RESUMEN
The incidence of oropharyngeal cancer induced by human papillomavirus (HPV) infection is steadily increasing in developed countries. These tumors are more chemoradiosensitive and have a better prognosis than HPV-negative one. In addition, they occur in younger and better-off patients with longer life expectancy. Current radiotherapy and chemotherapy protocols are currently being questioned as they may expose HPV-positive patients to excessive treatment and unnecessary toxic effects. Less intensive treatment regimens could possibly achieve similar efficacy with lower toxicity and improved quality of life. The aim of this work was to summarize the knowledge on these tumors and their implications for radiation oncologists. In this update, we will discuss ongoing de-escalation trials and highlight the issues raised by these studies. We will also comment on the results of recently published de-intensification studies. Three main strategies are analyzed in the present article: the de-escalation of the drug associated with radiotherapy, the de-escalation of the radiotherapy dose (in concomitant chemoradiotherapy, after induction chemotherapy, in a postoperative setting) and de-escalation of radiation target volumes. Our findings ultimately indicate that clinicians should not change the management of oropharyngeal cancer patients outside of clinical trials.
Asunto(s)
Neoplasias Orofaríngeas/terapia , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/complicaciones , Factores de Edad , Antineoplásicos/administración & dosificación , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Humanos , Quimioterapia de Inducción , Esperanza de Vida , Uso Excesivo de los Servicios de Salud , Neoplasias Orofaríngeas/clasificación , Pronóstico , Calidad de Vida , Oncólogos de Radiación , Dosificación RadioterapéuticaRESUMEN
Batch sorption experiments were performed to study the adsorption of six emerging pollutants from aqueous solutions using a commercial granular activated carbon as adsorbent. Caffeine, clofibric acid, diclofenac, gallic acid, ibuprofen and salicylic acid were selected as representative contaminants. The activated carbon was characterized by nitrogen adsorption at 77â K, and through the determination of point of zero charge. The effects of several operational parameters, such as pH, initial concentration of organic molecules, mass of adsorbent and contact time, on the sorption behaviour were evaluated. The contact time to attain equilibrium for maximum adsorption was found to be 40â min. The kinetic data were correlated to several adsorption models, and the adsorption mechanism found to follow pseudo-second-order and intraparticle-diffusion models with external mass transfer predominating in the first 15â min of the experiment. The equilibrium adsorption data were analysed using the Freundlich, Langmuir and Toth isotherm equation models. The similar chemical structure and molecular weight of the organic pollutants studied to make the adsorption capacity of the activated carbon used very similar for all the molecules.