Estro-Halt EU- Designed for Estrogen Support | Contains CDG, Indole-3-Carbinol & Apigenin

Product Information

Quantum Estro Support offers natural estrogen support for women and men.* This top-tier formula contains DIM ( diinydolylmethane ), which helps promote cell cycle activity and healthy estrogen metabolism.* This formula is anchored with comprehensive botanical support in two unique blends: Fem Phyto- Support TM and Estro ProBlend TM for optimal nutritional effect. * Quantum Estro Support is a top choice nutritional formula and is highly recommended as a valuable everyday hormone support supplement.* Quantum Quality Guarantee Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME® credits to an equivalent number of AMA PRA Category 1 Credits™. Information on the process to convert EACCME® credits to AMA credits can be found at www.ama-assn.org/education/earn-credit-participation-international-activities. Surgical margins of the cone specimen should be clear of both invasive and preinvasive disease (except for low-grade intraepithelial lesion) [IV, B]. Last but not least, our offices are easily accessible by public transport and different training can be provided to meet a number of educational/development needs. Histological tumor grade if required. It needs to be stressed that currently grading remains of uncertain value for squamous cell carcinoma and most subtypes of adenocarcinoma. For adenocarcinoma, the growth pattern (Silva Classification) is recommended.

Patients who are not candidates for extensive surgery should be treated with systemic chemotherapy. Additional treatment can be considered depending of the response [IV, B]. Treatment planning should be made on a multidisciplinary basis (generally at a tumor board meeting as defined in the ESGO quality indicators) and based on the comprehensive and precise knowledge of prognostic and predictive factors for oncological outcome, side effects, and quality of life [IV, A]. Management of disease found after SH should be based on expert pathology review and discussed in a multidisciplinary tumor board. In general, management of occult disease follows the principles of the standard management, and is based on pathologic findings, and clinical staging. Treatment strategy should aim to avoid combining further surgery and radiotherapy because of the high morbidity after combined treatment [III, B]. Adjuvant treatment may be considered also if only isolated tumor cells are detected in SLN, although its prognostic impact remains uncertain [IV, C]. Building on previous congresses, the next step towards this goal is to reflect and act on the radiotherapy opportunities and challenges brought on, and brought to light, around the world in recent years. With this aim, the congress theme is Radiation Oncology: Bridging the Care Gap.Future-proofing radiotherapy access. The fine balance between preferences and sustainability / Our resources are limited! An insight on optimising radiotherapy resources for the future / Speed Dating / Optimal health for all together - What do staff and patients need to achieve this? / The possibility to improve patient care is endless. (Some) initiatives to integrate into radiotherapy departments of the future / Young Networking Event & Quiz (including the Elsevier Young Investigator Awards Presentation) Fertility-sparing treatment should be performed exclusively in gynaecological-oncological centers with comprehensive expertise in all types of these surgical procedures [IV, A]. Diagnosis of T1a cancer should be based on a conization (or excision) specimen examined by an expert pathologist with accurate measurement of depth of invasion, margin status, coexisting pathology, and reliable assessment of LVSI [IV, B]. An exhibition featuring equipment and medical publishers will be held in the Exhibition area. The exhibition will open on Friday evening with the Networking evening and will remain open to the visitors from Saturday to Monday. Entrance is free for all registered participants. Companies and publishers who would like to participate in the exhibition may obtain more detailed information from the ESTRO Office.

Urinary derivation by ureteral stent or percutaneous nephrostomy should be considered to treat renal failure caused by tumoral obstruction. There are no clear guidelines to predict which patients will benefit from these procedures in terms of survival and quality of life, and its indication should be discussed carefully [IV, C]. Adjuvant/completion hysterectomy after definitive CTRT and IGBT should not be performed since it does not improve survival and is associated with both increased perioperative and late morbidities [II, E].Although evidence is limited, several antenatal management tools can be considered following fertility sparing therapy including screening and treatment of asymptomatic bacteriuria, screening for cervical incompetence and progressive cervical shortening by transvaginal ultrasonography, fetal fibronectin testing, screening (and treatment) for asymptomatic vaginal infection, vaginal progesterone application, total cervical closure according to Saling and cervical cerclage, if not placed during trachelectomy [IV, C]. Surgical LN staging is recommended in patients with T1b1 tumor with clear margins and absence of residual tumor on imaging (including non-suspicious LN). In case of histological evidence of PLN involvement, definitive CTRT is recommended and PALND, at least up to inferior mesenteric artery, may be considered for staging purposes [III, B]. If SLN is negative bilaterally in the pelvic level I area (below iliac bifurcation) LN dissection can be limited to level I [IV, B]. The presence or absence of lymphatic vessel invasion (LVI), which may be confirmed by immunohistochemistry. The quantification of the number of lymph vascular vessels involved by tumor cells is not mandatory but advisable for future prospective studies.

The management of “oligo” organ metastases (lung, liver, etc.) should be discussed in a multidisciplinary setting including the team involved in the treatment of the organ-affected metastasis. Treatment options are represented by local resection, thermal ablation, interventional BT, or stereotactic ablative radiotherapy according to the size and localization [IV, B].

HOW TO USE ESTRO SUPPORT?

Regular and systematic monitoring of side effects and quality of life should be performed to improve the quality of care [V, A].

Patients should be carefully counseled on the suggested treatment plan and potential alternatives, including risks and benefits of all options [V, A]. Follow-up is designed to monitor disease response, to detect recurrence and to screen for subsequent primary tumors [V, B]. Ben Heijmen (NL), Catharine Clark (UK), Charlotte Robert (FR), Christian Richter (DE), Coen Hurkmans (NL), Daniela Thorwarth (DE), Dietmar Georg (AT), Edmond Sterpin (BE), Eduard Gershkevitsh (EE), Faisal Mahmood (DK), Georgina Fröhlich (HU), Iuliana Toma-Dasu (SE), Kathrine Røe Redalen (NO), Livia Marrazzo (IT), Núria Jornet (ES), Ye Zhang (CH) imaging (preferentially both MRI and (PET-CT) with the patient in the treatment position should be used for target contouring.Medical management of malignant intestinal obstruction consists of antisecretory, corticosteroids, and antiemetic drugs. A nasogastric tube is recommended if vomiting and discomfort persist in spite of medical management. Surgical procedures can be considered in selected patients [IV, B]. Imaging (pelvic MRI±CT scan or PET-CT) should be performed not earlier than 3 months after the end of treatment [IV, B]. Ane Appelt (UK), Catharine Clark (UK), Christian Richter (DE), David Sarrut (FR), Dirk Verellen (BE), Eduard Gershkevitsh (EE), Kathrine Røe Redalen (NO), Livia Marrazzo (IT), Lorenzo Placidi (IT), Marianne Aznar (DK), Nuria Jornet (ES), Tiina Seppälä (FI), Uulke van der Heide (NL), Victor Hernandez (ES), Wolfgang Birkfellner (AT), Ye Zhang (CH)