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Permanent Prostate Brachytherapy: Lessons Learned, Lessons to LearnDr. Potters has provided an excellent and timely overview of transperineal interstitial permanent prostate brachytherapy (TIPPB). The historical context, as the title suggests, nicely illustrates the lessons already learned and those still to be learned. There are a few points I would like to discuss in further detail.
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Novel and Expanded Oncology Drug Approvals of 2016-PART 1: New Options in Solid Tumor ManagementThis article focuses on the new agents and indications that emerged in 2016 for solid tumor treatment. We review the drug indications, mechanisms of action, pivotal trial data, pertinent toxicities, use in special populations, and the appropriate clinical contexts for treatment planning.
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Clinical Management Updates in Mantle Cell LymphomaRecent advances in mantle cell lymphoma include: (1) identification of new pathways to target, (2) novel therapeutics to treat patients with relapsed/refractory disease, and (3) monitoring of minimal residual disease and adoption of a maintenance therapy approach to prevent relapses post induction or post stem cell transplantation.
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Managing Glioblastoma in the Elderly Patient: New OpportunitiesThis review discusses best practices for the treatment of glioblastoma in patients older than 65 years, and highlights management concerns in caring for this particular patient population.
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Economic and Quality of Life Outcomes: The Four-Step Pharmacoeconomic Research ModelIncreasingly, economic data are being considered in formulary decisions. In oncology, pharmacoeconomic evaluations are essential to help decision makers weigh the associated costs and outcomes of competing
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Response of the Normal Eye to High Dose RadiotherapyRadiation therapy of tumors near the eye or optic nerves often requires incidental irradiation of these structures, even when they are not clinically involved by tumor. Depending on the radiation treatment volume and dose required, radiation injury to the lens, lacrimal apparatus, retina, or optic nerve may result. The time to expression and severity of injury are dose-dependent. This paper reviews the results of 157 patients who were followed for a minimum of 3 years after radiotherapy for primary extracranial tumors at the University of Florida, in which the lacrimal gland, lens, retina, and/or optic nerve(s) received irradiation. This review shows that, after treatment at approximately 1.8 to 2.0 Gy per fraction, the incidence of severe dry-eye syndrome, retinopathy, and optic neuropathy appears to increase steeply after doses of 40, 50, and 60 Gy, respectively. [ONCOLOGY 10(6):837-852, 1996]
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Management of Hepatocellular CarcinomaThe article, “Management of Hepatocellular Carcinoma,” by Drs. Nakakura and Choti, is an excellent, comprehensive overview of the treatment modalities used for one of the most challenging cancers. The thoroughness of this review underscores the current frustration of the clinician in the management of this disease and the inadequacies of available therapies. The authors list more than 17 treatments for the various stages of this disease. However, if any one of the therapies mentioned offered cure to a majority of patients, there would be little need for more review articles or randomized controlled trials. There are few cancers that command such a vast array of differing therapies from so many different specialties.
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Prostate Cancer Risk Assessment ProgramProstate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and
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Synergizing Radiation Therapy and Immunotherapy for Curing Incurable CancersRadiation is often considered immunosuppressive, an activity that is most likely a result of the complex interplay of hormesis and the abscopal effect. The abscopal effect, also called the “distant bystander” effect, is a paradoxical effect of radiation on cellular systems whereby local radiation may have an antitumor effect on tumors distant from the site of radiation.
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In-Transit Melanoma: An Individualized ApproachThe management of in-transit metastases is challenging, since the treatments and extent of disease vary greatly based on the number, depth, location, and distribution of lesions, and on their biological behavior.
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Management of Congenital Vascular Lesions of the Head and NeckCongenital vascular lesions are often misdiagnosed and, for the most part, left untreated. The absence of a uniformly accepted classification of these lesions and confusion over their natural history are partly responsible. A new classification of these lesions recognizes two distinct groups of lesions, hemangiomas and vascular malformations.
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Initial Treatment of Well-Differentiated Neuroendocrine TumorsIn patients with advanced, unresectable NETs, there are several treatment options; which of these may be considered depends on the site of origin of the tumor.
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5-FU or UFT Combined With Leucovorin for Previously Untreated Metastatic Colorectal CancerThis phase III study compares leucovorin plus fluorouracil (5-FU) 425 mg/m2, days 1 through 5, 28-day cycle, with oral leucovorin plus oral UFT (tegafur and uracil) 300 mg/m2, days 1 through 28, 35-day cycle, in terms of
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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Palliative Care AlwaysIn this article, we present or review the evidence for providing palliative care concurrently with oncologic care, guideline-based recommendations for screening and incorporation of palliative care, and a case-based discussion to demonstrate palliative care across the continuum of cancer care.
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Management of Progressive Metastatic Prostate CancerMetastatic prostate cancer is a growing health problem and is the second leading cause of cancer death in men. While the response of patients with metastatic prostate cancer to initial hormonal manipulation is excellent, the
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EGFR Inhibitors in Lung CancerTargeted therapies inhibiting the epidermal growth factor receptor(EGFR) have been introduced in the treatment of patients with advancednon–small-cell lung cancer (NSCLC). Many inhibitors of theEGFR have been developed, targeting either the extracellular receptordomain with antibodies or the intracellular tyrosine kinase bindingdomain with small molecules. The tyrosine kinase inhibitor (TKI)gefitinib (Iressa) was the first targeted drug to be registered for thetreatment of NSCLC after failure of chemotherapy. Given concurrentlytogether with platinum combination chemotherapy both TKIs gefitiniband erlotinib (Tarceva) failed to increase activity. Sequential targetedtherapy after chemotherapy is currently being investigated further. Studieswith the monoclonal antibody cetuximab (Erbitux) combined withchemotherapy are ongoing. Side effects of the small molecules aremainly skin rash and diarrhea, whereas the antibodies do not give diarrhea.Selection of patients, based on molecular markers and patientcharacteristics, has become an important issue for the further developmentof these drugs, given there is activity in a relatively small group ofpatients with NSCLC. Newer drugs inhibiting more than one receptorpathway are being investigated in order to find activity in a broadergroup of patients.
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Innovation in the Management of Brain MetastasesTherapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis and to reduce the subsequent risk of recurrences elsewhere in the brain. In the current review, we discuss recent developments in the management of patients with brain metastases.
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DNA Microarrays in Lymphoid MalignanciesIn the introduction to his book,The Order of Things, the Frenchstructuralist philosopher MichelFoucault posed the question: "Whenwe establish a considered classification,when we say that a cat and adog resemble each other less thantwo greyhounds do, on what groundsare we able to establish the validityof this classification with completecertainty?" He went on: "On whattable, according to what grid of identities,similarities, analogies do wesort out so many different and similarthings."
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UFT and Oral Calcium Folinate as First-Line Chemotherapy for Metastatic Gastric CancerLocally advanced or metastatic adenocarcinoma of the stomach still carries a poor prognosis, with 5-year survival rates of < 15%. Palliative chemotherapeutic regimens for this disease are largely 5-FU–based. We
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Eovist Injection and Resovist Injection: Two New Liver-Specific Contrast Agents for MRIIn this short review, we describe two new liver-specific contrast agents for MRI that are in clinical development. The main differences among the liver-specific contrast agents available at present are also discussed briefly.
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Paraganglioma: A Potentially Challenging TumorThe development of metastatic disease in patients with paraganglioma is an unusual and challenging event. This case report and review describes the specific features of this disease and the multiple therapeutic options.
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Cisplatin/Paclitaxel vs Cisplatin/Teniposide for Advanced Non-Small-Cell Lung CancerA total of 332 patients with advanced non-small-cell lung cancer were randomized by the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative
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New SSRI Antidepressants Offer Advantages in Cancer PatientsA 43-year-old married man was referred to Memorial Sloan-Kettering Cancer Center in June, 1995, for further management of a malignant brain tumor. He was asymptomatic until April, 1994, when he suffered a generalized seizure and was admitted to a local hospital. An MRI revealed a right parietal lobe lesion. The tumor was resected and found to be a glioblastoma multiforme.
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Upper Limb Swelling Following Mastectomy: Lymphedema or Not?BH is a 54-year-old white, married female with a health history significant for depression at the time of breast cancer diagnosis. She was scheduled for a routine bilateral mammogram in the summer of 2001. Following an abnormal mammogram of the right breast, BH was referred for an excisional biopsy, which was performed in July 2001.
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Infectious ComplicationsInfections are among the most common, potentially serious complications of cancer and its treatment.
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Oncology On-the-Go Podcast: Sacituzumab Govitecan for HR+/HER2– Advanced Breast CancerExperts from Emory Winship Cancer Institute discuss how the FDA approval of sacituzumab govitecan will impact the treatment of breast cancer.
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Current Imaging Techniques for Head and Neck TumorsModern head and neck imaging has led to advances in both the diagnosis and treatment of head and neck cancers. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies provide important information
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Novel Combinations With OxaliplatinOxaliplatin (Eloxatin) is a novel antineoplastic platinum derivative that may exert its cytotoxic effects by blocking DNA replication/transcription, thus resulting in cell death in proliferating cells, as well as apoptosis.
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Non-Hodgkin LymphomaThis management guide covers the risk factors, screening, diagnosis, staging, and treatment of non-Hodgkin lymphoma.
