Тема: Рак яичка?
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Старый 29.08.2012, 22:47
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FRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форумеFRSM этот участник имеет превосходную репутацию на форуме
External beam radiotherapy for stage I and nonbulky stage II disease
Refer patients with stage I and nonbulky stage II seminomas for external beam radiotherapy. Over a 3-week period, administer 2500 cGy in a hockey-stick field, including the para-aortic, paracaval, bilateral common iliac, and external iliac nodal regions. Recent protocols are reducing the radiation field to the para-aortic area only.
A 2005 randomized trial from the Medical Research Council compared adjuvant radiotherapy at 30 Gy versus 20 Gy for stage I seminoma. The lower dose resulted in equivalent associated relapse rates and reduced morbidity, especially regarding fatigue. Further follow-up was recommended to determine if associated long-term secondary malignancies develop.[23]
Mediastinal radiation was commonly administered but is currently avoided because chemotherapy is more effective. Mediastinal radiation may also diminish the ability to provide salvage chemotherapy later, if needed.
Only 3% of patients relapse after radiation therapy. Relapses are usually located outside the radiation field.
Short-term adverse effects include fatigue, nausea, vomiting, and GI upset.
Long-term adverse effects have become of more concern over the last several years. Zagars and colleagues (2004) published a review of all patients who underwent radiotherapy postorchiectomy for seminoma between 1951 and 1999. They then computed standardized mortality ratios based on the person-years method. They found an increased risk after 15 years for cardiovascular and secondary cancer mortalities and recommended investigating new therapies that do not confer these long-term effects.[24] Gamulin et al recommend cytogenetic screening as a way to detect high-risk individuals and thereby regularly monitor seminoma patients after the successful therapy.[25]
As an alternative to radiotherapy, single-agent carboplatin protocols are being studied. The Medical Research Council compared adjuvant carboplatin with radiotherapy and found equivalent relapse rates after a median follow-up period of 4 years. Long-term success of carboplatin therapy is unknown so should be considered experimental at this time.[26]
Chemotherapy for stage II bulky or stage III disease
After radical orchiectomy (see Surgical Care) and metastatic workup, administer 4 cycles of chemotherapy without radiotherapy in patients with advanced seminoma (stage IIB bulky or stage III).[27]
Clinical trials have evaluated numerous chemotherapeutic regimens. While the optimal regimen is debatable, 4 cycles of bleomycin, etoposide, and cisplatin (BEP) is standard.
Ongoing clinical trials are evaluating the omission of the fourth cycle, or bleomycin, in low-risk patients.
For poor-risk and salvage cases, physicians may use alternative regimens using ifosfamide and vinblastine with dose escalation.

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Melnichenko одобрил(а): рада новой встрече !
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