ABSTRACT
ABSTRACT: The focus of this book is to present emergent biotechnologies and then forecast their impact on future clinical practice guidelines (CPG). Four clinical cases have been presented at the beginning of this book in which current CPG recommendations failed to provide optimal management. Knowledge gaps, which cannot be solved by interpolation of current information, account for shortcomings in risk stratiˆcation and design of therapies that address proximate molecular pathogenic events. CPG methodology now allows for the rapid incorporation of new information, particularly molecular medicine and imaging techniques, to close these knowledge gaps. A complex molecular pathogenesis may be addressed by personalized single-or multimodality approaches involving targeted therapies, new chemotherapeutics, new radiopharmaceuticals, image-guided radiotherapy, or novel surgical procedures. Advances in bioinformatics will facilitate the compilation, analysis, and dissemination of this information. Primary and secondary prevention strategies for patients “at risk” based on genetic studies may also include targeted therapies. CPG recommendations can contain cascades in which modiˆcations are based on resource availability in certain
22.1 Introduction .......................................................................................................................... 368 22.2 Survey of Emergent Biotechnologies .................................................................................... 369
22.2.1 Molecular Medicine (Chapters 1, 2, 3, 4, 12, 19, 20, 21) .......................................... 369 22.2.2 Emergent Imaging Technologies (Chapters 8, 9, 10, 11, 13) ..................................... 370 22.2.3 Emergent Therapies .................................................................................................. 370
22.2.3.1 Nonsurgical Techniques for Lesion and Metastasis Ablation (Chapters 8 [Section 8.5.4], 13) .................................................................. 370
22.2.3.2 Emergent Surgical Techniques (Chapters 14, 15) ...................................... 371 22.2.3.3 Emergent Radioisotopic Therapies (Chapter 16) ....................................... 371 22.2.3.4 Emergent Radiotherapy Techniques (Chapter 17) ..................................... 371 22.2.3.5 Emergent Chemotherapeutics (Chapter 18) ............................................... 372 22.2.3.6 Emergent Targeted Therapies (Chapters 19, 20, 21) .................................. 372
22.3 Impact of Future CPG on Clinical Cases (Chapter 7) .......................................................... 372 22.3.1 Case 1: Familial PTC................................................................................................ 372 22.3.2 Case 2: Papillary Thyroid Microcarcinoma ............................................................. 373 22.3.3 Case 3: Hürthle Cell Carcinoma ............................................................................... 373 22.3.4 Case 4: Medullary Thyroid Cancer .......................................................................... 373
22.4 Final Thoughts ...................................................................................................................... 373
geographic areas or clinical settings around the world. Ultimately, being aware of potential innovations will encourage referrals for clinical investigation and earlier adoption of safe and effective biotechnologies when they become more widely available.
