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Biomedical subjects

M Javle

Publications and source records attributed to M Javle.

8 recordsLinked to original sources
PubMed2005

Cardiac function after chemoradiation for esophageal cancer: comparison of heart dose-volume histogram parameters to multiple gated acquisition scan changes.

In this paper we determine if preoperative chemoradiation for locally advanced esophageal cancer leads to changes in cardiac ejection fraction. This is a retrospective review of 20 patients treated at our institution for esophageal cancer between 2000 and 2002. Multiple gated acquisition cardiac scans were obtained before and after platinum-based chemoradiation (50.4 Gy). Dose-volume histograms for heart, left ventricle and left anterior descending artery were analyzed. Outcomes assessed included pre- and postchemoradiation ejection fraction ratio and percentage change in ejection fraction postchemoradiation. A statistically significant difference was found between median prechemoradiation ejection fraction (59%) and postchemoradiation ejection fraction (54%) (P = 0.01), but the magnitude of the difference was not clinically significant. Median percentage volume of heart receiving more than 20, 30 and 40 Gy were 61.5%, 58.5% and 53.5%, respectively. Our data showed a clinically insignificant decline in ejection fraction following chemoradiation for esophageal cancer. We did not observe statistically or clinically significant associations between radiation dose to heart, left ventricle or left anterior descending artery and postchemoradiation ejection fraction.

Aged↗
PubMed2004

Controversies in the multimodality management of locally advanced esophageal cancer: evidence-based review of surgery alone and combined-modality therapy.

Most patients with esophageal cancer present with locoregional disease, and the optimal initial management is controversial. The current National Comprehensive Cancer Network (NCCN) practice guidelines support diverse treatment options for locoregional disease, including surgical resection alone, definitive chemoradiation therapy, and preoperative combined-modality (neoadjuvant/trimodality) therapy. Many cancer centers worldwide favor a neoadjuvant approach, although the evidence supporting this practice is inconsistent. A concise review of the literature is presented. The topics discussed do not necessarily reflect each author's opinions or clinical practices.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Should preoperative, post-chemoradiotherapy endoscopy be routine for esophageal cancer patients?

Chemoradiation therapy is used widely for locoregional esophageal cancer. Patients with persistent disease may benefit from surgery. Preoperative esophagoscopy can identify persistent tumor but its accuracy is uncertain. The primary objective of this study is to assess the extent of agreement between esophagoscopy and surgical pathology in patients treated with neoadjuvant chemoradiation. A retrospective chart review of patients who underwent chemoradiation, preoperative endoscopy and surgery from January 1996 to December 2002 was performed. Cohen's kappa statistic was used to measure the degree of agreement between findings at endoscopic biopsy and surgical pathology. Thirty cases were identified. All patients received chemoradiation followed by surgical resection. There was insufficient agreement between tumor size (kappa 0.25, standard error 0.17, P = 0.07) and appearance (kappa 0.19, standard error 0.18, P = 0.14). Preoperative endoscopy revealed atypia/inflammation in 15 cases and dysplasia in eight. Of these 23 cases, 11 were adenocarcinomas at surgery. Only nine patients had concurrence between surgical pathology and endoscopy. The positive and negative predictive values of esophagoscopy for identifying residual tumor were 100% and 11%, respectively. Our data suggests that after chemoradiation, esophagoscopy is unreliable for excluding residual disease. The roles of other modalities need to be explored.

Adenocarcinoma↗
PubMed1998

Radiotherapy and chemotherapy for invasive bladder cancer.

Invasive bladder cancer is associated with locoregional and distant metastases. To improve the outcome of management, systemic chemotherapy has been combined with locoregional treatment. Programmes have been structured in which chemotherapy is administered before or after definitive radiotherapy or surgery, or in combination with radiotherapy. Most randomized trials to date have failed to define a survival benefit from initial chemotherapy, but evidence is emerging that classical adjuvant chemotherapy may improve survival. New cytotoxic agents, including paclitaxel and gemcitabine, accompanied by an emerging understanding of the factors governing cytotoxic drug resistance, may also lead to better management.

Chemotherapy, Adjuvant↗
PubMed1997

Evolving strategies of cytotoxic chemotherapy for advanced prostate cancer.

Despite the use of cytotoxic chemotherapy for advanced prostate cancer for half a century, its clinical utility in this setting remains undefined. Based on traditional methods of assessment, the list of the most active cytotoxic agents includes cyclophosphamide, doxorubicin, mitoxantrone and cisplatin. With the introduction of more structured methods of assessment, including careful assessment of indices of quality of life and serial measurement of serum prostate-specific antigen (PSA), the role of cytotoxic agents is being re-assessed. In view of the cell cycle characteristics of prostate cancer, there appears to be an emerging role for combination inhibitors of mitosis, including estramustine in combination with the vinca alkaloids, etoposide or paclitaxel.

Antineoplastic Agents↗
PubMed1996

Systemic Therapy for Invasive Bladder Cancer.

BACKGROUND: Bladder cancer is one of the most common malignancies in Western society. In the United States, approximately 10,000 of these patients present with invasive disease, and more progress from superficial bladder cancer. METHODS: The authors review the literature on systemic treatment for both localized and metastatic bladder cancer, and they include their experience in defining approaches to various stages of disease. RESULTS: Cisplatin-based combination chemotherapy is the most effective systemic approach for advanced bladder cancers, although few patients are cured. Neoadjuvant, perspective, and adjuvant trials, as well as concurrent chemoradiation studies, are in progress to attempt to demonstrate better outcomes. CONCLUSIONS: The combination of systemic chemotherapy and definitive local therapy may have a useful role in the management of locally advanced bladder cancers, but optimal schedules and true survival benefit have not been established.

Journal Article↗