RESUMO
The possibilities and results of multimodal treatment in rectal cancer were reviewed with respect to the results of surgical treatment only. Based on the results of 4 studies, reducing local relapse rates and increasing long-term survival rates significantly, postoperative radiochemotherapy (RCT) + chemotherapy (CT) should remain the recommended standard for R0 resected UICC II and III rectal cancers. Preoperative neoadjuvant radiotherapy (RT) reduced local relapse rates in 8 studies, and extended survival in one study that evaluated all eligible patients. Preoperative RT may evolve as standard, if the patient selection is improved and postoperative morbidity and long-term toxicity are reduced. Postoperative adjuvant RT reduced local relapses significantly in a single trial, and no impact on survival time is reported. Since postoperative RT is inferior to preoperative RT, this treatment cannot be recommended, if RT is chosen as a single treatment modality as an adjunct to surgery. Preoperative RCT + CT downstages resectable and nonresectable tumors and induces a higher sphincter preservation rate. This treatment may be routinely applied in nonresectable primary tumors or local relapses. Intraoperative RT could be added to this concept or be used together with preoperative/postoperative RT with the same indications. The results of local tumor excisions may be improved with pre- or postoperative RCT + CT.
Assuntos
Neoplasias Retais/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Terapia Combinada , Humanos , Hipertermia Induzida , Dosagem Radioterapêutica , Radioterapia Adjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/mortalidade , Taxa de SobrevidaAssuntos
Anafilaxia/induzido quimicamente , Anestésicos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Anafilaxia/tratamento farmacológico , Anafilaxia/imunologia , Anafilaxia/prevenção & controle , Anestesia Geral/efeitos adversos , Anestesia Geral/classificação , Anestesia Local/efeitos adversos , Anestesia Local/classificação , Difenidramina/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Efedrina/uso terapêutico , Humanos , Injeções Intravenosas , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Relaxantes Musculares Centrais/imunologia , Prednisona/uso terapêutico , Testes CutâneosAssuntos
Alérgenos/administração & dosagem , Asma/terapia , Imunoglobulina E/imunologia , Imunoterapia/efeitos adversos , Adolescente , Animais , Animais de Laboratório , Asma/imunologia , Testes de Provocação Brônquica , Criança , Pré-Escolar , Poeira/efeitos adversos , Humanos , Mixomicetos/imunologia , Pólen/imunologia , Esteroides/efeitos adversos , Vacinas Virais/administração & dosagemRESUMO
An approach to allergy diagnosis and treatment in the migrant population of the United States is derived from a review of selected aspects of pollen aerobiology and the nature and distribution of allergenic plants. Pollen distribution and importance are defined and divided into four relatively homogenous geographic regions of the continental United States. Botanic relationships between pollens are then summarized, especially as they relate to the methodology and results of studies of antigenic relationships between pollens. From this information, 13 mixes of tree pollens, 12 mixes of grass pollens, and 12 mixes of week pollens are proposed which would include the pollens of major and secondary importance found in the four defined geographic regions and which would be appropriate for puncture testing. Further grouping of antigens is described for use in intradermal testing and formulating treatment mixtures. A sample skin test sheet is presented which summarizes this information in a practical format.