Therapy adjuvant measures

Adjuvant therapy is usually systemic therapy that is administered to treat any existing micrometastases remaining after treatment of localized disease. Because adjuvant therapy is given to patients with no clinical evidence of cancer, the benefit of the treatment cannot be proven for an individual patient, but only for patient populations. Treatment decisions are based largely on an assessment of the presence of risk factors in an individual patient and the patient s estimated risk for cancer recurrence. The effectiveness of adjuvant therapies is measured statistically, by the relative and absolute reduction in the risk of recurrence. In con-... 

A number of potential prognostic factors have been identified for breast cancer. Prognostic factors are measurements available at diagnosis or time of surgery that in the absence of adjuvant therapy are associated with recurrence rate, death rate, or other clinical outcome. 

Such adjuvant therapy should be performed for several months after grass or tree pollen exposure and perennially for mite allergy patients nevertheless, clinical symptoms disappear after mattress and pillow encasing measures. It should be initiated before immunotherapy as well as be continued during immunotherapy, when therapy-related side effects or allergy-related symptoms appear or virus infections of the respiratory tract occur [16, 17],... 

The use of particular substances may be considered in concordance with the existing haemorrhage situation, (s. tabs. 19.3-19.5) These may constitute either an adjuvant therapy to endoscopic haemostasis or be used when endoscopic or surgical measures are not indicated or not possible. (22, 25, 28, 29, 40, 43, 51)... 

In chronic intoxication, the therapeutic objective is removal of the patient from the site of exposure and elimination of the noxa from the body (e. g. detoxification measures, infusions of calcium-disodium EDTA in cases of lead poisoning, etc.). There is no justification whatsoever for therapeutic nihilism. With the aid of dietetic measures (if necessary) and adjuvant therapy (N-acetylcysteine, antioxidants, ursodeoxycholic acid, S-adenosyl-methionine, etc.), the clinical course and hence the prognosis can be favourably influenced. Insufficient regression or inadequate normalization of laboratory parameters and histological changes despite removal of the patient from the area of exposure must arouse suspicion of a further, still existing noxa (alcohol, medicaments, other chemicals). 

Resection or liver transplantation are considered to be the only curative forms of treatment for cholangiocellular carcinoma. External or intracavitary radiation therapy is the method of choice when it comes to palliative measures. The spectrum of adjuvant or alternative therapy procedures used in HCC is broad, as it is for all oncological conditions. 

Zoledronic acid has also been investigated in the prevention of cancer treatment-induced bone loss in 401 premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer in a randomised, open-label. Phase 111 clinical trial [76]. In this study, patients received tamoxifen and goserelin with or without zoledronic acid (4 mg i.v. every 6 months) versus anastrozole and goserelin with or without zoledronic acid (4 mg i.v. every 6 months) for 3 years. The combination of zoledronic acid with endocrine therapy was well tolerated and was not associated with changes in renal function in this patient population. Over 3 years, 2, 904 serum creatinine measurements were taken, the mean serum creatinine level was 0.78 + 0.17 mg/ dl, and no patient had serum creahnine levels that exceeded 1.5 times the upper limit of normal [76]. 

Metaxalone was approved by the FDA in 1964 as an adjuvant therapy to rest, physical therapy, and other measures for rehef of discomfort associated with acute painfid musculoskeletal conditions. There were two double-blind studies of similar design in the mid-1960s that demonstrated the safety and efficacy of metaxalone compared to placebo. The treatment with metaxalone resulted in marked or moderate improvement of acute low hack syndrome (either pain or spasm) or acute exacerbation of chronic low back disorders. Metaxalone... 

Comparative studies Oral baclofen has been compared retrospectively with tizanidine as adjuvant therapy to botulinum toxin type A in the management of spasticity in children [77 ]. In 30 children with gastrocnemius spasticity, of whom 17 were treated with adjuvant oral baclofen and 13 received tizanidine, the mean Gross Motor Functional Measurement scores (77 versus 68) and caregiver questionnaire scores (70 versus 67) were higher with tizanidine than baclofen. The authors suggested that the combination of botulinum toxin type A with tizanidine is more effective and causes fewer adverse reactions than the combination of botulinum toxin type A and oral... 

One must note that the clinical utility of measuring tamoxifen and its metabolite in serum has yet to be shown. If and how this data will be used clinically is currendy a subject of research. At this time, only one study has been performed looking directly at the relationship between endoxifen concentration and outcomes (WHEL, in press). The results of this study suggest that breast cancer patients undergoing tamoxifen adjuvant therapy, who have serum endoxifen concentrations in the lowest quintile, are at increased risk for breast cancer recurrence. Replication of these findings, as well as prospective trials, would increase support of the use of therapeutic drug monitoring for tamoxifen, NDTam, and endoxifen. 

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