Skip to main content
SpringerLink
Log in

Medical Oncology

  • Chapter
  • First Online:
Book cover Palliative Surgery

  • 1052 Accesses

Abstract

The focus of this chapter is to discuss the impact of modern systemic therapy on the outcomes of patients with advanced malignancy. Gastrointestinal cancer is an ideal example where outcomes have improved and opportunities for surgery of palliative benefit have therefore multiplied. For advanced colorectal cancer in particular, where without effective systemic therapy the median survival was 6 months, there is now the potential for cure when surgery and chemotherapy are incorporated into the treatment plan. Here we will give a concise review of systemic agents along with their potential toxicities and highlight interventions that have now become evermore relevant for the surgeon to consider given the longer survival times of patients with advanced cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CT:

Computed tomography

EGFR:

Epidermal growth factor receptor

FDG-PET:

Fluorodeoxyglucose positron emission tomography

FOLFIRINOX:

5-fluorouracil irinotecan, oxaliplatin

HER2:

Human epidermal growth factor receptor 2

VEGF:

Vascular endothelial growth factor

References

  1. Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22(2):229–37.

    Article  CAS  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

    Article  PubMed  Google Scholar 

  3. Glimelius B, Hoffman K, Graf W, Påhlman L, Sjödén PO. Quality of life during chemotherapy in patients with symptomatic advanced colorectal cancer. The Nordic Gastrointestinal Tumor Adjuvant Therapy Group. Cancer. 1994;73(3):556–62.

    Article  CAS  PubMed  Google Scholar 

  4. Bennett L, Zhao Z, Barber B, Zhou X, Peeters M, Zhang J, et al. Health-related quality of life in patients with metastatic colorectal cancer treated with panitumumab in first- or second-line treatment. Br J Cancer. 2011;105(10):1495–502.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Kabbinavar FF, Wallace JF, Holmgren E, Yi J, Cella D, Yost KJ, et al. Health-related quality of life impact of bevacizumab when combined with irinotecan, 5-fluorouracil, and leucovorin or 5-fluorouracil and leucovorin for metastatic colorectal cancer. Oncologist. 2008;13(9):1021–9.

    Article  CAS  PubMed  Google Scholar 

  6. Belani CP, Brodowicz T, Ciuleanu TE, Krzakowski M, Yang SH, Franke F, et al. Quality of life in patients with advanced non-small-cell lung cancer given maintenance treatment with Pemetrexed versus placebo (H3E-MC-JMEN): results from a randomised, double-blind, phase 3 study. Lancet Oncol. 2012;13(3):292–9.

    Article  CAS  PubMed  Google Scholar 

  7. Chibaudel B, Maindrault-Goebel F, Lledo G, Mineur L, André T, Bennamoun M, et al. Can chemotherapy be discontinued in unresectable metastatic colorectal cancer? The GERCOR OPTIMOX2 study. J Clin Oncol. 2009;27(34):5727–33.

    Article  CAS  PubMed  Google Scholar 

  8. The Cancer Genome Atlas Network. Comprehensive molecular characterization of human colon and rectal cancer. Nature. 2012;487(7407):330–7.

    Article  PubMed Central  Google Scholar 

  9. The Cancer Genome Atlas Network. Comprehensive molecular portraits of human breast tumours. Nature. 2012;490(7418):61–70.

    Article  PubMed Central  Google Scholar 

  10. Merrill RM, Hunter BD. Conditional survival among cancer patients in the United States. Oncologist. 2010;15(8):873–82.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Yu XQ, Baade PD, O’Connell DL. Conditional survival of cancer patients: an Australian perspective. BMC Cancer. 2012;12(1):460.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Wang SJ, Emery R, Fuller CD, Kim J-S, Sittig DF, Thomas CR. Conditional survival in gastric cancer: a SEER database analysis. Gastric Cancer. 2007;10(3):153–8.

    Article  PubMed  Google Scholar 

  13. Buyse M, Thirion P, Carlson RW, Burzykowski T, Molenberghs G, Piedbois P. Relation between tumour response to first-line chemotherapy and survival in advanced colorectal cancer: a meta-analysis. Meta-Analysis Group in Cancer. Lancet. 2000;356(9227):373–8.

