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The morbidities associated with prostate cancer treatments have improved over the years. However, potential overtreatment and the risks of adverse events associated with radical treatment still pose a considerable challenge. Targeted focal therapy (TFT) of prostate cancer appears to be part of a logical continuum in the quest to improve upon the management of early organ-confined disease. TFT is a procedure in which only the cancer in the gland is ablated. The normal gland, sphincter, and in most cases the neurovascular bundles are preserved. Therefore, this approach averts some of the common complications of more radical therapy. Initial experience has been encouraging; however, long-term data and full implementation of emerging advances in imaging are urgently needed before the widespread adoption of this approach. In this review, we present the current status of our knowledge about this procedure and the most important challenges that need to be addressed. We also present the initial results with this approach at our center.

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Androgen deprivation, as a form of treatment for prostate cancer,has been used for decades. Within the last decade, however, its use hasincreased significantly. Therefore, it is incumbent upon the physicianto be familiar with the side effects associated with this treatment. Someof these side effects (eg, osteoporosis, changes in lipid profiles, andanemia) may be associated with significant morbidity, whereas others(eg, impotence, decreased libido, fatigue, and hot flashes) primarilyaffect the patient’s quality of life. Prevention strategies and treatmentsexist for many of these side effects. In addition, alternative forms ofantiandrogen therapy such as intermittent hormone ablation andantiandrogen monotherapy may be effective, with the added benefit ofminimizing side effects. This review focuses on the wide range of sideeffects associated with androgen ablation as well as preventive and treatmentstrategies.

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Baselli and Greenberg have presented a comprehensive overview of intravesical strategies for the management of superficial urothelial malignancies of the bladder, both past and present. A number of points made in the article deserve further

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The detailed map of the human genome can potentially transform future cancer therapy by merging genomics with pharmacology, thereby identifying which patients will benefit from specific therapeutic agents. Single-nucleotide polymorphisms (SNPs) provide a valuable tool for this pharmacogenetic approach to cancer therapy.

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Over the past decade, interest has been growing in the quality of life of men with prostate cancer. Traditionally considered a group with few psychological complications, 10% to 20% of men with prostate cancer are found to have clinically significant levels of psychological distress. This article reviews the prevalence of psychiatric symptomatology among prostate cancer patients, the psychological challenges of coping with the disease, and general guidelines for treatment. [ONCOLOGY 16:1448-1467, 2002]

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This review nicely summarizes the current state of combined-modality therapy for resectable rectal cancer, largely covering trials currently in progress in the United States. Although the article's title is "Multidisciplinary management of resectable rectal cancer," it really doesn't emphasize how multiple specialists manage rectal cancer patients per se, and thus, the article would probably be more appropriately titled, "Combined-modality therapy in resectable rectal cancer." It would have been interesting if the article had included more details on how radiation oncologists, medical oncologists, and surgeons can cooperate to deliver combined-modality therapy in higher proportions of patients with resectable rectal cancer, but this is a minor criticism.

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High-dose myeloablative therapy with allogeneic hematopoietictransplantation is an effective treatment for hematologic malignancies,but this approach is associated with a high risk of complications.The use of relatively nontoxic, nonmyeloablative, or reduced-intensitypreparative regimens still allows engraftment and the generation ofgraft-vs-malignancy effects, is potentially curative for susceptiblemalignancies, and reduces the risk of treatment-related morbidity.Two general strategies along these lines have emerged, based on theuse of (1) immunosuppressive chemotherapeutic drugs, usually apurine analog in combination with an alkylating agent, and (2) lowdosetotal body irradiation, alone or in combination with fludarabine(Fludara).

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Endocrine malignancies, although relatively uncommon, are often difficult to diagnose and treat effectively. According to American Cancer Society (ACS) estimates, more than 39,000 new cases of endocrine neoplasms will be diagnosed in the United States in 2009, and approximately 2,470 deaths will result from these cancers. This chapter will focus on thyroid and parathyroid cancers. (A discussion of carcinoid tumors, insulinomas, gastrinomas, and other gastrointestinal neuroendocrine tumors, as well as adrenocortical cancer, can be found in chapter 11.)

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Oncologists would be well advised to consider their obligations to the patient, as well as other stakeholders, and be prepared to resolve potential conflicts that go beyond the focus of their clinical training.

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Bladder cancer is the fourth most common cancer (excluding skin cancer) in the United States and ranks eighth as a cause of death from cancer among men; there will be an estimated 70,530 new cases and 14,680 cancer-related deaths in the United States in 2010.[1] Of new cases, 70% to 80% present with non–muscle-invasive bladder cancer (NMIBC). Despite endoscopic and intravesical treatments with curative intent, 50% to 70% of these cancers recur, usually within 5 years, and 10% to 30% progress to muscle-invasive disease, in the majority of cases as high-grade lesions.[2,3] Bladder cancer poses a significant economic burden due to the cost of the lifetime need for surveillance, the need to treat recurrent tumors, and the cost of complications associated with treatment. Medicare estimates have ranked bladder cancer treatment the seventh costliest among cancers, with a 5-year net cost of approximately one billion dollars.[4]

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This management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of pancreatic cancer, pancreatic cystic neoplasms, pancreatic endocrine tumors (PETs), carcinoid tumors of the GI tract, adrenocortical carcinoma, and pheochromocytoma.

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Given the longer course and natural history of low-grade gliomas, the goals of treatment should be to prolong overall survival and minimize neurocognitive decline.

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The article by Dr. Echarri Gonzalez and her colleagues regarding intraperitoneal (IP) chemotherapy for women with epithelial ovarian cancer provides a comprehensive yet practical review of the critical questions surrounding the use of IP chemotherapy.

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Dr. Marshall has done an excellentjob in his review of thecurrent status of the design,development, and delivery of cancervaccines with emphasis on vaccinesfor the treatment of gastrointestinalcancers. He has clearly delineated boththe promise and potential limitationsof this actively emerging field ofinvestigation.

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ABSTRACT Worldwide incidence and mortality due to the coronavirus disease 2019 (COVID-19) pandemic is greatest in the United States, with the initial epicenter in New York. In Nassau County, New York, where we practice, our institution has had more than 2500 cases and has discharged from the hospital more than 1000 patients. As many academic and private institutions have swiftly shifted their clinical and research priorities to address the pandemic, data are emerging regarding both the impact of malignancy on COVID-19 outcomes as well as the challenges faced in assuring that cancer care remains unimpeded. Of concern, recent studies of cancer patients primarily in China and Italy have suggested that advanced malignancy is associated with increased susceptibility to severe COVID-19 infection. At present, more than 500 clinical trials are underway investigating the pathogenesis and treatment of COVID-19, including expanded use of oncology drugs, such as small molecular inhibitors of cytokine pathways. Here, we begin by reviewing the latest understanding of COVID-19 pathophysiology and then focus our attention on the impact of this virus on hematologic and oncologic practice. Finally, we highlight ongoing investigational treatment approaches that are so relevant to the care of oncology patients during this extraordinary pandemic.

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In this interview we discuss the goals of the Community Oncology Alliance, highlights from their annual meeting, and the challenge of transitioning cancer care to the hospital setting.

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Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.

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Accurate staging plays a primary role in determining the appropriate treatment of gastrointestinal malignancies. Recently, laparoscopy has emerged as a staging modality that is more sensitive and specific in staging most

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This management guide covers the risk factors, symptoms, screening, diagnosis, prevention, and staging of breast cancer.

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Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.

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We must now come to a uniform consensus regarding the descriptions of these risk groups in order to truly determine which treatments have the best oncologic efficacy, while minimizing overtreatment and optimizing patients’ quality of life.

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We review the current data regarding the prognostic and predictive value of IDH mutation and 1p/19q codeletion in gliomas. We also discuss possible management algorithms using these biomarkers to tailor surgical and adjuvant therapy for specific diffuse gliomas.

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Dr. Cherny’s article on the managementof cancer pain is acomprehensive review thatshould prove to be a helpful resource.As physicians in a palliative care andoncology program, we discuss howwe utilize these principles and whatwe see put into practice by others.Cherny and Catane have already documentedthat the great majority ofoncologists do a substantial amountof palliative care, whether they call itthat or not, and that most oncologistswould be willing to work with palliativecare or symptom managementspecialists.[1] Knowledge is only onepart of the solution, and must be pairedwith better practice by health-care professionalsand help from our patients.Articles like this will only help if oncologistspay attention.

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Cancer Network spoke with Dr. Jennifer A. Ligibel on the diet and exercise interventions to reduce breast cancer recurrences.

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Oncologists grapple with an element of psychological stress that relatesto the suffering their patients experience. Although this stress maynot be unique to oncology, it is profound. When these stresses becomeoverwhelming, they lead to physician burnout. It is important to understandwhat makes an oncologist feel successful, what coping strategieshelp combat burnout, and what adds to the process of renewal. Thedoctor-patient relationship plays an important role for many oncologistsin this regard, and communication skills are increasingly recognizedfor their importance in this arena. We outline several clinical scenariosthat pose particular challenges to oncologists. These include breakingbad news and the patient’s response to hearing bad news, transitions incare and offering end-of-life care, participation in investigational studies,error disclosure, complementary and alternative medicine, spirituality,family discussions, and cross-cultural issues. By highlighting therelevant psychosocial issues, we offer insight into, and tools for, anenriched dialogue between patient and oncologist. The doctor-patientrelationship can be viewed as the ultimate buffer for dealing with thehassles encountered in clinical oncology.

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Smoking kills more than 430,000 people each year in the United States and is currently estimated to be responsible for 30.5% of all cancer-related deaths in our society. The majority of these deaths could be prevented,

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We review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma.

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As advances in treatment strategies continue to focus on individualization of therapy, the identification of disease subsets is crucial to strategizing optimal therapeutic approaches.

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Bone health is a critical issue in the management of women with breast cancer. Many women who develop breast cancer are postmenopausal, which already predisposes them to osteoporosis. Systemic treatments for breast cancer, including chemotherapy and endocrine therapy, decrease circulating levels of estrogen in both pre- and postmenopausal women, further accelerating the natural process of bone loss. The primary concern in breast cancer patients is that this accelerated bone loss, known as cancer treatment–induced bone loss (CTIBL), will lead to an increase in fractures, chronic pain, and loss of mobility. Bisphosphonates are highly effective at slowing the rate of bone loss in postmenopausal women with osteoporosis and at preventing skeletal-related events in women with metastatic breast cancer. Many studies are now focusing on the role of bisphosphonates in preventing CTIBL in the adjuvant setting. Both oral and intravenous bisphosphonates have shown promising activity in preventing CTIBL in patients receiving chemotherapy or hormonal therapy. In addition, emerging data indicate that the use of bisphosphonates in the adjuvant setting may prevent disease recurrence and prolong survival. Data from a number of ongoing trials will further elucidate the role of bisphosphonates in the adjuvant setting over the next few years.