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Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, even though there is a relative lack of consistent evidence that this care model improves outcomes. In this review, we present the available literature regarding how to set up and run an efficient multidisciplinary care model for lung cancer patients with emphasis on team members’ roles and responsibilities. Moreover, we present some limited evidence about multidisciplinary care and its impact on lung cancer outcomes and survival. This review provides simple guidance on setting up and running a multidisciplinary service for lung cancer patients. It highlights the importance of defined roles and responsibilities for team members. It also presents concise information based on the literature regarding the impact of multidisciplinary care in lung cancer outcomes (e.g. survival of patients undergoing lung cancer surgery)., Despite lack of robust evidence, multidisciplinary care remains the cornerstone in lung cancer care https://bit.ly/3qFXy2w

Several adjuvant approaches are regarded as available options in the management of localized, resectable gastric cancer .The objective of our study was to evaluate multiple field and anteroposterior conformal technique.Ninety-seven patients received three dimensional conformal (3DCRT) postoperative adjuvant radiation therapy for gastric carcinoma. Thirty-five patients received anteroposterior (AP/PA) fields (Group B), while 62 patients were irradiated with multifield technique (Group A). Their ages ranged between 29-85 years. The objective of the study was to evaluate the quality of life (QoL) for all patients after the completion of radiotherapy using the QLQ-C30 of the EORTC questionnaire (European Organization for Research and Treatment of Cancer) and to investigate any measurable differences between those two radiation techniques according to QUANTEC criteria and the radiotoxicity.In terms of QUANTEC criteria, the multifield technique was superior concerning the left kidney (p=0.025), right kidney (p0.001), spinal cord (p0.001) and planning target volume (PTV) coverage (p0.001). According to EORTC/ RTOG toxicity criteria, the rate of diarrhea was higher in AP/ PA technique (p=0.028). In terms of QLQ-C30, the multifield technique was superior concerning appetite loss (p=0.022), diarrhea (p=0.046) and global QoL (p0.001).On the basis of QLQ-C30 questionnaire, EORTC/ RTOG toxicity and dosimetric parameters, the present report has shown that the three dimensional multifield conformal radiotherapy is superior compared to AP-PA techniques.

"As its title suggest, this thesis will explore the letters of Bishop Basil of Caesarea as instruments of communion. In particular I will examine how Basil used his letters as instruments for arriving at, maintaining and expressing communion within a pro-Nicene church. For Basil, the divinity of the Father, Son and Holy Spirit was affirmed best through doxological worship and had ecclesiastical communion as its lasting expression. Basil’s letters became the instruments through which he nurtured the fulfilment of his ecclesiological vision of the church as communion. His pastoral and theological message, although often set in an individual and local setting, persistently upheld a social and universal outlook expressed in terms of the church’s communion. He insisted that the most fervent relationship with God involves communion with human persons as well. Personal being within the church is intrinsically relational and communal. When Christians are united in communion with God through partaking of the Eucharist in any given worshipping community, they are united without division and without confusion with all believers and across all periods of time. Basil not only addressed and communicated with people from various walks of life but also became a voice for them as well. Whether letters were addressed to clergy, magistrates, civil or military officials, ascetics, youth, widows, friends or congregations, they found their way to being copied and circulated amongst the faithful and proved to be foundational in bringing into communion the churches of the East. Basil regarded maintaining and expressing communion as of the highest importance for the ministry of the bishop. The act of letterwriting between bishops facilitated their “being in communion” within the Nicene church and when required served as proof of this communion through establishing a canon of communion. Amongst Nicene bishops, an affirmation of a creed in writing became the guarantor of a bishop’s communion and a sign of his collegiality with all other bishops. The collective voice of the bishops on issues of faith, doctrine and morals, was essential not only to safeguard the church’s communion but also to enhance its accessibility. As instruments of communion Basil’s letters reveal what he understood as the characteristics of ecclesial communion. This thesis concludes that key characteristics of communion for Basil are that it be eucharistic, in the Spirit and in Christ, Trinitarian, inspired by the New Testament, traditional, nicene, episcopal, ascetical, institutional, identifying with the poor, catholic, accessible and safeguarded, mutually responsible, doing God’s will, and beneficial. "

Malignant gliomas (glioblastoma multiforme and anaplastic astrocytoma) which have a combined incidence of 5-8/100,000 population, represent the most common primary central nervous system tumors. The treatment outcomes even with aggressive approach including surgery, radiation therapy and chemotherapy are dismal with median reported survival is less than 1 year. Temozolomide is a new drug which has shown promise in treating malignant gliomas and other difficult-to-treat tumors. This drug is a per os (p.o) imidazotetrazine second-generation alkylating agent which represents the leading compound in a new class of chemotherapeutic agents that enter the cerebrospinal fluid and do not require hepatic metabolism for activation. The efficacy of temozolomide was tested in vitro studies and has demonstrated schedule-dependent antitumor activity against highly resistant malignancies, including high-grade glioma (HGG). In addition, in clinical studies, temozolomide consistently demonstrates reproducible linear pharmacokinetics with approximately 100% p.o. bioavailability, noncumulative minimal myelosuppression that is rapidly reversible, and activity against a variety of solid tumors in both children and adults. Moreover, preclinical studies have evaluated the combination of temozolomide with other alkylating agents and inhibitors of the DNA repair protein O(6)-alkylguanine alkyltransferase to overcome resistance to chemotherapy in malignant glioma and malignant metastatic melanoma. At the present time temozolomide is approved in the United States for the treatment of adult patients with refractory anaplastic astrocytoma and, in the European Union, for treatment of glioblastoma multiforme showing progression or recurrence after standard therapy. Temozolomide's characteristics which make it a candidate for a wide range of clinical testing to evaluate the potential of combination treatments in different tumor types are its predictable bioavailability and minimal toxicity. An overview of the mechanism of action of temozolomide and a summary of results from more important randomized controlled clinical trials in high grade gliomas are presented here.

