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Diagnostic DilemmaA 48-year-old man is referred for evaluation. He has a history of hypercholesterolemia and obesity. Treatment with cholesterol-lowering medication was associated with elevated liver chemistries. When the elevated liver chemistries persisted
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Changing Concepts in the Management of Endometrial CancerThe authors present the major issues and controversies surrounding the treatment of endometrial cancer. A variety of therapeutic approaches have been used in the past, including surgery alone, preoperative radiation and surgery, surgery and
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Planned Radiation in Axillary Management of Breast CancerThis video examines how planned radiation will impact management of the axilla in breast cancer patients undergoing mastectomy.
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Vaccine Therapy, Oncolytic Viruses, and GliomasIn this article, we will discuss some of the vaccination and oncolytic virus strategies being evaluated in the clinic for malignant gliomas. The vaccines reviewed here include the cell-based and the non–cell-based.
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Higher Facility Volume Linked With Better Radiation Outcomes for Head and Neck CancersA study presented last month at ASTRO found that better radiation outcomes for head and neck cancer were associated with higher facility volume.
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Clinical Selection of Candidates for Mutational Testing for Cancer SusceptibilityAdvances in molecular genetics have evolved at such a fast pace that physicians may be bewildered about their clinical translation into patient care. However, genetic counselors, particularly those trained in cancer genetics, have been extremely helpful. The challenge to the physician, however, calls for an understanding of the natural history of hereditary cancer syndromes, which is often reflected in the pedigree. Pedigree/family history information must be compiled in sufficient detail to arrive at the most likely hereditary cancer syndrome diagnosis so that the molecular geneticist can search for the mutation. Finally, the challenge to the clinician is melding this into an accurate diagnosis, in order to provide highly targeted screening and management for high-risk patients. This article is an attempt to crystallize all of these issues in a format that will help physicians—particularly those in the oncology community—to meet this challenge effectively.
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Role of Adjuvant Therapy in Resected Stage II/IIIA Non-Small-Cell Lung CancerThe search for effective postoperative adjuvant therapy for patients with resected non-small-cell lung cancer (NSCLC) has been spurred by a high rate of failure after definitive surgery. Except for patients with resected T1, N0, M0 lesions, failure rates exceed 30%. Widespread application of adjuvant therapy has been reined in by a disappointing lack of effectiveness in this setting.
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Handbook of Brain Tumor ChemotherapyAfter 2 decades of minimal progress, there have been important advances in the treatment of brain tumors with chemotherapy. A trial conducted by the European Organization for Research and Treatment of Cancer (EORTC) and the National Cancer Institute of Canada (NCIC) recently demonstrated the benefit of radiation therapy with concomitant and adjuvant temozolomide (Temodar) chemotherapy for glioblastomas. There is also increasing evidence that chemotherapy may be beneficial for anaplastic and low-grade gliomas, as well as a variety of less common tumors.
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Neoadjuvant Strategies for Pancreatic CancerWe have made much progress over the past 30 years in the surgical management of pancreatic cancer, and perioperative mortality rates are low in centers with experience in the treatment of this disease. However, surgical resection is clearly limited in achieving local and systemic control of pancreatic cancer, and chemoradiation will likely become a part of any successful pancreatic cancer treatment program.
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Use of Molecular Biomarkers to Inform Adjuvant Therapy for Colon CancerIn this review, we will discuss adjuvant chemotherapy in non-metastatic colon cancer, the existing prognostic and predictive molecular biomarkers in the field, and how to integrate these molecular biomarkers into the decision about whether to administer adjuvant therapy.
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The Costs of Cancer Care in the United States: Implications for ActionThe total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high
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Gleason 6 Prostate Cancer: Serious Malignancy or Toothless Lion?There is strong evidence from longitudinal cohort studies of men with both treated and untreated Gleason 6 prostate cancer to suggest that Gleason 6 disease, when not associated with higher-grade cancer, virtually never demonstrates the ability to metastasize and thus represents an indolent entity that does not require treatment.