    Article  CAS  PubMed  Google Scholar 

  14. Suzuki C, Blomqvist L, Sundin A, Jacobsson H, Byström P, Berglund Å, et al. The initial change in tumor size predicts response and survival in patients with metastatic colorectal cancer treated with combination chemotherapy. Ann Oncol. 2012;23(4):948–54.

    Article  CAS  PubMed  Google Scholar 

  15. Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50 Suppl 1:122S–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Von Hoff DD, Ramanathan RK, Borad MJ, Laheru DA, Smith LS, Wood TE, et al. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol. 2011;29(34):4548–54.

    Article  Google Scholar 

  17. Hendlisz A, Golfinopoulos V, Garcia C, Covas A, Emonts P, Ameye L, et al. Serial FDG-PET/CT for early outcome prediction in patients with metastatic colorectal cancer undergoing chemotherapy. Ann Oncol. 2012;23(7):1687–93.

    Article  CAS  PubMed  Google Scholar 

  18. Gwilliam B, Keeley V, Todd C, Roberts C, Gittins M, Kelly L, et al. Prognosticating in patients with advanced cancer – observational study comparing the accuracy of clinicians’ and patients' estimates of survival. Ann Oncol. 2013;24(2):482–8.

    Article  CAS  PubMed  Google Scholar 

  19. Chabner BA. Clinical strategies for cancer treatment: the role of drugs. In: Chabner BA, Longo DL, editors. Cancer chemotherapy and biotherapy: principles and practice. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 3–14.

    Google Scholar 

  20. Karapetis CS, Khambata-Ford S, Jonker DJ, O’Callaghan CJ, Tu D, Tebbutt NC, et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med. 2008;359(17):1757–65.

    Article  CAS  PubMed  Google Scholar 

  21. Seidman AD, Fornier MN, Esteva FJ, Tan L, Kaptain S, Bach A, et al. Weekly trastuzumab and paclitaxel therapy for metastatic breast cancer with analysis of efficacy by HER2 immunophenotype and gene amplification. J Clin Oncol. 2001;19(10):2587–95.

    CAS  PubMed  Google Scholar 

  22. Baselga J. Targeting tyrosine kinases in cancer: the second wave. Science. 2006;312(5777):1175–8.

    Article  CAS  PubMed  Google Scholar 

  23. Bhojani N, Jeldres C, Patard J-J, Perrotte P, Suardi N, Hutterer G, et al. Toxicities associated with the administration of sorafenib, sunitinib, and temsirolimus and their management in patients with metastatic renal cell carcinoma. Eur Urol. 2008;53(5):917–30.

    Article  CAS  PubMed  Google Scholar 

  24. Sternberg CN, Davis ID, Mardiak J, Szczylik C, Lee E, Wagstaff J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol. 2010;28(6):1061–8.

    Article  CAS  PubMed  Google Scholar 

  25. Je Y, Schutz FAB, Choueiri TK. Risk of bleeding with vascular endothelial growth factor receptor tyrosine-kinase inhibitors sunitinib and sorafenib: a systematic review and meta-analysis of clinical trials. Lancet Oncol. 2009;10(10):967–74.

    Article  CAS  PubMed  Google Scholar 

  26. Hapani S, Sher A, Chu D, Wu S. Increased risk of serious hemorrhage with bevacizumab in cancer patients: a meta-analysis. Oncology. 2010;79(1–2):27–38.

    Article  CAS  PubMed  Google Scholar 

  27. Kesmodel SB, Ellis LM, Lin E, Chang GJ, Abdalla EK, Kopetz S, et al. Preoperative bevacizumab does not significantly increase postoperative complication rates in patients undergoing hepatic surgery for colorectal cancer liver metastases. J Clin Oncol. 2008;26(32):5254–60.

    Article  PubMed  Google Scholar 

  28. Scappaticci FA, Fehrenbacher L, Cartwright T, Hainsworth JD, Heim W, Berlin J, et al. Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol. 2005;91(3):173–80.

