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Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates these...
Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Urinary Tract Calculi IV: Nutrition Therapy and Prevention

Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
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Kidney Transplant II: Surgical Procedure

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Induction of Invasive Transitional Cell Bladder Carcinoma in Immune Intact Human MUC1 Transgenic Mice: A Model for Immunotherapy Development
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Neoadjuvant chemotherapy for bladder cancer.

Peter C Black1, Gordon A Brown, H Barton Grossman

  • 1Department of Urology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1373, Houston, TX 77030, USA.

World Journal of Urology
|November 23, 2006
PubMed
Summary

Neoadjuvant chemotherapy improves survival for bladder cancer patients after radical cystoprostatectomy. A risk-adapted approach minimizes toxicity by offering treatment only to high-risk individuals unlikely to benefit from adjuvant chemotherapy.

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Published on: December 1, 2013

Area of Science:

  • Uro-oncology
  • Medical oncology
  • Surgical oncology

Background:

  • Radical cystoprostatectomy (RCP) has a 30-45% failure rate, necessitating improved multimodal therapies.
  • Cisplatin-based chemotherapy shows success in metastatic bladder cancer and is now used for high-risk, non-metastatic disease.

Purpose of the Study:

  • To review the evidence supporting peri-operative chemotherapy in bladder cancer.
  • To evaluate the efficacy of neoadjuvant chemotherapy (NAC) compared to adjuvant chemotherapy.
  • To present a risk-adapted strategy for NAC to optimize patient selection and minimize toxicity.

Main Methods:

  • Literature review of studies on peri-operative chemotherapy for bladder cancer.
  • Analysis of evidence for neoadjuvant and adjuvant chemotherapy efficacy and toxicity.
  • Discussion of patient selection criteria for NAC.

Main Results:

  • Neoadjuvant chemotherapy demonstrates improved survival outcomes in patients with high-risk bladder cancer.
  • Both neoadjuvant and adjuvant chemotherapy have limitations, including treatment-related toxicity and difficulty identifying responders.
  • A risk-adapted approach can spare low-risk patients from unnecessary treatment toxicity.

Conclusions:

  • Peri-operative chemotherapy, particularly neoadjuvant chemotherapy, is crucial for improving survival in bladder cancer.
  • Risk stratification is essential for tailoring neoadjuvant chemotherapy, maximizing benefits while minimizing harm.
  • Future strategies should focus on identifying predictive markers for neoadjuvant chemotherapy response.