Download Clinical Oncology Fourth Edition: Basic Principles and by Neal, Anthony J PDF

Download Clinical Oncology Fourth Edition: Basic Principles and by Neal, Anthony J PDF

By Neal, Anthony J

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Optimum initial management of the primary tumour and regional metastases is vital if later relapse is to be avoided, and close liaison between surgeon and oncologist is required to enable the best use of each modality. MANAGEMENT OF THE PRIMARY TUMOUR Surgery for a malignant tumour may have several components: ■ ■ ■ tissue biopsy to establish the diagnosis removal of malignant disease with a clear margin of normal tissue repair, reconstruction and restoration of function. This may vary according to the extent of resection and anatomical site, from simple primary wound closure to major reconstruction of bone and soft tissue with vascularized grafts and prostheses.

Trial infrastructure Clinical trials demand an extensive infrastructure within a dedicated central clinical trials 33 unit that will co-ordinate the trial and provide a central point for randomization, data collection and analysis. It should be independent from the investigators entering and treating patients in the trial who are usually based in many different centres all accruing relatively small numbers of patients. A randomized clinical trial may take several years before it is completed and analysed to give reliable results that will be translated into clinical practice.

For example, the risk of local relapse in the breast following simple excision with no radiotherapy is around 30–50 per cent depending upon tumour size. On this basis, if all patients are treated following lumpectomy, half may never have required treatment; the difficulty lies in predicting accurately those who will relapse. A further consideration is the fact that local relapse following lumpectomy may be treated successfully in many women and will still occur in 5–10 per cent even with radiother- Quality of life apy.

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