Quality of Survival

Till, J. E.

doi:10.1007/978-3-642-83101-0_3

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…Because the persistence of proteinuria is common several weeks after drug withdrawal, patients in a Japanese phase 2 study with grade 2 proteinuria were allowed to continue lenvatinib, demonstrating no concern about serious renal dysfunction. 17 Drug withdrawal is required when either an increase in creatinine level or leg oedema occurs but is not required when grade 2 proteinuria occurs without increased creatinine or leg oedema. When grade 3 or worse proteinuria occurs, drug withdrawal is preferred regardless of any increase in creatinine level or leg oedema.…”

Section: Management Of Adverse Events Related To Vegfr-targeted Tkimentioning

confidence: 99%

Management of recurrent or metastatic thyroid cancer

Tahara

2018

ESMO Open

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Recently, vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) have become available for the treatment of recurrent or metastatic thyroid cancer. However, a number of clinical challenges that impact the use of VEGFR-targeted TKI in daily clinical practice have arisen. Toxicity is considerable, to the extent that most physicians hesitate to start VEGFR-targeted TKI and prefer to continue a watch-and-wait approach until the patient’s disease markedly worsens. This delayed use of VEGFR-targeted TKI leads to a higher incidence of serious adverse events than was reported in clinical trials. Moreover, the watch-and-wait approach has several demerits, including a worsening of quality of life, worsening of outcomes in patients of older age or with follicular thyroid cancer and increased risk of brain metastasis or bleeding. Thus, optimal timing for the start of VEGFR-targeted TKI requires careful consideration. Moreover, management of VEGFR-targeted TKI toxicities requires appropriate supportive care, well-organised infrastructure in the outpatient clinic and patient education. Future treatment will progress to precision medicine based on molecular testing. Promotion of precision medicine requires the establishment of a system of easy access to molecular testing and the promotion of translational research for the development of new drugs.

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Section: Management Of Adverse Events Related To Vegfr-targeted Tkimentioning

confidence: 99%

Management of recurrent or metastatic thyroid cancer

Tahara

2018

ESMO Open

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Results of surgical treatments and prognostic factors for hepatic hilar bile duct cancer

Ishiyama

Fuse

Kuzu

et al. 1998

Journal of Hepato-Biliary-Pancreatic Surgery

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Results of surgical treatments for 57 patients who underwent resection for hepatic hilar bile duct cancer between 1984 and 1997 were studied. Bile duct resection was performed in eight patients, and combined resection of bile duct and liver was performed in 49 patients, of whom vascular reconstruction was added in 15 patients and pancreatoduodenectomy (PD) in six patients. All the operations of bile duct resection that were not combined with hepatectomy were non-curative. In the patients who underwent combined resection of the bile duct with liver, outcomes of the patients with well-differentiated adenocarcinoma were better than those with other lower-grade tumors. The factors related to the degree of tumor extension, such as serosal invasion, lymph node metastasis, lymphatic vessel invasion, perineural invasion, venous vessel invasion, and vascular involvement, were other factors which significantly influenced the survival. Curative resection yielded significantly better results than non-curative resection. Of all these variables, good tumor differentiation and vascular involvement were recognized as important prognostic factors by multivariate analysis. Most of the postoperative deaths were encountered in patients who underwent additional operations to hepatectomy, such as vascular reconstruction or PD. Improvement of surgical techniques and perioperative care has yielded better outcomes of vascular reconstruction. However, the application of hepatopancreatoduodenectomy should be limited due to poor outcomes of widespread bile duct cancer of which the histological grade is usually low. Whereas prognosis of bile duct cancer involving the hepatic hilus is mainly determined by the biologic characteristics of the tumor, surgeons should consider the fact that most patients die of local recurrence regardless of the biologic character of the tumor when curative resection is not performed.

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Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

Nimura

Kamiya

Kondo

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

364

298

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From 1977 to 1997, surgical resection was possible in 142 (80%) of 177 patients with hilar cholangiocarcinoma after relieving jaundice by single or multiple percutaneous transhepatic biliary drainage followed by percutaneous transhepatic cholangioscopy and/or percutaneous trans-hepatic portal vein embolization. Curative resection was possible in 108 (61%) of the 142 patients, and 100 of these patients underwent various types of hepatectomy with caudate lobectomy for a 30-day operative mortality rate of 6% and 9% hospital mortality. Combined portal vein resection was carried out in 43 cases including 41 hepatectomies and 2 bile duct resections. Hepatopancreatoduodenectomy was performed in 16 patients. Cancer recurrence was observed in 58 of the 108 patients undergoing curative resection. The 3-, 5-, and 10-year survival rates for 100 patients undergoing curative hepatectomy and 8 with curative bile duct resection were 43%, 26%, and 19%; and 31%, 16%, and 0%, respectively; those for 40 patients with positive lymph node metastasis, 84 with perineural invasion, and 43 with combined portal vein resection were 27%, 14%, and 7%; 34%, 21%, and 13%; and 18%, 6%, and 0%, respectively. These survival rates are significantly better than those for 35 patients with unresectable cancer. Curative resection after aggressive preoperative management is recommended as a reasonable surgical approach to hilar cholangiocarcinoma.

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Quality of Survival

Cited by 5 publications

References 18 publications

Management of recurrent or metastatic thyroid cancer

Management of recurrent or metastatic thyroid cancer

Results of surgical treatments and prognostic factors for hepatic hilar bile duct cancer

Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

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