The presence of two or less unfavourable factors identifies low-risk groups, and for these low-risk patients it is probably a good strategy to defer radiotherapy until tumour progression (Pignatti et al, 2002).
Moreover, in some patients, especially those at the lowest risk for early disease progression, deferred RT in favor of active surveillance or chemotherapy alone may remain a reasonable treatment approach.
The most significant study was that conducted by the British National Lymphoma Investigation Group, which randomized 309 patients with advanced indolent lymphoma (204 with FL) to immediate treatment with chlorambucil or to systemic therapy deferred until disease progression [ 18].
We performed a multi-centre randomised phase III study comparing the use of Dexamethasone, Aspirin, and immediate addition of Diethylstilbestrol (DAiS) vs Dexamethasone, Aspirin, and deferred (until disease progression) addition of Diethylstilbestrol (DAdS).
Conversely, if the labs are worsening, LDH is increasing, and the patient is physically deteriorating, then nurses note the suspected progression, deferring to the treating physician to make further therapeutic decisions.
This was a multi-centre, randomised, open-label phase III trial to compare two treatment strategies in patients with newly diagnosed CRPC: the trial compared the use of Dexamethasone, Aspirin, and immediate addition of Diethylstilbestrol (DAiS) vs Dexamethasone, Aspirin, and deferred (until disease progression) addition of Diethylstilbestrol (DAdS).
The investigators' reason in both cases was to defer treatment until symptomatic disease progression.
Such disease stabilization is of particular importance for patients who are not liver transplant candidates, as prevention of further disease progression may significantly defer or prevent complete liver failure, where no further treatment options exist.
Multiple causes may contribute to loss of muscle mass, and improved nutrition, including intake of high-quality animal protein, is just one of the possible methods to defer development of the condition and/or delay its progression.
AS allows patients with low risk disease to defer definitive therapy, potentially indefinitely, until objective evidence of disease progression is noted.
