ABSTRACT
La cirugía oncológica se desarrolló como una rama de la cirugía general, que busca facilitar la interacción entre la radioterapia, la oncología médica y las demás especialidades, para concertar un plan terapéutico integral y multidisciplinario del paciente con cáncer. En este artículo se presenta una revisión narrativa de los principios básicos del abordaje diagnóstico y terapéutico del paciente oncológico, bien sea con un diagnóstico inicial o recurrente. Se hace particular énfasis en la necesidad de plantear un tratamiento curativo de ser posible, con márgenes claros y con una aproximación quirúrgica que tenga en cuenta el comportamiento y la diseminación tumoral. Cuando la curación no sea posible, en el contexto de un tratamiento multimodal, la cirugía paliativa es una opción válida y acertada. Los principios de la cirugía oncológica deben ser interiorizados y respetados por todos los cirujanos que enfrentan y tratan pacientes con cáncer. La observancia de estos principios garantizará mejores resultados para los pacientes.
Surgical Oncology has developed as the branch of general surgery that seeks to facilitate the interaction between different specialties, such as medical oncology, radiation oncology and many others, in order to offer a complete and multidisciplinary management of the patient with cancer. In this article we present a narrative review of the basic principles for the diagnosis and therapeutic approach in the oncology patient, either in patients with new diagnosis or in those with recurrent disease. We made particular emphasis on the need to formulate a curative strategy, with clear and negative margins and taking into consideration the pattern of oncologic spread and biologic behavior. In cases where cure is not feasible, and in the context of a multimodal approach, palliative surgery is a valid and appropriate option. The basic principles of surgical oncology should be adopted and respected by all surgeons that treat patients with cancer. The proper adherence to these principles will guarantee better results for these patients.
Subject(s)
Humans , Neoplasms , Cancer Care Facilities , Early Detection of Cancer , General Surgery , Neoplasm StagingABSTRACT
The design of malarial vaccine based on the circumsporozoite (CS) protein, a majuor surface antigen of the sporozoite stage of the malaria parasite, requires the identification of T and B cell epitopes for inclusion in recombinant or synthetic vaccine candidates. We have investigated the specificity and function of a series of T cell clones, derived from volunteers immunized with Plasmodium falciparum sporozoites in an effort to identify relevant epitopes in the immune response to the pre-erythrocytic stages of the parasite. CD4+ T cell clones were obtained wich specifically recognized a repetitive epitope located in the 5'repeat region of the CS protein. This epitope, when conjugated to the 3'repeat region in a synthetic MAPs construct, induced high titers of antisporozoite antibodies in C57B1 mice. A second T cell epitope, which mapped to aa 326-345 of the carboxy terminal, was recognized by lytic, as well as non-lytic, CD4+ T cells derived from the sporozoite-immunized volunteers. The demonstration of CD4+ CTL in the volunteers, and the recent studies inthe rodent model (Renia et al., 1991; Tsuji et al., 1990), suggested that CS-specific CD4+ T cells, in addition to their indirect role as helper cells in the induction of antibody and CD8 + effector cells, may also play a direct role in protection against sporozoite challenge by targeting EEF within the liver