Problem Based Learning Issues
Janix M. De Guzman, MD
Tumor Response
• Definitions of response are complete, partial, minor, stable, and progressive disease.
• By convention, a "response" indicates that the disease has regressed by at least 50% as determined by serial bidimensional measurements and that no new lesions have appeared elsewhere for a period of at least 4 weeks.
• The absence of clinical evidence of tumor in the breast by physical examination was categorized as clinical complete response (cCR).
• A clinical partial response (cPR) was assigned if the product of the two largest perpendicular diameters of the breast tumor had decreased by 50% or more.
• Minor response
– a less than 50% decrease in sum of products of perpendicular diameters of all measurable tumor.
• Progressive disease (cP) was assigned if there was a 50% or greater increase in tumor size.
• Patients whose breast tumor did not meet the criteria for cCR, cPR, or cP were considered to have stable disease (cS).
• Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;(30):96-102
•
Forastiere A, Jacobs C. Biophysiology of Antineoplastic Chemotherapy
for Head and Neck Cancer
http://famona.tripod.com/ent/cummings/cumm006.pdf.
Cystic Hygroma
• Recurrence following complete resection is approximately 10%.
• goal of performing surgery
– completely remove the cystic hygroma or to remove as much disease as possible, sparing all vital structures.
• Radical ablative surgery not justified
• Recurrence is not treated easily because of scarring and deformation of tissue planes.
• Resect the cystic hygroma to the greatest extent possible when clinically apparent.
Adjuvant Therapy
• No mention on the role of chemotherapy and radiotherapy.
• Sclerosing Agents
– Bleomycin – toxic, cause pulmonary fibrosis
– Picibanil (OK-432) – contains penicillin and streptococci for large unilocular cysts.
– Absolute alcohol – works well with vascular malformations
References