidity and requires specialised input. With current sophisticated radiological staging and the ability to spare critical normal tissues with intensity-modulated radiotherapy, a "one-size-fits-all" approach is probably inappropriate. Radiotherapy dose-escalation and intensification of the concurrent chemotherapy might improve local control, but may also adversely affect colostomy-free survival. Integration of biologic therapy with conventional chemotherapies looks hopeful in the future. Copyright © 2012 Elsevier Inc. All rights reserved. Source


Glynne-Jones R.,Center for Cancer Treatment | Renehan A.,Christie NHS Foundation Trust | Renehan A.,University of Manchester
Hematology/Oncology Clinics of North America | Year: 2012

The primary aim of anal cancer treatment is loco-regional control with preservation of anal function. Phase III trials consistently demonstrate radiotherapy with concurrent 5FU and mitomycin (MMC) chemoradiation is the standard of care for anal cancer. Salvage surgery is associated with considerable morbidity and requires specialised input. With current sophisticated radiological staging and the ability to spare critical normal tissues with intensity-modulated radiotherapy, a "one-size-fits-all" approach is probably inappropriate. Radiotherapy dose-escalation and intensification of the concurrent chemotherapy might improve local control, but may also adversely affect colostomy-free survival. Integration of biologic therapy with conventional chemotherapies looks hopeful in the future. © 2012 Elsevier Inc. Source


Glynne-Jones R.,Center for Cancer Treatment
Recent Results in Cancer Research | Year: 2012

There is good quality evidence that preoperative radiotherapy reduces local recurrence but there is little impact on overall survival. This is not completely unexpected as radiotherapy is a localised treatment and local control may not prevent systemic failure. Optimal quality-controlled surgery for patients with operable rectal cancer in the trial setting can be associated with local recurrence rates of less than 10 % whether patients receive radiotherapy or not (Quirke et al. 2009). However, despite the reassuring results of randomised trials, concerns remain that radiotherapy increases surgical morbidity (Horisberger et al. 2008; Stelzmueller et al. 2009; Swellengrebel et al. 2011), which can compromise the delivery of postoperative adjuvant chemotherapy. There are also significant late effects from pelvic radiotherapy (Peeters et al. 2005; Lange et al. 2007) and a risk of second malignancies (Birgisson et al. 2005; van Gijn et al. 2011). If preoperative radiotherapy does not impact on survival, can it be omitted in selected cases? The answer is yes - with the proviso that we are using good quality magnetic resonance imaging and good quality TME surgery within the mesorectal plane and the predicted risk of subsequent metastatic disease justifies its use. In this case, the concept of neoadjuvant chemotherapy (NACT) is a potentially attractive alternative strategy which might have less early and long-term side effects compared to preoperative radiotherapy - particularly where the MRI predicts a high risk of metastatic disease in the context of a modest risk of local recurrence. This chapter discusses a more precise method of risk categorisation for locally advanced rectal cancer, and discusses possible options for neoadjuvant chemotherapy (NACT). © 2012 Springer-Verlag Berlin Heidelberg. Source


Cameron M.G.,Center for Cancer Treatment | Kersten C.,Center for Cancer Treatment | Guren M.G.,University of Oslo | Fossa S.D.,University of Oslo | Vistad I.,Sorlandet Hospital Trust
Radiotherapy and Oncology | Year: 2014

Background and purpose: Patients with prostate cancer (PC) and a symptomatic pelvic tumor may be treated with palliative pelvic radiotherapy for symptom relief or to delay symptom progression. Radiotherapy dose and fractionation regimens vary. We aimed to provide an overview of the literature and to evaluate palliative pelvic radiotherapy of PC focusing on symptomatic effect, quality of life (QOL), and toxicity, and to determine the optimal radiotherapy schedule. Material and methods: Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptom and QOL responses were eligible. Results: Nine studies were included, all retrospective chart reviews there were large variations in radiotherapy dose and fractionation. Overall symptom response rate was 75% and positive responses were reported for hemorrhage (73%), pain (80%), bladder outlet obstruction (63%), rectal symptoms (78%) and ureteric obstruction (62%). Toxicity results were not evaluable. Conclusions: Despite limitations in the review process and the included studies, we conclude that pelvic radiotherapy for symptomatic PC appears to provide effective palliation of a variety of symptoms there is currently no valid documentation regarding onset or duration of palliation. No recommendations can be provided regarding target dose or fractionation schedule in this context. © 2013 Elsevier Ireland Ltd. All rights reserved. Source


Cameron M.G.,Center for Cancer Treatment | Kersten C.,Center for Cancer Treatment | Vistad I.,Sorlandet Hospital Trust | Fossa S.,University of Oslo | Guren M.G.,University of Oslo
Acta Oncologica | Year: 2014

Background. Locally advanced and recurrent rectal cancers frequently cause pelvic morbidity including pain, bleeding and mass effect. Palliative pelvic radiotherapy is used to relieve these symptoms and delay local progression. There is no established optimal radiotherapy regimen and clinical practices vary. Our aim was to review the efficacy and toxicity of palliative pelvic radiotherapy of symptomatic rectal cancer and to evaluate different fractionation schedules, based on published literature. Material and methods. Systematic literature searches of Medline, Embase and Cochrane databases were performed through 2011. Studies reporting symptomatic response or quality of life (QOL) after palliative radiotherapy for rectal or rectosigmoid cancer were eligible. Results. Twenty-seven studies were included, of which 23 were retrospective reviews. There were no patient-reported outcomes or QOL assessments. There were large variations in applied radiotherapy regimens. Pooled overall symptom response rate was 75% and positive responses were reported for pain (78%), bleeding and discharge (81%), mass effect (71%) and other pelvic symptoms (72%). Toxicity results were not evaluable. Conclusion. Palliative pelvic radiotherapy for symptomatic rectal cancer appears to provide relief of a variety of pelvic symptoms, although there is no documented optimal radiotherapy regimen in this context. There is inadequate evidence regarding onset, duration and degree of symptom palliation, QOL and associated toxicity with this treatment and prospective studies are therefore needed. © 2014 Informa Healthcare. Source

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