To prospectively assess the efficacy of the selective serotonin inhibitor escitalopram on painful bone metastases, in combination with external beam irradiation.Forty-three patients with cancer metastatic to bone and suffering from depression were treated with 3 Dimensional Conformal Radiotherapy (3DCRT) (30 Gy; 3 Gy/fraction, 5 days/week) combined with escitalopram (20 mg/day). Pain relief was evaluated with Wong/Baker Faces Pain Scale. The patients reported outcome using a RTOG-EORTC quality-of-life self-questionnaire (QLQ-C30 v3.0) and the status of depression according to Hamilton Scale (HAM-17). The assessment was performed at baseline and 6-8 weeks after radiotherapy.Patients treated with radiotherapy and escitalopram tended to show a good response to pain and improvement of their quality of life.Though our data concerned a rather small number of patients, addition of escitalopram to 3DCRT accomplished a high clinical benefit rate on neuropathic pain from bone metastasis.

intravesical treatment for the radiation induced cystitis. Materials and Methods: Between September 2009 and December 2012, in a prospective way, 20 patients with prostate cancer that had showed radiation induced cystitis after radiotherapy, were selected for the present analysis and were treated with intravesical instillations of CYSTISTAT. All candidates had undergone three-dimensional confomal radiotherapy with a total dose of 72-74 Gy. They all suffered from radiation induced cystitis and painfull bladder syndrome and treated with 4 weekly bladder instillations of CYSTISTAT and 2 monthly instillations thereafter. Patients were started to be clinically evaluated 6 months post radiotherapy. Symptoms of haematuria, frequency of voiding and findings from cystoscopy were assessed before and 3 months after CYSTISTAT treatment, according the EORTC/RTOG criteria. Results: The median age was 66 years. Treatment response was evaluated up to 20 months post radiotherapy. The patients were undergone cystoscopy before and after the CYSTISTAT treatment. All candidates completed the treatment scheme and no serious side effects of intravesical instillation of CYSTISTAT were recorded. A significant reduce of radiation induced cystitis was noted, since the mean score of radio-cystitis before and after the CYSTISTAT instillation was 2.70 ± 0.47 and 1.45 ± 0.51, respectively (P

Malignant gliomas (glioblastoma multiforme and anaplastic astrocytoma) which have a combined incidence of 5-8/100,000 population, represent the most common primary central nervous system tumors. The treatment outcomes even with aggressive approach including surgery, radiaton therapy and chemotherapy are dismal with median reported survival is less than 1 year. Temozolomide is a new drug which has shown promise in treating malignant gliomas and other difficult-to-treat tumors. This drug is a per os (p.o) imidazotetrazine second-generation alkylating agent which represents the leading compound in a new class of chemotherapeutic agents that enter the cerebrospinal fluid and do not require hepatic metabolism for activation. The efficacy of temozolomide was tested in vitro studies and has demonstrated schedule-dependent antitumor activity against highly resistant malignancies, including high-grade glioma (HGG). In addition, in clinical studies, temozolomide consistently demonstrates reproducible linear pharmacokinetics with approximately 100% p.o. bioavailability, noncumulative minimal myelosuppression that is rapidly reversible, and activity against a variety of solid tumors in both children and adults. Moreover, preclinical studies have evaluated the combination of temozolomide with other alkylating agents and inhibitors of the DNA repair protein O6-alkylguanine alkyltransferase to overcome resistance to chemotherapy in malignant glioma and malignant metastatic melanoma. At the present time temozolomide is approved in the United States for the treatment of adult patients with refractory anaplastic astrocytoma and, in the European Union, for treatment of glioblastoma multiforme showing progression or recurrence after standard therapy. Temozolomide's characteristics which make it a candidate for a wide range of clinical testing to evaluate the potential of combination treatments in different tumor types are its predictable bioavailability and minimal toxicity. An overview of the mechanism of action of temozolomide and a summary of results from more important randomized controlled clinical trials in high grade gliomas are presented here. © 2009 by the authors.

Introduction: Wilms tumor (nephroblastoma) represents 20% of malignant tumors in childhood. Less than 3% of diagnosed cases are found in adults and 10% of those are diagnosed in stage IV with multiple metastases (contralateral kidney, liver etc). Lung metastases is uncommon (