    Article  CAS  PubMed  Google Scholar 

  29. Erinjeri JP, Fong AJ, Kemeny NE, Brown KT, Getrajdman GI, Solomon SB. Timing of administration of bevacizumab chemotherapy affects wound healing after chest wall port placement. Cancer. 2011;117(6):1296–301.

    Article  CAS  PubMed  Google Scholar 

  30. Starlinger P, Alidzanovic L, Schauer D, Maier T, Sommerfeldt S, Herberger B, et al. Activity of bevacizumab at the time of surgery after 6 weeks of preoperative cessation. J Clin Oncol. 2012;30 Suppl 4:abstract 455.

    Google Scholar 

  31. Boleti E, Sarwar N, Jones RR, Chowdhury S, Crabb SJ, Shamash J, et al. The safety and efficacy of pazopanib prior to planned nephrectomy in metastatic clear cell renal cancer. J Clin Oncol. 2012;30 Suppl 5:abstract 427.

    Google Scholar 

  32. Powles T, Kayani I, Blank C, Chowdhury S, Horenblas S, Peters J, et al. The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol. 2011;22(5):1041–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Cowey CL, Amin C, Pruthi RS, Wallen EM, Nielsen ME, Grigson G, et al. Neoadjuvant clinical trial with sorafenib for patients with stage II or higher renal cell carcinoma. J Clin Oncol. 2010;28(9):1502–7.

    Article  CAS  PubMed  Google Scholar 

  34. Demetri GD, Von Mehren M, Blanke CD, Van den Abbeele AD, Eisenberg B, Roberts PJ, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347(7):472–80.

    Article  CAS  PubMed  Google Scholar 

  35. Pessaux P, Marzano E, Casnedi S, Bachellier P, Jaeck D, Chenard M-P. Histological and immediate postoperative outcome after preoperative cetuximab: case-matched control study. World J Surg. 2010;34(11):2765–72.

    Article  PubMed  Google Scholar 

  36. Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer. N Engl J Med. 2005;352(5):476–87.

    Article  CAS  PubMed  Google Scholar 

  37. Cunningham D, Atkin W, Lenz H-J, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal cancer. Lancet. 2010;375(9719):1030–47.

    Article  PubMed  Google Scholar 

  38. Grothey A, Sargent D, Goldberg RM, Schmoll H-J. Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol. 2004;22(7):1209–14.

    Article  CAS  PubMed  Google Scholar 

  39. Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27(22):3677–83.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Folprecht G, Gruenberger T, Bechstein WO, Raab H-R, Lordick F, Hartmann JT, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol. 2010;11(1):38–47.

    Article  CAS  PubMed  Google Scholar 

  41. Fiori E, Lamazza A, Schillaci A, Femia S, Demasi E, Decesare A, et al. Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. Am J Surg. 2012;204(3):321–6.

    Article  PubMed  Google Scholar 

  42. Meisner S, González-Huix F, Vandervoort JG, Repici A, Xinopoulos D, Grund KE, et al. Self-expanding metal stenting for palliation of patients with malignant colonic obstruction: effectiveness and efficacy on 255 patients with 12-Month’s follow-up. Gastroenterol Res Pract. 2012;2012:296347.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Karoui M, Charachon A, Delbaldo C, Loriau J, Laurent A, Sobhani I, et al. Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg. 2007;142(7):619–23.

    Article  PubMed  Google Scholar 

  44. Bielawska B, Hookey LC, Jalink D. Large-diameter self-expanding metal stents appear to be safe and effective for malignant colonic obstruction with and without concurrent use of chemotherapy. Surg Endosc. 2010;24(11):2814–21.

    Article  PubMed  Google Scholar 

  45. Scheer MGW, Sloots CEJ, Van der Wilt GJ, Ruers TJM. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol. 2008;19(11):1829–35.