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Immunologic and Biologic Properties of the Primary Tumor During Prolonged Neoadjuvant ChemoimmunotherapyPatients with locally advanced cancers have a poor prognosis when treated with radiotherapy and/or surgery alone. The appearance of distant metastases shortly after removal of the primary tumor indicates that micrometastases are already present at the time of diagnosis. We observed a favorable outcome in patients with locally advanced breast cancer treated with a prolonged regimen of neoadjuvant chemotherapy plus granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine]) compared with patients receiving fewer chemotherapy cycles prior to surgery and radiotherapy. These results can partly be explained by the dose-intensive regimen used, but biologic and immunologic processes inherent to the prolonged presence of the primary tumor and its draining lymph nodes might also contribute to the beneficial outcome. The effects of the prolonged presence of the primary tumor during chemotherapy and GM-CSF administration on the antitumor immune response, and more specifically the functional properties of dendritic cells and T cells, are currently being investigated in a multicenter randomized clinical trial comparing prolonged neoadjuvant chemotherapy plus cytokines with a conventional treatment schedule. Aside from investigations concerning the immune system, other biologic processes, such as tumor angiogenesis, are being investigated at the same time. [ONCOLOGY 16(Suppl 1):32-39, 2002]
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HER2-Positive Breast Cancer: Remaining ChallengesIn their article, "Trastuzumab and Beyond: New Possibilities for the Treatment of HER2-Positive Breast Cancer," Drs. Morris and Carey provide an excellent summary of therapeutic progress in this disease, and also turn their attention to the challenge now facing us--that of understanding the heterogeneity of HER2-positive breast cancer and mechanisms of resistance to trastuzumab (Herceptin)-based therapy.
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Pressures of Managed Care Spur Interest in Clinical GuidelinesClinical practice guidelines have been a subject of increasing interest for the past several years, and, recently, they have been developed for oncology. In March, 1996, the National Comprehensive Cancer Network (NCCN), a coalition of 15 major US cancer centers, presented the first version of their practice guidelines in oncology. These guidelines covered most of the major cancer sites.
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Psychosocial Consequences of DNA Analysis for MEN Type 2Multiple endocrine neoplasia type 2 (MEN-2) is characterized by medullary thyroid carcinoma in combination with pheochromocytomas and, sometimes, parathyroid adenomas. Since 1993, the psychosocial implications of DNA analysis for MEN-2 have been studied in the Netherlands. This article summarizes the first results of that study. Individuals who applied for DNA analysis cited the need to reduce uncertainty as the major reason for wanting the test. An unfavorable test outcome resulted in anxiety and depression but also relief.
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Use of Hematopoietic Hormones for Bone Marrow Defects in AIDSAboulafia provides an extensive review of the occurrence of and treatments for bone marrow disorders that complicate HIV infection and AIDS. Understanding of the pathogenesis of these disorders is increasing, and the availability of recombinant colony-stimulating factors (CSFs) has, in many ways, facilitated the treatment of HIV-1 infection and its complications. Nonetheless, numerous critical questions remain regarding the optimal use of these expensive and powerful reagents.
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Implementing Recommendations for the Early Detection of Breast and Cervical Cancer Among Low-Income WomenAlthough the causes and natural histories of breast and cervical cancer are different, the public health responses to these diseases have been similar. Early detection of breast cancer and primary prevention of cervical cancer are possible through community-based screening programs; however, early detection of both breast and cervical cancer is less common among low-income women (defined as up to 250% of poverty level, depending on family size). This report presents morbidity and mortality data regarding breast and cervical cancer, screening recommendations, an update on the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and recommended priority activities for the NBCCEDP. The NBCCEDP is a major public health effort to increase breast and cervical cancer screening among uninsured, low-income women.
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Gynecologic Malignancies in Older WomenThe aging of the population is a social phenomenon that will present a challenge to clinical practice in the 21st century. Women constitute a majority of the elderly population as they outlive males by 5 to 7 years. Ovarian,
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Myelodysplastic Syndromes: Where Do We Go From Here?The review by Dr. Akhtari outlines the diagnosis, prognosis, and treatment options for patients with myelodysplastic syndromes (MDS), and touches on the current challenges in treating patients suffering from MDS.
