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In a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an

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The panel reviewed the pertinent literature in vulvar cancer and voted on three variants to establish appropriate use of imaging, adjuvant radiation, including dose, fields, and technique, as well as adjuvant chemotherapy. This report will aid clinicians in selecting appropriate patients for adjuvant treatment and will provide guidelines for the optimal delivery of adjuvant radiation therapy and chemotherapy.

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Approximately 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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The myriad changes that oncology physicians have experienced in the last 20 years are certainly applicable to oncology nurses, in particular, the technology explosion and its effects on diagnosis, treatment, and survivorship; the emergence of cancer as a disease of the elderly; challenges posed by shortages of health care workers; and the fact that almost all cancer patients today are treated as outpatients. Recent therapeutic innovations and management approaches have been keenly felt by oncology nurses, who typically play a major role in patient education.

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In a single-center, open, phase II trial, we assessed the toxicity and activity of a triple combination therapy-doxorubicin at 30 mg/m2 (day 1), paclitaxel (Taxol) at 135 mg/m2 (day 2), and gemcitabine (Gemzar) at 2,500 mg/m2

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The magnitude of the role surgical exploration and extirpation play in the contemporary management of patients with advanced ovarian cancer is hard to overstate. Beyond diagnostic confirmation, the aggressive posture taken to remove bulk disease provides-among other benefits-symptomatic relief, theoretically enhanced immunologic integrity, chemosensitivity, and improved survival characteristics.

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Melanoma continues to be a poorly understood and frequently under-recognized cancer threat to society. The authors have provided a comprehensive overview of this malignancy from diagnosis to advanced-stage therapy.

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Tumor growth is the result of two opposing processes--cell division and cell loss. As long as division outpaces loss, tumors will continue to grow. The form of "active" cell death called apoptosis is now known to be controlled by specific genes, and it is hoped that manipulating the expression of these genes could shift the balance in favor of cell loss.

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As increasing numbers of stemcell transplant recipients becomelong-term survivors, interestin understanding their longtermimmune status also assumesgreater urgency. One important strategyfor protecting patients againstcertain infections is the use of vaccinations.Just a few years ago, therewere no published recommendationsregarding this issue. Since then, boththe European Group for Blood andMarrow Transplantation (EBMT)and the Centers for Disease Controland Prevention (CDC) have publishedrecommendations. Drs. Goldberg,Cicogna, Rowley, and Pecoracritically review the CDC recommendationsin a nicely written articleand provide important backgroundinformation.

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These guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.

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Pressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure

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Radiation therapy is not part ofthe traditional treatment approachto cutaneous melanoma.Aggressive surgical resection ofboth the primary site and regional nodalmetastases has long been consideredthe only option for achievinglong-term disease-free and overall survival.Many patients who present withmelanoma have thin lesions (< 1 mmBreslow thickness) and are essentiallycured with a wide local excision ofthe primary site. Patients with thickermelanomas and clinically negativeregional nodal basins often undergowide excision and sentinel node biopsyto identify occult nodal metastases.Those who have a sentinel lymphnode positive for metastatic diseaseor clinically positive nodes undergo atherapeutic lymph node dissection toprovide local control and possibly preventdistant metastatic disease. Recentarticles such as the one by Balloand Ang, however, highlight the in-creasedrole of external-beam radiationtherapy in the treatment of malignantmelanoma.

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The best clinical outcomes for patients with endometrial cancer seem to be achieved with either surgery alone or a combination of surgery and radiation therapy. Although once administered preoperatively, irradiation is now

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Studies of hematopoietic stem-cell transplantation as a treatment for severe autoimmune diseases (SADS) are currently in progress. Dr. Burt thoroughly reviews the rationale for these studies. It includes: (1) preclinical studies showing that marrow transplantation is an effective therapy in animal models of autoimmune disease; (2) observations of the effect of stem-cell grafts on SADS in patients transplanted for other indications; and (3) improvements in the safety of the transplant procedure.

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The role of radiation therapy (RT) in lung cancer is long established; some of the earliest Radiation Therapy Oncology Group reports dealt with non-small cell lung cancer (NSCLC).[1,2] More recently, the advent of stereotactic body RT (SBRT) techniques has provided significant local control rates after focused treatment of selected small metastases and inoperable early stage lesions.[3,4] Our center has been in the forefront of examining SBRT and its role in central [5] or bilateral [6] lesions, its effect on PET imaging [7] and pulmonary function testing,[8] and subsequent frequency of brachial plexopathy,[9] chest wall toxicity,[10] or pneumonitis.[11] Still, even this highly conformal technique comes with potentially significant dose to adjacent normal tissue. This is in the context of an emerging appreciation for the pulmonary consequences of elevated mean lung dose,[12] or V5 after pneumonectomy.[13] For each lung cancer patient requiring RT, an effective mechanism to deliver dose to the tumor while minimizing dose to uninvolved lung is called for. Enter protons.

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This management guide of endocrine malignancies covers the risk factors, diagnosis, screening, and treatment of both thyroid and parathyroid cancers.

