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Proton Therapy for Prostate Cancer: Show Me the CER!Hoppe et al present an excellent review of the physics relevant to an understanding of proton therapy-and of the available literature assessing the use of proton beams in the management of prostate cancer.
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ACR Appropriateness Criteria® Localized Nodal Indolent LymphomaThe present guidelines review epidemiology, pathology, presentation, workup, staging, prognostic factors, and treatment options for patients with localized nodal indolent lymphoma, with an emphasis on radiation guidelines, including radiation dose, field design, and radiation techniques.
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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Further Considerations in the Treatment of Locally Advanced Lung CancerProbably no other topic in thoracic oncology has resulted in more controversy than that of the management of locally advanced non–small-cell lung cancer (NSCLC). Although recent large randomized studies have yielded more reliable and objective data on which to base treatment decisions than were available a decade ago, management of these patients is still influenced by specialty bias and philosophical beliefs.
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AL Amyloidosis: Who, What, When, Why, and WhereIn the current issue of ONCOLOGY, Gertz and Dispenzieri provide a scholarly review of the early recognition, diagnosis, and treatment of immunoglobulin light-chain (AL) amyloidosis.
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Commentary (Smith/Sandler)-Testicular Cancer: Maintaining the High Cure RateAs Dr. Raghavan has emphasizedin his excellent overviewof the current therapyfor testis cancer, it is critical that thesuccess of therapy for this diseasenot be compromised by a desire toavoid the complications of therapy.We would wholeheartedly agree withhis assertion that modifications intherapy must be introduced with athoughtful and structured approachto minimize the risk to efficacy.
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Physicians Must Unite Against New Bureaucratic ‘Hassles’ to Practicing MedicineI read with interest the article based on a presentation by Dr. David Hussey concerning physician competency reviews (December 2000). Dr. Hussey, who is president of the American Society for Therapeutic Radiology and Oncology
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Glioma-Associated Fatigue and Cognitive DysfunctionIn this interview we discuss fatigue, cognitive dysfunction, and psychiatric problems in patients with glioma and review which patients are more likely to encounter these issues.
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Age Matters... Or Does It?Anemia raises special concerns in older cancer patients. This review addresses the prevalence, causes, and mechanisms of anemia in older individuals, the complications of anemia in this population (including its impact on cancer treatment), and the appropriate management of anemia in the elderly.
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European Experience With Irinotecan Plus Fluorouracil/Folinic Acid or MitomycinTremendous progress has been made in the medical treatment of advanced colorectal cancer during the past 2 to 3 years, due to the availability of several new drugs. Of these new agents, irinotecan (CPT-11 [Camptosar]) seems
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Synchronous Bilateral Breast Cancer With Discordant HistologyA 48-year-old Caucasian woman presented with a palpable right breast mass. Physical examination confirmed a lump on the upper outer quadrant of her right breast. On PET/CT scan there was an incidental finding of increased metabolic activity in the left lateral breast.
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Book Review: Euthanasia is Not the Answer-A Hospice Physician's ViewRecent broad interest in euthanasia and assisted suicide by society at large has prompted this review of euthanasia. This fine,
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Therapeutic Options in Gastric Cancer: Neoadjuvant Chemotherapy vs Postoperative ChemoradiotherapyThe majority of patients who undergo resection for gastric cancer experience relapse and ultimately die of their disease. Therefore, considerable attention has been paid to neoadjuvant and adjuvant strategies to improve surgical outcomes. Two different approaches have been tested in major clinical trials conducted in the past several years: Postoperative chemoradiotherapy was assessed in a US Southwest Oncology Group/Intergroup study (SWOG 9008/INT 0116), and perioperative chemotherapy was studied in a UK Medical Research Council (MRC) randomized trial (the MRC Adjuvant Gastric Infusional Chemotherapy [MAGIC] trial). These trials demonstrated statistically significant survival benefits in patients with resectable gastric cancer. This review will consider these trials and their implications for clinical practice.
