Cycles surgery

The general case cycles surgery for auxiliary discrete dynamical... 

In the chemical reaction networks that we study, there is no small parameter with a given distribution of the orders of the matrix nodes. Instead of these powers of we have orderings of rate constants. Furthermore, the matrices of kinetic equations have some specific properties. The possibility to operate with the graph of reactions (cycles surgery) significantly helps in our constructions. Nevertheless, there exists some similarity between these problems and, even for... 

Figure 1 The main operation of the cycle surgery on a step back we get a cycle...

Dominant systems are acyclic. All the stationary rates in the first order are limited by limiting steps of some cycles. Those cycles are glued in the hierarchical cycle gluing procedure, and their limiting steps are deleted in the cycles surgery procedures (see Section 4.3 and Figure 1). 

Adjuvant tamoxifen therapy generally is initiated shortly after surgery or as soon as pathology results are known and the decision to administer tamoxifen as adjuvant therapy is made. The administration of tamoxifen should be limited to administration after completion of chemotherapy based on results from a study that randomized patients to receive chemotherapy for six cycles with concurrent tamoxifen, followed by continued tamoxifen for a total of 5 years, or chemotherapy with sequential tamoxifen for 5 years.39 After a median follow-up of 8.5 years, the administration of sequential tamoxifen resulted in an estimated DFS advantage of 18% [hazard ratio (HR) = 1.18] compared with the concurrent use of tamoxifen with chemotherapy.39 It is believed the growth-inhibitory effect of... 

After initial surgery, the gold standard of care is six cycles of a taxane/platinum-containing regimen for patients with advanced ovarian cancer. 

In patients with bulky disease or a significant tumor burden, neoadjuvant chemotherapy can be used to decrease tumor burden to increase the likelihood of optimal tumor debulking during surgery.35 Typically, three cycles of the standard combination taxane/platinum regimen is administered once every 3 weeks. After surgery, the patient will receive another three to six cycles depending on response to chemotherapy. 

This 67-year-old patient was optimally debulked and completed six cycles of paclitaxel/carboplatin after her surgery. HerCA-125 normalized (12 U/mL, 12 kU/L) on completion of her chemotherapy treatment, and her CT scan was negative. This patient returns to your clinic for her first 3-month follow-up appointment. Her CA-125 is (45 U/mL, 45 kU/L), and she reports some mild bloating. CT scan report states mild fluid accumulation in the pelvic cavity. 

Overall survival is affected by the success of the initial surgery to debulk the tumor to less than 1 cm of disease and response to first-line chemotherapy. The CA-125 level should be monitored with each cycle, and at least a 50% reduction in CA-125 after four cycles of taxane/platinum chemotherapy is related to an improved prognosis. Patients who achieve a complete response should have follow-up examinations every 3 months, including CA-125 determination, physical examination, pelvic examination, and appropriate diagnostic scans (e.g., CT scan, MRI, or PET scan) and should be evaluated for the detection of disease. Evaluate patients for resolution of any residual chemotherapy-related side effects, including neuropathies, nephrotoxicity, ototoxicity, myelosuppression, and nausea/vomiting. 

Gorodeski GI [1996] The Cervical Cycle. In Adashi EY, Rock JA and Rosenwaks Z (eds.), Reproductive Endocrinology, Surgery, and Technology. Lippincott-Raven Publishers, Philadelphia New York, pp. 301-324... 

Vanderbilt University Medical Center has recently completed accruing patients to a Phase II study of neoadjuvant chemoradiation, which consists of preoperative paclitaxel (175 mg/m2,3-h infusion) followed by cisplatin 75 mg/m2 d 1 and 21. Concurrent radiation was given to a total dose of 3000 cGy, in 200 cGy/fraction. Patients who are resectable go on to surgery 4 wk after completion of chemoradiation, whereas those who are unresectable (i.e., cervical esophageal cancer) continue to a total dose of 60 Gy without treatment interruptions. One month following surgery, patients receive two cycles (q 21-28 d) of postoperative chemotherapy, which consists of paclitaxel 175 mg/m2 over 3 h d 1,5-FU 350 mg/m2, d 1-3, and leucovorin 300 mg d 1-3. Preliminary analysis of this... 

Between 3/95 and 3/98,47 patients were enrolled. At restaging, prior to surgery, eight (17%) were found to have progressed, while seven patients had metastases documented at surgery. Complete resection was achieved in 33 (70%) patients. At the time of surgery there were 5/33 patients with complete pathologic, pCRs (15%), and 9 (27%) had only microscopic residual foci. Only 25 patients were able to complete the two cycles of postoperative chemotherapy. Median survival was found to be 15 mo,and at 46 mo 16.5% of patients were alive (62). 

It is interesting to note that the results from our studies at Vanderbilt using lower doses of radiation have led to similar survival rates, local control, and less toxicity when compared to centers using higher doses of radiation. This dose of radiation was based on earlier studies that utilized two cycles of cisplatin, 5-FU, etoposide, and leucovorin with 3000 cGy of radiation followed by resection. The median survival of 24 mo and 2-yr survival of 51% was better than historical controls treated with surgery alone (63,64). 

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