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Clinical guidelines under the format of decision trees are a widespread tool to organise first line curative services in Africa.
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Metastatic TC patients, scheduled for first-line curative cisplatin-based combination chemotherapy in the Leiden University Medical Center were included between 2007 and 2009.
20 Unfortunately, elderly people, in particular octogenarians, are less likely to be offered surgical resection as a first-line curative treatment option owing to either coexisting comorbid conditions or advanced disease at the time of diagnosis.
According to the current guidelines, TACE is the first line non-curative treatment for intermediate stage patients [ 1].
Transarterial chemoembolization is a well-established treatment for HCC and the current guidelines recommend TACE as a first line non-curative treatment for intermediate stage patients with multinodular asymptomatic tumors without vascular invasion or extrahepatic spread [ 1].
RP represents the first line treatment with curative intent, followed by RT (interstitial or external-beam) which is becoming a valid alternative to surgery in patients with low- to intermediate-risk PCa and a long life expectancy [ 2].
Geographical inaccessibility combined with poverty explains the low curative first line care utilisation rates: an average of 0.21 contacts per person per year over the past 5 years for the whole population and of 0.81 if only the population within an area of 5 km from a health centre is considered.
Curative resection remains the first line of treatment; however, due to a high recurrence rate, the overall survival of patients with HCC is poor.
Furthermore, the first line treatment had to be surgery with curative intent, the pathological staging (tumour size and axillary lymph node status according to the pTpN classification) had to be known and tumour marker values of CEA and CA 15-3 had to be available at least within 30 days preceding surgery.
The intensification of first line treatment is believed to increase the rate of patients amenable for a secondary curative approach and even if surgery might not be an option this treatment approach could result in improved long-term disease control.
First line.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com