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Closing Reflection: A Journey of Understanding and ResiliencePanelists discuss how emerging treatments, digital health tools, and enhanced care coordination could streamline disease management and improve quality of life while identifying opportunities to strengthen provider communication and access to resources.
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Reporting Only ‘Unanticipated’ AEs of Trial Drugs Would Reduce IRB Workload, But Would Patient Safety Suffer?Enrollment in clinical trials is crucialto continued scientific discovery andimproved patient care.
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Gynecologic Malignancies in Older WomenThe demographics of the US population continue to change dramatically, as the absolute number and proportion of older people relative to the remainder of the population increases. Last year, the number of persons older than 65 years was estimated to be 35 million, representing almost 13% of the overall population; by 2030, the older population is expected to double. Along with the general aging of the population, the percentage of persons older than 85 years is also growing rapidly, as is the ethnic and racial diversity within the older population.
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Combined-Modality Therapy for Head and Neck CancerIn the past, head and neck cancers were felt to be primarily a locoregional control challenge. Distant metastases were not thought to occur frequently. However, the popularity of combined-modality programs emphasizing regional treatment with surgery and radiation in the 1960s enhanced the ability to control the disease at the primary site and within the regional cervical lymphatics. Nevertheless, survival was not improved because treatment failure at distant sites occurred frequently. Apparently, prior treatment programs that did not provide locoregional control masked the ability of this disease to spread to distant sites. Patients died of uncontrolled locoregional disease before they could experience distant metastases.
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What We Can Learn From Our PatientsPatient satisfaction data can give practices insight into their operations and make specific, practice-level adjustments accordingly, and with aggregated data we can gain insights into global practice responsiveness and patient perceptions regarding care.
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Prognostic Indicators in DCISAhead of SABCS we discuss the biology and treatment of ductal carcinoma in situ, as well as research into prognostic indicators that could help guide treatment decisions.
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Cancer Centers Must Promote Culture in Support of Reimbursement for Clinical TrialsAt the ACCC 40th Annual National Meeting, David Evans, RN, MSN, MBA, discussed some of the top reimbursement issues that cancer centers face when it some to clinical trials.
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Management of Anemia in Patients With CancerSince our first "Quality of Life in Current Oncology Practice and Research" symposium was held at St. Mary Medical Center in Long Beach, California in February 1989, and published in ONCOLOGY in May 1990, there has been a marked increase in the use of quality of life measures to determine the outcomes of interventions in clinical oncology. Measuring the effects of anemia treatment with quality of life tools is a fine example of the importance of these tools to gauge the impact and clinical significance of interventions. It is, therefore, both timely and relevant that we dedicate our fifth symposium to the management of anemia in patients with cancer.
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Frontline Immunotherapy/Bevacizumab Ups PFS in PD-L1–Positive mRCCThis video examines a phase II study that compared atezolizumab with or without bevacizumab vs sunitinib in untreated patients with metastatic renal cell carcinoma.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) should prove interesting in that the study design will permit observation of the natural history of a potentially lethal malignant disease, influenced only by palliative treatments. My comments will focus on the concerns raised by this study design. I will not address possible biases of the trial introduced by: (1) enrollment of less than 20% of the eligible population; (2) an enrollment rate per participating center of less than 3 patients per year; (3) a 7-year enrollment period; and (4) a 12-year follow-up (for a total trial duration of 19 years).
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Active Surveillance: Not Your Father’s Watchful WaitingActive surveillance is becoming a very reasonable and appropriate “treatment” strategy for men with low-risk localized prostate cancer, as Large and Eggener eloquently describe in this review article. It is important to recognize that active surveillance is not what was once referred to as “watchful waiting,” which I believe many patients interpret as “watching and waiting to die.
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Shared Decision Making and Screening: An Ongoing Dialogue Informed by DataA state of equipoise now exists for various surgical options in the treatment of early lung cancer, underscoring the need for shared decision making.
