Lege Artis Medicinae

[CONTEMPORARY THERAPY OF COLORECTAL TUMORS]

LAKATOS László, LAKATOS Péter László

MARCH 20, 2005

Lege Artis Medicinae - 2005;15(03)

[Chemo-radiotherapy of colorectal tumours has become a successful field in oncology. The cornerstone of the treatment has remained the 5- FU containing regimes, however the improvement of administration protocols (e.g. continuous infusion, oral administration) and the addition of biomodulating agents has improved efficacy considerably. The recent availability of newer agents, like irinotecan and oxaliplatin has significantly improved survival of advanced (metastatic) colorectal cancer, extending up to 20 months average survival, also being a consequence of the more aggressive treatment of hepatic and lung metastases. The adjuvant chemotherapy of Dukes’ C tumours has become standard, while the treatment of high-risk B2 tumours is also recommended. Neoadjuvant/adjuvant chemo-radiotherapy improves the prognosis of rectal tumours, however the optimal regime has not yet been determined. The combination of two or more agents is superior to monotherapy and the route and sequence of administration may also influence efficacy. The biological agents of the near future including cetuximab (directed against epidermal growth factor receptor) and bevacizumab (a monoclonal antibody to vascular endothelial growth factor) may further improve survival in poor prognosis patients. The use of the new drugs is limited at the moment by their high costs.]

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[In the last decades the classical clinical specialties have further differentiated. Increasing number of different new subspecialties were born due to the consequences of the robust progress in basic sciences and medical technology. This process has further accelerated due to the new challenges and possibilities in patients' care. Similar tendencies could be seen in neurology. Recently, significant demand has arisen for educational programs for neurologists who want to be familiar in stroke management. These tendencies are also substantiated by stroke epidemiology. In industrialized countries rapid increase in stroke morbidity has been predicted by the increasing life-expectancy. The management of different acute stroke syndromes, the rehabilitation and treatment of post-stroke states needs education and special skills in the field of vascular neurology. Special postgraduate educational programs in vascular neurology (stroke-ology) are formulated in USA as a new subspecialty and it is under preparation in some countries in Europe as well. In Hungary, the Hungarian Stroke Society has initiated the special clinical training and educational programs as preconditions of issuing a license in vascular neurology.]

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