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Metabolic Syndrome After Hormone-Modifying Therapy: Risks Associated With Antineoplastic TherapyThe incidence of metabolic syndrome is rapidly increasing. Metabolic syndrome is associated with elevated morbidity and mortality secondary to cardiovascular disease, insulin resistance, and hepatic dysfunction. A body of evidence has already implicated metabolic syndrome as a cancer risk factor; emerging evidence now suggests that cancer survivors themselves may be at risk for developing metabolic syndrome as a result of their anti-cancer therapy. Treatment of both breast cancer and prostate cancer often involves hormone-modifying agents that have been linked to features of metabolic syndrome. Androgen suppression in men with prostate cancer is associated with dyslipidemia, increasing risk of cardiovascular disease, and insulin resistance. Anti-estrogen therapy in women with breast cancer can affect lipid profiles, cardiovascular risk, and liver function. Similar findings have been noted in men with testicular cancer treated with chemotherapy. In addition, several emerging therapies, including mammalian target of rapamycin (mTOR) inhibitors and targeted kinase inhibitors, are increasingly associated with some features of metabolic syndrome. As the number of cancer survivors continues to grow, consideration of these factors and of the risk of metabolic syndrome will become increasingly important when choosing between therapy options and managing long-term follow-up.
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Vaccines to Prevent High-Grade GliomaThis video examines current research on the use of vaccines in low-grade glioma for the prevention of high-grade disease.
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UFT Plus Cisplatin With Concurrent Radiotherapy for Locally Advanced Non–Small-Cell Lung CancerA phase II study of combined-modality treatment consisting of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus cisplatin (Platinol) and concurrent radiotherapy was conducted to evaluate the activity of this regimen in
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ACR Appropriateness Criteria® Management of Vaginal CancerThis article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.
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Seventy-Year-Old Man With Large Bladder Mass: Diagnostic and Clinical Challenges of an Uncommon NeoplasmA 70-year-old man presented at our institution for a second opinion regarding diagnosis of a urinary bladder mass. He had a 3-year history of worsening urinary incontinence and urgency, for which he had undergone colonoscopy, as well as testing for prostate issues; all test results were negative.
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Psychosocial Consequences of DNA Analysis for MEN Type 2Multiple endocrine neoplasia type 2 (MEN-2) is characterized by medullary thyroid carcinoma in combination with pheochromocytomas and, sometimes, parathyroid adenomas. Since 1993, the psychosocial implications of DNA analysis for MEN-2 have been studied in the Netherlands. This article summarizes the first results of that study. Individuals who applied for DNA analysis cited the need to reduce uncertainty as the major reason for wanting the test. An unfavorable test outcome resulted in anxiety and depression but also relief.
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Transplant Registries: Guiding Clinical Decisions and Improving OutcomesOver the past 3 decades, hematopoietic stem cell transplantation has become a lifesaving art that is applied to a variety of malignant and nonmalignant disorders.[1] In the 1970s, several groups demonstrated that advanced leukemia and aplastic anemia patients were cured using sibling-matched allogeneic bone marrow transplantation. By the 1980s, many published reports confirmed that relapsed and refractory lymphoma patients could attain long-term disease-free survival as a result of utilizing autologous bone marrow transplantation.
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Ductal Lavage: What We Know and What We Don’tDr. Newman has written a comprehensiveand judicious reviewon the highly topical subjectof ductal lavage, and is to becongratulated. We would like to giveparticular emphasis to several of theissues she raises.
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New Testing for Lung Cancer ScreeningIn this review, the authors discuss past attempts at lung cancer screening, the results of the National Lung Cancer Screening Trial, and innovative tests for lung cancer screening currently being evaluated.
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Treatment of Prostate Cancer in Obese PatientsObesity is a complex, chronic disease that has reached epidemic proportions in the United States. Obesity is now linked with numerous health conditions, including many oncologic diagnoses. Its association with prostate cancer, the most prevalent cancer in men, has also been investigated, with studies suggesting a direct relationship between increasing obesity and prostate cancer mortality. Outcomes data for specific interventions in obese patients with prostate cancer have only recently begun to emerge. Surgery, while feasible even in the very obese, may result in less than optimal cancer control rates. Brachytherapy data are emerging, and are promising. No outcomes data are available for the use of external-beam radiation in obese patients. Long-term data for external-beam radiation, as well as for surgery and brachytherapy, are required to determine the most appropriate treatment for obese patients with prostate cancer. These data, coupled with a more thorough understanding of the biochemical relationship between obesity and prostate cancer, will be necessary to make optimal management decisions for obese patients with prostate cancer in the future.
