Tumor size reduction

Treatment of primary hepatoma by the SMANCS/Lipiodol method has been approved in Japan for more than 6 years, since 1995. When the drug is dehvered by intraarterial administration using catheter, this treatment produces definite tumor size reduction (in >90% of cases), improved survival scores, and especially a good quality of life with very little side effect (Table 4). Furthermore, patients can be out of bed within a few days after the procedure (the Seldinger method is used for arterial infusion under the X-ray system). For all cases of primary hepatoma combined (including Child s criteria of A-C cirrhosis), the 5- to 7- year survival rate is about 30% with this method. With other treatments, no survival would be expected during this time frame. Hepatoma patients with milder liver cirrhosis (such... 

Nevertheless, assessing the efficacy of TACE can be difficult because multiple factors can be used to measure the success. These factors include patient survival, tumor size reduction, generation of tumor necrosis, lipiodol retention, biological response, quality of life, and improvement of the symptoms. This is the challenging problem when interpreting the published data. 

US is sufficient in most unilateral WT patients to assess tumor size reduction during neoadjuvant chemotherapy. Absence of tumor response may be related to histological type (high-risk form or stromal type). Progression of localized WT is rarely seen in patients during preoperative chemotherapy. However, these cases are known to have poorer survival (Ora et al. 2007). 

Intraarterial infusion of microspheres containing adriamycin was used for the local treatment of breast cancer and recurrent breast cancer with liver metastases (123). A reduction in tumor size was noted when the microspheres were injected into the internal and lateral thoracic arteries for treatment of the primary tumor. However, hepatic artery injection for liver metastases resulted in improvement in only one of three patients treated. 

Raloxifene is actually used for the treatment and prevention of postmenopausal osteoporosis. Also, if raloxifene has been shown to have any effect on uterine leiomyomas in vitro and in animal models, to date no concrete efficacy has been demonstrated in normally cycled premenopausal women. Moreover, the addition of raloxifene to GnRH-a administration can be useful for limiting GnRH-a-related side effects and increasing the rate of reduction in tumor size. 

Several cycles of treatment may be necessary to achieve a substantial reduction in tumor size. The chemotherapeutic regimen, especially when one is dealing with large, solid tumors, probably should include agents that have cytotoxic activity against resting cells. 

The observation that mitotane (Lysodren) could produce adrenocortical necrosis in animals led to its use in the palliation of inoperable adrenocortical adenocarcinomas. A reduction in both tumor size and adrenocortical hormone secretion can be achieved in about half of the patients taking the drug. Because normal adrenocortical cells also are affected, endogenous glucocorticoid production should be monitored and replacement therapy administered when appropriate. 

Therefore size reduction may not always provide the intended advantage. Nevertheless, enhanced distribution into the central core of the tumor is likely to result in better overall control of tumor growth and disease progression. While the benefit of improved tissue penetration is debated, it is clear that modification of antibody molecules by reducing their size through enzyme digestion will invariably increase the plasma clearance. 

A dopamine agonist is the usual initial treatment for prolactinomas. Significant reduction in both tumor size and serum prolactin levels occurs in about 85% of those receiving these drugs for 6 months or longer. 

Therapeutic modalities in cancer treatment may involve surgery, radiation, and/or chemotherapy. The objectives of cancer chemotherapy include (1) cure, (2) reduction in tumor size, and (3) prolongation of life. At the present time, approximately 50 percent of patients with cancer can be cured, with drug treatment estimated to contribute in 17 percent of cases. Cancer chemotherapy can be curative in testicular cancer, diffuse large cell lymphoma, Hodgkin s disease, choriocarcinoma, certain childhood tumors (acute lymphoblastic leukemia, Burkitt s lymphoma, Wilms tumor, and embryonal rhabdomyosarcoma). Certain cancers are more resistant to chemotherapy than others (e.g., lung and colon). 

Objective response (reduction in tumor size for a minimum amount of time)... 

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