If daily image guidance techniques, such cone-beam CT scans are utilized, it may be possible to reduce the planning target volume (PTV). Postoperative doses of 45-50.4 Gy for R0 complete surgical resection with negative margins are appropriate to reduce long-term complications such as stricture.
Higher doses of 54-60 Gy would be Inhibitors,research,lifescience,medical recommended for patients with R1 resections. Conclusions Adjuvant chemoOlaparib supplier radiation is a suitable option for the management of the resected, locally advanced esophageal cancer patient, especially for T3/T4 disease, nodal positivity, and R1 or R2 resection. Doses of 45 to 50.4 Gy can be used for R0 to R1 resections, but for gross residual disease, a boost of 5-9 Gy may be considered. For tumors of the intrathoracic esophagus, concurrent cisplatin and 5-FU can be used, and for GEJ carcinomas, the Inhibitors,research,lifescience,medical INT-0116 protocol can be recommended. The available data suggests an improvement in local control and a possible survival improvement with the use of postoperative radiation therapy. Inhibitors,research,lifescience,medical Footnotes No potential conflict of interest.
Oxaliplatin (L -OHP)-fluoropyrimidine combinations are widely used in the first-line treatment for metastatic colorectal cancer (1)-(3). Due to recent advances in molecular targeted therapies, cetuximab (Cmab), an anti-epidermal growth
factor receptor (EGFR) antibody, is recommended as the first-line therapy with L -OHP, leucovorin, and fluorouracil (FOLFOX) or as second-line therapy after a FOLFOX regimen for stage IV colorectal cancer patients (4),(5). Peripheral sensory neurotoxicity Inhibitors,research,lifescience,medical (PSN) is a dose-limiting toxicity that is associated with L-OHP, which is the key drug in the FOLFOX regimen. Therefore, a stop-and-go approach has been proposed to manage PSN (6). PSN
can either be transient and acute or chronic due to the accumulation Inhibitors,research,lifescience,medical of L-OHP (2),(7). The hallmarks of PSN are dysesthesia and paresthesia in the limbs, which are triggered by cold exposure and in some cases accompanied by cramps (8). PSN occurs in 90% of patients who receive L-OHP and persists in 30% of patients after one year of stopping treatment (1). In addition, L-OHP must be discontinued when the cumulative dose reaches 800 mg/m2 because 10-15% of cases develop grade 3 or higher functional disorder (1),(9). Previous studies on the mechanism of PSN reported that calcium and magnesium replacement effectively reduced chronic PSN, because suggesting that these supplements are efficacious (10),(11). Moreover, the prospective CONcePT study confirmed the effectiveness of calcium and magnesium replacement (12). However, Cmab has been reported to induce hypomagnesaemia (13)-(15). This anti-EGFR antibody blocks EGFR in the nephron and inhibits magnesium reabsorption from the convoluted distal tubule, leading to magnesium loss from the kidneys (13)-(15).