Download Adjuvant Therapy of Primary Breast Cancer by M. H. N. Tattersall (auth.), Professor Dr. Hans-Jörg Senn, PDF

By M. H. N. Tattersall (auth.), Professor Dr. Hans-Jörg Senn, Priv.-Doz. Dr. Aron Goldhirsch, Dr. Richard D. Gelber, Dr. Bruno Osterwalder (eds.)

The final "consumer" of the information provided at meetings at the basic therapy of operable breast melanoma is the sufferer, and whilst, as during this sickness, some great benefits of treatment are quite mod­ est, the supply and interpretation of the information from trials be­ comes a subject of basic value. the results of current deal with­ ment are in truth such that extra sufferers relapse regardless of remedy than are expected to learn from it. it's, accordingly, tremendous dif­ ficult for the health care provider to suggest unequivocally one specific adjuvant therapy modality for the immense inhabitants of girls with breast melanoma. the translation of effects from scientific research-oriented seasoned­ grams is consistently utilized, although, within the therapy of breast melanoma sufferers outdoors of medical trials. From provided or put up­ ed information, many physicians extrapolate symptoms for using a given therapy routine for his or her sufferers, perceiving it because the "best on hand remedy. " it's crucial that the "best on hand remedy" be chosen separately for every sufferer. notwithstanding, contemplating the modest impression of remedy upon end result, it really is critical that those that give you the information - those people who are inquisitive about either pa­ tient care and scientific learn - make it recognized that the simplest cur­ hire remedy for the inhabitants of breast melanoma sufferers is avail­ capable in the framework of scientific trials. during this means not just present-day sufferers but additionally destiny ones will derive the best benefit.

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Preoperative chemotherapy will act simultaneously on both the systemic and the locoregional component, with the effective downstaging of the tumor enabling subsequent surgery (Frei et al. 1986). In a subset of patients in whom the systemic, but not the loco regional, component will be eradicated, such resection can be considered a curative procedure (Ragaz Experimental Basis and Clinical Reality of Preoperative Chemotherapy 31 et al. 1987 a). Recent data also indicate that as a result of debulking large tumors, surgery could not only take place, but also radical surgery may be replaced by a more conservative approach (Frei et al.

1986a, 1986b). However, trials testing the concept should continue to be designed and implemented because the contribution of dose intensity to treatment outcome will probably depend upon the specific therapeutic situation (Pater 1987). In addition, trials must be conducted to see how dose intensity can be further increased above present levels in an attempt to approve treatment results. If these attempts are successful, we will not yet have reached the limits of what is possible to achieve with chemotherapy.

Distribution of age is shown in Table 2. For all patients, a history and physical examination, complete blood count, serum chemistry, urinalysis, electrocardiogram, echocardiogram, chest roentgenograms, bone scans, liver echography, assays of carcinoembryonic antigen levels, and bilateral mammograms were performed. The initial treatment consisted of intravenous infusion of a combination of vinblastine (6 mg/m 2), thiotepa (6 mg/m 2), methotrexate (25 mg/m 2), 5-fluorouracil (350 mg/m 2) (VTMF), delivered for 1 h, with, in groups III and IV, Adriamycin (VTMFA) (30 mg/m 2) added.

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