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Paclitaxel for Breast Cancer: The Memorial Sloan-Kettering Cancer Center ExperienceThe proven safety profile and antitumor activity of paclitaxel (Taxol) in the treatment of metastatic breast cancer led investigators at Memorial Sloan-Kettering Cancer Center (MSKCC) to further examine the agent's potential in the treatment of advanced breast cancer. Efficacy and tolerability studies of paclitaxel as single-agent therapy were undertaken, along with parallel investigations of quality-of-life parameters. The studies examined the effects of 96-hour infusion schedules of paclitaxel and are currently assessing the feasibility of a weekly 1-hour infusion schedule. Researchers at MSKCC also compared the results of a variety of two- and three-drug paclitaxel-containing regimens to determine possible synergism and better define safety profiles. They examined the combination of paclitaxel and edatrexate, as well as a promising combination of paclitaxel and a monoclonal antibody directed at growth factor receptors. The latter ongoing trial will include both laboratory studies that examine possible cellular mechanisms for the combination's observed synergy and a clinical trial that combines paclitaxel with a monoclonal antibody directed against the epidermal growth factor. In conclusion, the investigators discuss the optimal integration of paclitaxel into doxorubicin/cyclophosphamide (Cytoxan, Neosar)-based adjuvant therapy for node-positive stage II-III resectable breast cancer. [ONCOLOGY 11(Suppl):20-28, 1997]
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Oncologic Imaging, Second EditionAlthough the title might be slightly misleading, Oncologic Imaging is actually a compendium of information on the detection, diagnosis, imaging, staging, and treatment of cancer. This is the second edition of a multiauthor book that first appeared in
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What Is the Role of Maintenance Rituximab in Follicular NHL?Recent trials have demonstrated improvements in progression-free and overall survival with the inclusion of the chimeric anti-CD20 monoclonal antibody rituximab (Rituxan) in chemotherapy regimens for treatment-naive and relapsed patients with advanced-stage follicular non-Hodgkin's lymphoma (NHL). As rituximab therapy has significant single-agent activity in follicular NHL, is generally well tolerated, and has no dose-limiting or significant hematologic toxicity, a number of approaches evaluating maintenance therapy with extended dosing of rituximab are being tested. Trials have demonstrated prolonged progression-free survival in patients treated with maintenance rituximab using a variety of schedules following treatment with single-agent rituximab, induction or salvage chemotherapy, or salvage therapy with rituximab and chemotherapy combinations. Small increases in neutropenia and infections have been reported with extended rituximab use. Ongoing trials are evaluating the optimal use of rituximab (maintenance vs retreatment) and the benefit of rituximab maintenance following treatment of therapy-naive patients treated with rituximab-containing chemoimmunotherapy induction regimens. This article discusses the risks and benefits of maintenance rituximab for follicular NHL.
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Combining Artificial Neural Networks and Transrectal Ultrasound in the Diagnosis of Prostate CancerDrs. Porter and Crawford carefullyassess the role of artificialneural networks (ANNs)as predictive models of outcomes forinitial prostatic biopsies performed inconjunction with transrectal ultrasound(TRUS). Obviously, the treatmentof prostate cancer rests onestablishing the diagnosis via biopsy,and TRUS-guided core biopsies havebeen the standard of care since Hodgeet al reported the superiority of thistechnique in 1989.[1]
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Gynecologic Manifestations of Hereditary Nonpolyposis Colorectal CancerHereditary nonpolyposis colorectal cancer (HNPCC) is an autosomaldominant cancer susceptibility syndrome associated with inheriteddefects in the DNA mismatch repair system. HNPCC family membersare at high risk for developing colorectal, endometrial, and ovariancancers. Studies of HNPCC families have helped define the importantrole that mismatch repair genes play in the molecular pathogenesis ofendometrial and ovarian cancers. This review will describe some of theimportant clinical and molecular features of HNPCC-related endometrialand ovarian cancer and describe how genetic susceptibility can beidentified in patients with sporadic endometrial and ovarian cancers. Itis important to identify patients with HNPCC, as families of mutationcarriers may benefit from genetic counseling, testing, and intensifiedcancer surveillance.