    Article  CAS  PubMed  Google Scholar 

  46. McCahill LE, Yothers G, Sharif S, Petrelli NJ, Lai LL, Bechar N, et al. Primary mFOLFOX6 plus bevacizumab without resection of the primary tumor for patients presenting with surgically unresectable metastatic colon cancer and an intact asymptomatic colon cancer: definitive analysis of NSABP trial C-10. J Clin Oncol. 2012;30(26):3223–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol. 2009;27(20):3379–84.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Tebbutt NC, Norman AR, Cunningham D, Hill ME, Tait D, Oates J, et al. Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases. Gut. 2003;52(4):568–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Hapani S, Chu D, Wu S. Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis. Lancet Oncol. 2009;10(6):559–68.

    Article  CAS  PubMed  Google Scholar 

  50. Damjanov N, Weiss J, Haller DG. Resection of the primary colorectal cancer is not necessary in nonobstructed patients with metastatic disease. Oncologist. 2009;14(10):963–9.

    Article  PubMed  Google Scholar 

  51. Karoui M, Roudot-Thoraval F, Mesli F, Mitry E, Aparicio T, Des Guetz G, et al. Primary colectomy in patients with stage IV colon cancer and unresectable distant metastases improves overall survival: results of a multicentric study. Dis Colon Rectum. 2011;54(8):930–8.

    Article  PubMed  Google Scholar 

  52. Faron M, Bourredjem A, Pignon J-P, Bouche O, Douillard J-Y, Adenis A, et al. Impact on survival of primary tumor resection in patients with colorectal cancer and unresectable metastasis: pooled analysis of individual patients’ data from four randomized trials. J Clin Oncol. 2012;30 Suppl 15:abstract 3507.

    Google Scholar 

  53. Costi R, Mazzeo A, Di Mauro D, Veronesi L, Sansebastiano G, Violi V, et al. Palliative resection of colorectal cancer: does it prolong survival? Ann Surg Oncol. 2007;14(9):2567–76.

    Article  PubMed  Google Scholar 

  54. Gonsalves WI, Wolpert J, Tashi T, Ganti AK, Subbiah S, Ternent C, et al. Assessment of prognostic factors after primary tumor resection in metastatic colon cancer patients: a Veteran’s Affairs Central Cancer Registry (VACCR) analysis, 1995–2008. J Surg Oncol. 2012;106(4):486–90.

    Article  PubMed  Google Scholar 

  55. Gervaz P, Rubbia-Brandt L, Andres A, Majno P, Roth A, Morel P, et al. Neoadjuvant chemotherapy in patients with stage IV colorectal cancer: a comparison of histological response in liver metastases, primary tumors, and regional lymph nodes. Ann Surg Oncol. 2010;17(10):2714–9.

    Article  PubMed  Google Scholar 

  56. Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg. 2004;240(3):438–50.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg. 1995;19(1):59–71.

    Article  CAS  PubMed  Google Scholar 

  58. Steele BG, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D. A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group Protocol 6584. J Clin Oncol. 1991;9(7):1105–12.

    PubMed  Google Scholar 

  59. Delaunoit T, Alberts SR, Sargent DJ, Green E, Goldberg RM, Krook J, et al. Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741. Ann Oncol. 2005;16(3):425–9.

    Article  CAS  PubMed  Google Scholar 

  60. Gonzalez M, Robert JH, Halkic N, Mentha G, Roth A, Perneger T, et al. Survival after lung metastasectomy in colorectal cancer patients with previously resected liver metastases. World J Surg. 2012;36(2):386–91.

    Article  PubMed  Google Scholar 

  61. Iida T, Nomori H, Shiba M, Nakajima J, Okumura S, Horio H, et al. Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg. 2013;257(6):1059–64.

    Article  PubMed  Google Scholar 

  62. Fiorentino F, Hunt I, Teoh K, Treasure T, Utley M. Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis. J R Soc Med. 2010;103(2):60–6.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010;(3):CD004064.

    Google Scholar 

  64. Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358(1):36–46.

    Article  CAS  PubMed  Google Scholar 

  65. Bang Y-J, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376(9742):687–97.

    Article  CAS  PubMed  Google Scholar 

  66. Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K, et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer – a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer. 2011;47(15):2306–14.

    Article  CAS  PubMed  Google Scholar 

  67. Kang JH, Lee II S, Lim DH, Park K-W, Oh SY, Kwon H-C, et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol. 2012;30(13):1513–8.

