Surgery remains the primary determinant of cure in patients with localized rectal cancer, and total mesorectal excision is now widely accepted as standard of care. The widespread implementation of neoadjuvant short-course radiotherapy (RT) or long-course chemoradiotherapy (CRT) has reduced local recurrence rates from 25% to 40% to less than 10%; Preoperative RT in resectable rectal cancer has a number of potential advantages, most importantly reducing local recurrence, and down-staging effect. In this article making a comprehensive literature review searching the reliable medical data bases of PubMed and Cochrane we present all available information on the role of radiation therapy alone or in combination with chemotherapy in preoperative setting of rectal cancer. Data reported show that in locally advanced rectal cancer the addition of radiation therapy or CRT pre surgically has significantly improved sphincter prevention surgery. Moreover, the addition of chemotherapy to radiation therapy in preoperative setting has significantly improved pathologic complete response rate and loco-regional control rate without improvement in sphincter preserving surgery. Finally, the results of recently published randomized trials have shown a significant improvement of pre- vs postoperative CRT on local control; however, there was no effect on overall survival.

Despite the fact that gastric cancer is decreasing in incidence in the United States, it remains one of the most commonly diagnosed and most fatal cancers worldwide. In localised disease, surgery remains the cornerstone of treatment. Nevertheless, the low overall survival rates at 5 years due to locoregional and distant recurrences has led to a large debate regarding the role of radiation therapy and chemotherapy in addition to curative resection. Recent data have shown that, even with improved surgical techniques, locoregional failure rates in these patients ranged between 57% and 88%. Failures were noted in the gastric bed, regional nodes, gastric remnant, anastomosis and duodenal stump, all of which can be encompassed in a regional radiation field, indicating the need of further locoregional treatment. In this article, a comprehensive literature review of the reliable medical databases of PubMed and Cochrane is made and we present all available information on the role of radiation therapy in the preoperative and postoperative setting of gastric cancer. Data reported show that in locally advanced gastric cancer the addition of radiation therapy post surgery has significantly improved disease-free survival as well as overall survival. Moreover, in unresectable gastric cancer, the combination of radiation therapy with chemotherapy has significantly improved mean and overall survival rates. The role of radiation therapy in patients with resectable gastric cancer is being further evaluated in ongoing phase III trials.

Capecitabine (Xeloda®) is an oral fluoropyrimidine which is produced as a pro-drug of fluorouracil, and shows improved tolerability and intratumor drug concentrations following its tumor-specific conversion to the active drug. We have searched the Pubmed and Cochrane databases from 1980 to 2009 with the purpose of reviewing all available information on Capecitabine, focusing on its clinical effectiveness against colorectal cancer. Special attention has been paid to trials that compared Capecitabine with standard folinic acid (leucovorin, LV)-modulated intravenous 5-fluorouracil (5-FU) bolus regimens in patients with metastatic colorectal cancer. Moreover the efficacy of Capecitabine on metastatic colorectal cancer, either alone or in various combinations with other active drugs such as Irinotecan and Oxaliplatin was also assessed. Finally, neoadjuvant therapy consisting of Capecitabine plus radiation therapy, for locally advanced rectal cancer was analysed. This combination of chemotherapy and radiotherapy has a special role in tumor down staging and in sphincter preservation for lower rectal tumors. Comparative trials have shown that Capecitabine is at least equivalent to the standard LV-5-FU combination in relation to progression-free and overall survival whilst showing a better tolerability profile with a much lower incidence of stomatitis. It is now known that Capecitabine can be combined with other active drugs such as Irinotecan and Oxaliplatin. The combination of Oxaliplatin with Capecitabine represents a new standard of care for metastatic colorectal cancer. Combinating the Capecitabine-Oxaliplatin regimen with promising new biological drugs such as Bevacizumab seems to give a realistic prospect of further improvement in time to progression of metastatic disease. Moreover, preoperative chemo-radiation using oral capecitabine is better tolerated than bolus 5-FU and is more effective in the promotion of both down-staging and sphincter preservation in patients with locally advanced rectal cancer. Finally, the outcomes of recently published trials suggest that capecitabine seems to be more cost effective than other standard treatments for the management of patients with colorectal cancer.

Ionizing radiation is extensively used in medicine and its contribution to both diagnosis and therapy is undisputable. However, the use of ionizing radiation also involves a certain risk since it may cause damage to tissues and organs and trigger carcinogenesis. Computed tomography (CT) is currently one of the major contributors to the collective population radiation dose both because it is a relatively high dose examination and an increasing number of people are subjected to CT examinations many times during their lifetime. The evolution of CT scanner technology has greatly increased the clinical applications of CT and its availability throughout the world and made it a routine rather than a specialized examination. With the modern multislice CT scanners, fast volume scanning of the whole human body within less than 1 min is now feasible. Two dimensional images of superb quality can be reconstructed in every possible plane with respect to the patient axis (e.g. axial, sagital and coronal). Furthermore, three-dimensional images of all anatomic structures and organs can be produced with only minimal additional effort (e.g. skeleton, tracheobronchial tree, gastrointestinal system and cardiovascular system). All these applications, which are diagnostically valuable, also involve a significant radiation risk. Therefore, all medical professionals involved with CT, either as referring or examining medical doctors must be aware of the risks involved before they decide to prescribe or perform CT examinations. Ultimately, the final decision concerning justification for a prescribed CT examination lies upon the radiologist. In this paper, we summarize the basic information concerning the detrimental effects of ionizing radiation, as well as the CT dosimetry background. Furthermore, after a brief summary of the evolution of CT scanning, the current CT scanner technology and its special features with respect to patient doses are given in detail. Some numerical data is also given in order to comprehend the magnitude of the potential radiation risk involved in comparison with risk from exposure to natural background radiation levels.

Low-dose rate brachytherapy has become a mainstream treatment option for men diagnosed with prostate cancer because of excellent long-term treatment outcomes in low-, intermediate-, and high-risk patients. To a great extend due to patient lead advocacy for minimally invasive treatment options, high-quality prostate implants have become widely available in the US, Europe, and Japan. High-dose-rate (HDR) afterloading brachytherapy in the management of localised prostate cancer has practical, physical, and biological advantages over low-dose-rate seed brachytherapy. There are no free live sources used, no risk of source loss, and since the implant is a temporary procedure following discharge no issues with regard to radioprotection use of existing facilities exist. Patients with localized prostate cancer may benefit from high-dose-rate brachytherapy, which may be used alone in certain circumstances or in combination with external-beam radiotherapy in other settings. The purpose of this paper is to present the essentials of brachytherapies techniques along with the most important studies that support their effectiveness in the treatment of prostate cancer.

Objective

To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time.

Methods

Meta-regression analyses of available data. Data Sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials.

Results

Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%–82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening tended to decrease by 1.72% per year (P =0.086). Corresponding annual changes in European, North American, and Australian settings were −0.68% (P =0.494), −2.02% (P =0.044), and +2.59% (P =0.010), respectively. Changes were not influenced by national guide-lines.

Conclusions

Considering the increasing incidence of melanoma and other skin malignancies, as well as their relative potential consequences, the FBSE implementation time-trend we retrieved should be considered a worrisome phenomenon.

Urothelial carcinoma of the upper urinary tract represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75% with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers, while endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. Several controversies remain in their management, including a selection of endoscopic versus laparoscopic approaches, management strategies on the distal ureter, the role of lymphadenectomy, and the value of chemotherapy in upper tract disease. Aims of this paper are to critically review the management of such tumors, including endoscopic management, laparoscopic nephroureterectomy and management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in their treatment.