Gastrointestinal Stromal Tumors Zalcberg, John R.; Yip, Desmond; Hemmings, Christine ...
Gastrointestinal Oncology,
10/2010
Book Chapter
Open access
Gastrointestinal stromal tumors (GISTs) though relatively rare are the most common mesenchymal tumors of the gastrointestinal tract. In the past treatment was mainly confined to surgical resection. ...These tumors are relatively resistant to chemotherapy and radiotherapy. Recent understanding of pathogenesis especially the role of gain of function KIT gene mutations has enabled the rationale development of effective targeted therapies such imatinib mesylate in a relatively short period of time for both the advanced and adjuvant settings. Sunitinib, a multikinase inhibitor, has also been proven as second line therapy and other biological agents such as nilotinib and sorafenib are in clinical testing. Mutational analysis of GIST contributes predictive and prognostic information helping to guide biological therapies. The multidisciplinary management of GIST has also challenged some traditional oncological paradigms.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The results of a questionnaire answered by 205 medical patients are reported (100 patients with cancer and 105 with other medical conditions). The questionnaire examined beliefs and preferences ...regarding various aspects of cancer, including expectations of medical management and treatment. The issues examined relate to beliefs and preferences about information giving, trust of doctors' control of decision making, expectations of help, expectations of treatment, the treatment of cancer pain including morphine use, and issues of terminal care. Some patients appear to hold the inconsistent beliefs that doctors should tell them all they want to know, but that doctors do not know a lot of what they would like to be told. They were also ambivalent about who should make decisions, patient or doctor, suggesting a preference for collaborative consensus decision making. It may be important to inform patients more clearly about what doctors can and cannot reasonably be expected to know and do. Some incorrect beliefs about management were related to fear about having cancer. The results suggest the need for better communication between patients and their professional carers and the need for accessible health information about cancer management to be available to the general public.
Medical education in palliative care Buchanan, J; Millership, R; Zalcberg, J ...
Medical journal of Australia,
1990-Jan-01, Volume:
152, Issue:
1
Journal Article
Peer reviewed
There has been recent concern about both the care of dying patients and the adequacy of the preparation that most doctors receive for this task. The role of the doctor in palliative care is discussed ...and the educational needs of medical students in palliative care are suggested. A palliative care course for fifth-year students at the Austin Hospital-Repatriation General Hospital Clinical School, University of Melbourne, is described. This course recently has been adopted by the Victorian Palliative Care Council as a model for undergraduate palliative medicine education, and has been recommended to the University of Melbourne and Monash University Medical Schools for incorporation in each Clinical School curriculum.
The efficacy and toxicity of 120 mg/m2 etoposide and 100 mg/m2 carboplatin given i.v. daily x 3 together with 750 mg/m2 cyclophosphamide and 1.4 mg/m2 vincristine given i.v. on day 1 (ECCO) in a ...regimen given every 28 days for 6 courses was assessed in 90 (40 limited stage, 50 extensive stage) previously untreated patients with small-cell lung cancer. Mediastinal irradiation using 50 Gy in 25 fractions was given to limited-stage patients without progression after 3 courses of chemotherapy. Cranial irradiation with 30 Gy in 10 fractions was given to all patients attaining a complete response (CR). Objective responses were seen in 83% CR, 60%; partial response (PR), 23% of patients with limited and 76% (CR, 22%; PR, 54%) of those with extensive disease. The median relapse-free survival for objective responders with limited disease was 13.4 months, with a median of 8.0 months for extensive-stage patients. The median relapse-free survival for patients achieving a CR was 13.4 months, with a median of 7.8 months for those undergoing a PR. The median survival was 13.3 months for patients with limited disease, with a median of 9.6 months for those with extensive disease. The median survival following a CR was 18.2 months, with a median survival of 9.9 months for those showing a PR. The combination was well tolerated, with either no nausea or nausea only (WHO grade 0 or 1) in 56% of patients and minimal mucositis, renal toxicity, neurotoxicity or ototoxicity. Neutropenia measuring less than 1.0 x 10(9) WBC/l (WHO grade 3 or 4) was seen in 74% of patients, with two deaths due to infection occurring during neutropenia. Thrombocytopenia of less than 50 x 10(9) platelets/l (WHO grade 3 or 4) occurred in 24% of patients. ECCO is a new, active, well-tolerated program for previously untreated patients with small-cell lung cancer.
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