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Pheochromocytomas are tumors of the neural crest-derived chromaffin cells. The hallmark of this rare and fascinating neoplasm is the synthesis and secretion of catecholamines in an unregulated and potentially life-threatening manner. Most pheochromocytomas produce an abundance of norepinephrine. Epinephrine- or dopamine-secreting pheochromocytomas are less common.[1] Pheochromocytomas can also be nonfunctional.[1] Approximately 10% of pheochromocytomas can be categorized as either bilateral, multifocal, extra-adrenal, familial, or malignant; thus, pheochromocytomas are often remembered by medical students as the "10% tumor." Newer reports, however, suggest that pheochromocytomas may be extra-adrenal in up to 30% of cases.[2,3] This brief review will address the diagnosis and management of benign and malignant pheochromocytoma.

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A solitary pulmonary nodule (SPN) is the most common radiographic presentation of lung cancer. The imaging characteristics of solitary pulmonary nodules are described and illustrated. The appearance and implications of

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The debate over screening for lung cancer continues. While there have been many advances in treatment for late-stage disease, screening and prevention are likely the most cost effective and best approaches to preventing lung cancer deaths.

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Daniel V. T. Catenacci, MD, and colleagues present findings from a study of circulating tumor DNA as a predictive biomarker for gastric and gastroesophageal cancer.

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Despite advances in the treatment of many malignancies, a large number of cancer patients will require evaluation and possible surgical intervention for lesions that have metastasized or directly invaded the spinal column. The need for heightened awareness of and aggressive early intervention for spinal metastases is underscored by many studies that have reported a relationship between pretreatment and posttreatment neurologic function in these patients. Recommendations for operative intervention should be made following an evaluation of the patient by multiple specialties, both medical and surgical. In the last decade, advances in surgical techniques for tumor decompression and spine stabilization, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures with improved outcomes and reduced morbidity. This article will review the factors favoring an operative recommendation in patients with metastatic spinal disease, preoperative evaluation, and available surgical options. Patients with symptomatic spinal metastases should receive early surgical consultation as part of a multidisciplinary approach to their disease process. [ONCOLOGY 14(7):1013-1024, 2000]

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The combination of oxaliplatin plus fluorouracil/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for colorectal cancer (CRC), both as adjuvant therapy and as treatment for metastatic disease. Unfortunately, platinum-based chemotherapies also produce neurotoxicity as a side effect. Neurotoxicity is the most common dose-limiting toxicity of oxaliplatin, and it is one of the major causes for patients to stop receiving chemotherapy. It can manifest as either of two distinct syndromes: a transient, acute syndrome that can appear during or shortly after the infusion (~1%–2% of patients), and a dose-limiting, cumulative sensory neuropathy. Calcium/magnesium (Ca/Mg) infusions have been used to decrease the incidence of oxaliplatin-induced neuropathy. The actual utility of Ca/Mg infusions in this setting has been an interesting and controversial topic. They may reduce the severity of neurotoxicity, but some investigators have questioned whether they also will alter the efficacy of these chemotherapy regimens. In this paper, we review the clinical data concerning the usefulness of Ca/Mg infusions in reducing the incidence of oxaliplatin-induced neuropathy as well as their effect on responsiveness to chemotherapy.

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Each year, 2.4 million patients in the United States develop healthcare–associated infections (HAIs), requiring treatment at an annualcost of approximately $4.5 billion. HAI is the primary cause of deathin approximately 30,000 patients and contributes to the death of 70,000annually. Oncology patients are more susceptible than other patientsto HAIs due to compromised immune systems, surgery (drains),invasive technology (catheters), and environmental factors. This paperwill review each of these risk factors and discuss preventive steps suchas a predictive index, antibiotic therapy, and infection control practices.

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Clinical applications of image-based radiation therapy for the study of prostate cancer have expanded significantly over the past years. The results of recent studies of magnetic resonance imaging (MRI) combined with magnetic

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The patient is a 5-month-old Caucasian boy with no developmental abnormalities who presented Christmas Eve 2004 to his pediatrician with increasing fussiness, emesis, and inability to tolerate oral intake. He had a temperature of 100.2°F but otherwise normal vital signs. Physical exam at that time revealed a distended abdomen. He was sent home with a diagnosis of viral gastroenteritis.

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Skin cancer is the most common malignancy in the United States, with approximately 1 million cases being diagnosed in 1997.[1] Of these cases, more than 40,000 will be classified as malignant melanoma, the most serious and aggressive form of skin cancer.[1] The worldwide incidence of melanoma is increasing more rapidly than any other form of cancer, and has shown an increase of about 4% per year in the United States.[1,2]

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There will always be patients who are either not surgical candidates or who refuse radical cystectomy, but in all other cases radical extirpative surgery should be the preferred management for patients with HGT1 disease who fail to respond to intravesical bacillus Calmette-Guérin therapy.

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Conventional therapy for advanced-stage ovarian cancer-ie, aggressive cytoreductive surgery followed by aggressive chemotherapy-was established more than 3 decades ago [Editor’s note: See Dr. Schwartz’s article, “Cytoreductive Surgery in the Management of Ovarian Cancer,” in last month’s issue of ONCOLOGY]. Since that time, no prospective randomized trials have been reported to confirm the efficacy of this treatment strategy.