    Article  CAS  PubMed  Google Scholar 

  68. Loehrer PJ, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, et al. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2011;29(31):4105–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  69. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25(15):1960–6.

    Article  CAS  PubMed  Google Scholar 

  70. Burris HA, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15(6):2403–13.

    CAS  PubMed  Google Scholar 

  71. Romanus D, Kindler HL, Archer L, Basch E, Niedzwiecki D, Weeks J, et al. Does health-related quality of life improve for advanced pancreatic cancer patients who respond to gemcitabine? Analysis of a randomized phase III trial of the cancer and leukemia group B (CALGB 80303). J Pain Symptom Manage. 2012;43(2):205–17.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  72. Vaccaro V, Sperduti I, Milella M. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;365(8):768–9.

    Article  CAS  PubMed  Google Scholar 

  73. Gourgou-Bourgade S, Bascoul-Mollevi C, Desseigne F, Ychou M, Bouché O, Guimbaud R, et al. Impact of FOLFIRINOX compared with gemcitabine on quality of life in patients with metastatic pancreatic cancer: results from the PRODIGE 4/ACCORD 11 randomized trial. J Clin Oncol. 2013;31(1):23–9.

    Article  CAS  PubMed  Google Scholar 

  74. Jeurnink SM, Van Eijck CHJ, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18–27.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Larssen L, Medhus AW, Hauge T. Treatment of malignant gastric outlet obstruction with stents: an evaluation of the reported variables for clinical outcome. BMC Gastroenterol. 2009;9:45–50.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Conrad C, Lillemoe KD. Surgical palliation of pancreatic cancer. Cancer J. 2012;18(6):577–83.

    Article  PubMed  Google Scholar 

  77. Tey J, Back MF, Shakespeare TP, Mukherjee RK, Lu JJ, Lee KM, et al. The role of palliative radiation therapy in symptomatic locally advanced gastric cancer. Int J Radiat Oncol Biol Phys. 2007;67(2):385–8.

    Article  PubMed  Google Scholar 

  78. Field KM, Michael M. Part II. Liver function in oncology: towards safer chemotherapy use. Lancet Oncol. 2008;9(12):1181–90.

    Article  CAS  PubMed  Google Scholar 

  79. Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev 2006;(2):CD004200.

    Google Scholar 

  80. Kasuga A, Ishii H, Ozaka M, Matsusaka S, Chin K, Mizunuma N, et al. Clinical outcome of biliary drainage for obstructive jaundice caused by colorectal and gastric cancers. Jpn J Clin Oncol. 2012;42(12):1161–7.

    Article  PubMed  Google Scholar 

  81. Feuer DJ, Broadley KE, Shepherd JH, Barton DP. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2000;4, CD002764.

    PubMed  Google Scholar 

  82. Hoda D, Jatoi A, Burnes J, Loprinzi C, Kelly D. Should patients with advanced, incurable cancers ever be sent home with total parenteral nutrition? A single institution’s 20-year experience. Cancer. 2005;103(4):863–8.

    Article  PubMed  Google Scholar 

  83. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004;1, CD002916.

    PubMed  Google Scholar 

  84. Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012;307(22):2383–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville South, 5011, SA, Australia

    Peter S. Savas MBBS, BMedSci

  2. Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Woodville Road, Adelaide, 5011, SA, Australia

    Timothy J. Price MBBS, FRACP

Authors
  1. Peter S. Savas MBBS, BMedSci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy J. Price MBBS, FRACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Peter S. Savas MBBS, BMedSci or Timothy J. Price MBBS, FRACP .

Editor information

Editors and Affiliations

  1. Department of General Surgery, Mount Gambier General Hospital, Flinders University—Rural Medical School, Mount Gambier, South Australia, Australia

    Matthias W. Wichmann

  2. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia

    Guy Maddern

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Savas, P.S., Price, T.J. (2014). Medical Oncology. In: Wichmann, M., Maddern, G. (eds) Palliative Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-53709-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-53709-7_7

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-53708-0

  • Online ISBN: 978-3-642-53709-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation