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Current Role of Retroperitoneal Lymph Node Dissection in Testicular CancerCarcinoma of the testis is the most common malignancy in males 15 to 35 years of age. Testicular cancer has become one of the most curable solid neoplasms and, as such, serves as a paradigm for the multimodality treatment of malignancies. The cure rate for patients with clinical stage I disease is nearly 100%, and patients with advanced disease now achieve complete remission rates of over 90%. The markedly improved outlook for patients with this cancer over the past 15 years has led to a reassessment of management options, especially in patients with clinical stage I disease. The realization that platinum-based chemotherapy could cure most patients with an advanced nonseminomatous germ cell tumor (NSGCT), especially those with minimal disease, led to the introduction of various strategies to decrease the morbidity associated with surgical management. These strategies include surveillance protocols, chemotherapy for clinical stage II disease, and observation protocols for a subset of patients with advanced disease who have had a partial response to chemotherapy. Retroperitoneal lymph node dissection (RPLND) has an important place in the management of both low- and high-stage testicular cancer. It offers the patient two basic benefits: accurate staging and the possibility of a surgical cure, even in the presence of metastatic disease. [ONCOLOGY 11(5):717-729, 1997]
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Estrogen Replacement Therapy for Breast Cancer PatientsFemale reproductive hormones cause breast cancer. Long-term use of postmenopausal hormones increases the risk of breast cancer. The apparent survival advantage seen in women diagnosed with breast cancer while taking
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Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s LymphomaRecords from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-
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Sentinel Lymph Node Biopsy in a Young Child With Thick Cutaneous MelanomaThe presence or absence oflymph node metastases is themost significant prognostic factorfor survival and recurrence in malignantmelanoma. Lymph node diseasedecreases the 5-year survival by 40%to 50%. The number of metastatic nodesand whether nodal metastases are clinicallyoccult or apparent are independentpredictors of survival.[1]
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Future of Proton-Beam Radiation Therapy Shines Among Inoperable Lung CancersResearch from Japan documenting remarkable survival rates among patients with inoperable lung cancer may only hint at the potential of proton-beam radiation therapy. The study out of the Proton Medical Research Center in Tennoudai, Japan, documented high survival rates for 55 patients suffering from stage I inoperable non-small-cell lung cancer.
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Anorexia/Cachexia in Patients with HIV: Lessons for the OncologistThis article provides a nice overview of HIV-associated wasting. The paper makes a number of strong points. In particular, it focuses on anorexia and decreased oral intake as key to wasting. In this vein, both the discussion by Von Roenn and Knopf and Tables 1 and 2 offer a very valuable review of the multiple reasons why HIV-infected patients may eat less. Given the many medications that we often need to use in these patients, the text discussion about the ways in which medications can result in decreased oral intake, reinforced by Table 2, is particularly useful.
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Interpreting Intratumoral Hypoxia: Can It Guide Therapy?The role of hypoxia as a key determinant of outcome for human cancers has encouraged efforts to noninvasively detect and localize regions of poor oxygenation in tumors. In this review, we will summarize existing and developing techniques for imaging tumoral hypoxia. A brief review of the biology of tumor oxygenation and its effect on tumor cells will be provided initially. We will then describe existing methods for measurement of tissue oxygenation status. An overview of emerging molecular imaging techniques based on radiolabeled hypoxic markers such as misonidazole or hypoxia-related genes and proteins will then be given, and the usefulness of these approaches toward targeting hypoxia directly will be assessed. Finally, we will evaluate the clinical potential of oxygen- and molecular-specific techniques for imaging hypoxia, and discuss how these methods will individually and collectively advance oncology.
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Clinical Oncology, Second EditionA comprehensive textbook on clinical oncology should have broad appeal to readers from various disciplines, including educators, clinicians, and scientists working with cancer patients. Students of the medical disciplines must also have a reference textbook to guide them in their educational exploration, whether they are in the field of medicine itself or in complementary areas. We look to comprehensive textbooks not only to provide us with the latest updates in different disease entities, but also to guide us by choosing the most relevant areas of study and investigation. The editors who compiled this textbook have met these challenges, while maintaining a readability that is suitable for various levels of expertise and comprehension
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Commentary (Kosuri/Otterson): Coming to Grips With Hand-Foot SyndromeIn this issue of ONCOLOGY,Scheithauer and Blum write aninformative review on the chemotherapeuticside effect of hand-footsyndrome, a not uncommon toxicityof several chemotherapeutic agents.They focus their discussion on capecitabine(Xeloda) and review the literatureregarding the best way to managehand-foot syndrome. Capecitabine isan oral fluoropyrimidine that is convertedto fluorouracil (5-FU) intratumorallyand delivers sustained 5-FU,thus simulating continuous-infusionregimens. It is now widely acceptedthat continuous-infusion regimens of5-FU are more effective and less toxicthan bolus regimens. However,historically, continuous-infusion regimensof 5-FU have not been in favorin the United States for logisticreasons.
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Contemporary Issues Surrounding Small Renal Masses: Evaluation, Diagnostic Biopsy, Nephron Sparing, and Novel Treatment ModalitiesIn this review, we summarize the diagnosis of small renal masses, the role of renal mass biopsy, different treatment strategies, and future directions, including emerging molecular biomarkers.
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Sorafenib for HCC: A Pragmatic PerspectiveThe diagnosis and treatment of hepatocellular carcinoma (HCC) constitute a complex and challenging clinical paradigm.
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Next Steps in the Management of EGFR Exon 20 Insertion–Positive mNSCLCClosing out their discussion on mobocertinib data and the EXCLAIM cohort, experts share hope for the future management of the EGFR exon 20 insertion–positive mNSCLC.
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Robotics in Head and Neck Cancer: Future OpportunitiesA series of promising new advances have emerged in H&N oncology in recent years. Among these are the advancement of highly conformal radiation delivery techniques (e.g. IMRT, protons); the successful introduction of molecular targeted therapies (e.g. cetuximab); the recognition of HPV as a powerful prognostic biomarker; and the development of minimally invasive surgical techniques. The application of transoral robotic surgery (TORS) in H&N cancer is reviewed by Bhayani et al in this issue of ONCOLOGY[1].
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Immunotherapy Resistance in Pancreatic CancerThis video examines the role of immunotherapy in pancreatic cancer, highlighting the resistance to novel treatments in this setting and trials attempting to confront this problem.
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New Targets and New Mechanisms in Lung CancerThis review will describe the well-known use of VEGF antibodies; the current uses of EGFR and ALK tyrosine kinase inhibitors; newer agents being used against MET, FGFR, and other intracellular targets; insights regarding the field of immunotherapy in lung cancer; and finally, newer developments in chemotherapy.
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ASTRO 2017: Long-Term Data Support Single SBRT Dose in Certain Early Lung CancersThis video reviews long-term results of the NRG Oncology RTOG 0915 trial, a randomized phase II study that compared stereotactic body radiation therapy delivered in one fraction vs four fractions for stage I peripheral non–small-cell lung cancer patients with unresectable disease.
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Primary Carcinoid Tumors of the Lung: A Role for RadiotherapyPrimary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.
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Updated ASCO Guidelines for Optimal Small Cell Lung Cancer ManagementPractices are on the cusp of better understanding small cell lung cancer that in turn can help to advance treatment strategies for patients, says Gregory Peter Kalemkerian, MD.
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Use of Bisphosphonates in Patients With Metastatic Bone DiseaseThe bisphosphonates have now joined an elite group of drugs that have annual sales greater than $1 billion. Although the major therapeutic target of these agents is osteoporosis, their use in cancer, particularly in osteolytic bone disease due to breast cancer and myeloma, is growing very rapidly. Pamidronate (Aredia), the only bisphosphonate currently approved for this indication in the United States, is now prescribed for the majority of patients with myeloma, as well as a substantial number of patients with breast cancer.
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Clinical Trial Simulation of a 200-µg Fixed Dose of Darbepoetin Alfa in Chemotherapy-Induced AnemiaOur objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-µg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic
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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate CancerThe purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.
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Surgical Approach to Organ Preservation in the Treatment of Cancer of the LarynxNonsurgical approaches to preservation of the larynx in the treatment of laryngeal carcinoma include either radiation alone or chemotherapy and radiation in combination. In light of the common use of total laryngectomy,
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Routine 3D Treatment Planning: Opportunities, Challenges, and HazardsThree-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to
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Surgical Approach to Organ Preservation in the Treatment of Cancer of the LarynxIn the past 10 years, the introduction of combined chemotherapy and radiation as an alternative to total laryngectomy for patients with advanced laryngeal cancer ushered in a new treatment paradigm termed "organ preservation." The adoption of
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Reassessing Adjuvant Treatment of Early-Stage Breast Cancer in Elderly Women: Focus on Findings from 2007 ASCO MeetingApproximately 212,920 new cases of invasive breast cancer were estimated to occur in the United States in 2006.1 The incidence rate has continued to rise slowly over the past 20 years due to the continued increase of breast cancer in women aged 50 and older (375 cases per 100,000 women), peaking at 75 to 79 years of age (525 per 100,000 women).
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Commentary (Nowakowski/Rajkumar): New Treatments for Multiple MyelomaIn the past decade there has been arapid increase in our understandingof the biology of multiple myelomaand the development of newtreatment strategies.[1] In the currentissue of ONCOLOGY, Richardson etal provide an excellent overview ofnew agents in the treatment of multiplemyeloma. Two of these agentsare currently available in the UnitedStates outside of clinical trials: thalidomide(Thalomid) and bortezomib(Velcade). The thalidomide analog-lenalidomide (Revlimid)-will likelybe available in the near future,while several other novel agents arebeing evaluated in clinical trials.Richardson and colleagues haveplayed a major role in the developmentof bortezomib and lenalidomide,as well as numerous novel agentscurrently in clinical trials. Their reviewis therefore particularly enlightening,and provides a first-handaccount of the clinical developmentof various new drugs for the treatmentof myeloma.
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Commentary (Dalbagni): Current Management of Unusual Genitourinary CancersThis two-part article by Krieg and Hoffman, published last month and concluded in this issue, explores the current management of penile cancer (part 1) and urethral cancer in both men and women (part 2). My remarks will focus on female and male urethral cancer.
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Outlook for 2017: Acute Leukemias, MDS, and CLLThis look ahead at hematologic malignancies in 2017 focuses on new agents being studied for the treatment of acute leukemias, myelodysplastic syndromes, and chronic lymphocytic leukemia.
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Commentary (Tricot): Tandem Transplantation in Multiple MyelomaIn the early 1980s, McElwain andcolleagues demonstrated thathigh-dose melphalan (Alkeran,100–400 mg/m2) was very effectivein patients with aggressive (plasmacell leukemia) or refractory myeloma.[1] Other researchers subsequentlyconfirmed these results.[2-4]Unfortunately, the duration of cytopeniaassociated with such treatmentwas excessive (3 to 4 weeks), leadingto a treatment-related mortalityrate of 10% to 20%.
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Guillermo Garcia-Manero, MD, on Eprenetapopt-Azacytidine Combo in TP53+ MDSThe MD Anderson expert discussed the phase 3 trial – designed to evaluate frontline eprenetapopt in combination with azacytidine (Vidaza) in patients with TP53-mutant positive myelodysplastic syndrome (MDS) – that recently completed full enrollment.
