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Based on our experience and a review of the literature, we conclude that superficial, well- to moderately differentiated T1 cancers of the anal margin may be successfully treated with radiotherapy alone or local

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The definition of overtreatment of rectal cancer is controversial,and thus it is difficult to accurately quantitate its prevalence. All componentsof rectal cancer treatment are associated with significant potentialfor morbidity and dysfunction that may have a negative impacton the patient’s quality of life. No one would disagree with the tenetthat overtreatment should be avoided whenever possible. Despite thatconsensus, little attention is given in the literature to the issues ofovertreatment of rectal cancer. This review article presents a varietyof clinical scenarios and summarizes available data demonstratingthat overtreatment of some patients with rectal cancer is occurring ona regular basis. It is hoped that this will stimulate clinicians to criticallyreview their own practices to eliminate such overtreatment. Developmentof new clinical trials to determine whether current practiceguidelines are promoting overtreatment of selected rectal cancer patientsis proposed.

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Bone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.

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Paclitaxel (Taxol) and vinorelbine (Navelbine) are both microtubule toxins but with opposite mechanisms of action. Paclitaxel promotes the assembly of microtubules, whereas vinorelbine prevents microtuble assembly.

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With many centers seeking to adopt IORT, there are licensing, proctoring, staffing, technical support, and reimbursement issues that need to be considered. We have reviewed the current international experience and describe one community cancer center’s experience with initiating an IORT breast cancer program.

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The understanding of the relationship between genetic variation and an individual patient’s response to radiation therapy has gained significant ground over the past several years. Genetic markers have been identified that could ultimately serve as the foundation for predictive models in clinical practice, and that hold the potential to revolutionize the delivery of precision medicine in oncology.

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The treatment of advanced colorectal cancer over the past 4 decades has required the use of intravenous chemotherapy, most typically fluorouracil (5-FU). The possibility of providing

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Intensive outpatient care is rapidly becoming the primary mode of care for selected patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation. Although the traditional inpatient model of care may still be necessary for high-risk patients, published data suggest that outpatient care is safe and feasible during or after administration of high-dose chemotherapy and autologous PBSC transplant. Blood and marrow transplant (BMT) centers have developed programs to provide more outpatient care under three basic models: an early discharge model, a delayed admission model, and a comprehensive, or total, outpatient model. This review will describe these models of care and address the elements necessary for the development of an outpatient BMT program, including patient selection, staff development, and patient and caregiver education. Available supportive care strategies to facilitate outpatient care will also be highlighted.

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Scheithauer and Blum have madean important contribution to thediscussion of hand-foot syndrome,an increasingly common disorder.They emphasize the occurrenceof hand-foot syndrome in the contextof therapy with capecitabine (Xeloda),a prodrug for fluorouracil (5-FU)that in many ways mimics the continuousinfusion of that compound. Theauthors point out that the only provenmethod for managing hand-foot syndromeis interruption and/or reductionin the dose of the administeredtreatment, and they cite retrospectivedata from completed trials in colorectalcancer to support the hypothesisthat such a policy does not impair treatmentefficacy. We feel that severalpoints deserve further amplification.

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Pituitary adenomas are benign neoplasms that can be effectively managed by a variety of therapeutic options. The clinician's goal in managing patients with these tumors should be to minimize the morbidity of each intervention used in diagnosis and treatment. Standard diagnostic interventions include MRI, hormonal assessment, and tissue diagnosis. Therapies include transsphenoidal surgery, external-beam radiotherapy, newer stereotactic irradiation techniques, and medical management. Appropriate treatment selection requires detailed knowledge of the expected outcomes and side effects of each option. Newer and perhaps less toxic treatment techniques are evolving and require further evaluation. [ONCOLOGY 11(6):791-796, 1997]

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The relatively recent introduction of a new class of chemotherapeutic agents--the taxoids--has raised hope of improved survival for patients with advanced or metastatic cancer. Following encouraging preclinical results of taxoid combinations, this phase I, nonrandomized trial was designed to evaluate a 1-hour intravenous infusion of docetaxel (Taxotere) on day 1 combined with fluorouracil (5-FU) as a daily intravenous bolus for 5 consecutive days.

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Few of us enjoy performing a task if we feel that we are not very good at it. Furthermore, the simpler the task appears to be, the more embarrassed we feel about our perceived lack of ability. As a result, we tend to avoid the whole situation

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In this review, we discuss the discovery and biologic significance of HE4 and evaluate available evidence regarding the utility of HE4 as a biomarker for ovarian and endometrial cancer.

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Inflammatory cytokines plus the human immunodeficiency virus Tat protein apparently trigger the development of early Kaposi's sarcoma. Activated spindle cells provide a self-perpetuating, autocrine-supported mechanism for further development of hyperplastic lesions. In more advanced stages, a true neoplastic process may develop. [ONCOLOGY 10(Suppl):34-36, 1996]

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Dr. Paulino provides an excellent summary of current knowledge about Wilms' tumor and its treatment. He stresses the need to improve treatment for those with aggressive tumors and possibly avoid adjuvant treatment in a subset of patients.

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Like Burnison and Lim, we conclude conveying our sense of optimism that progress is being made-and that important clinical questions are being asked related to the care of patients afflicted with ATC. We believe, however, that in the final analysis, important progress will remain highly dependant upon collaborations conducted across specialties, across institutions, and across nations.

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Approximately one third of patients with epithelial ovarian cancer present with localized or early-stage disease. Prognostic features identify certain subsets of patients with good risk characteristics who do not require adjuvant

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Only about 15% of patients diagnosed with lung carcinoma eachyear are surgical candidates, either due to advanced disease orcomorbidities. The past decade has seen the emergence of minimallyinvasive therapies using thermal energy sources: radiofrequency,cryoablation, focused ultrasound, laser, and microwave; radiofrequencyablation (RFA) is the best developed of these. Radiofrequency ablationis safe and technically highly successful in terms of initial ablation.Long-term local control or complete necrosis rates drop considerablywhen tumors are larger than 3 cm, although repeat ablations can beperformed. Patients with lung metastases tend to fare better with RFlung ablation than those with primary lung carcinoma in terms of localcontrol, but it is unclear if this is related to smaller tumor size at time oftreatment, lesion size uniformity, and sphericity with lung metastases,or to differences in patterns of pathologic spread of disease. The effectsof RFA on quality of life, particularly dyspnea and pain, as well aslong-term outcome studies are generally lacking. Even so, the resultsregarding RF lung ablation are comparable to other therapies currentlyavailable, particularly for the conventionally unresectable or high-risklung cancer population. With refinements in technology, patient selection,clinical applications, and methods of follow-up, RFA will continueto flourish as a potentially viable stand-alone or complementarytherapy for both primary and secondary lung malignancies in standardand high-risk populations.

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This look ahead at hematologic malignancies in 2017 focuses on new agents being studied for the treatment of multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma, and myeloproliferative neoplasms.

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Today we speak with Dr. Robert Coleman about several new agents that have shown promise in early-stage clinical trials for ovarian cancer.

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Syed and Rowinsky present acomprehensive review of newtargeted therapies for breast cancer.This is an important review thatsummarizes new biologic targets andcurrent drugs in development for thetreatment of breast cancer-a rapidlyevolving field. Among the targets addressedin the article are epidermalgrowth factor receptor (EGFR), Ras/Raf/mitogen-activated protein (MAP)kinase, phosphatidylinositol 3-kinase(PI3K)/protein kinase B (AkT)/moleculartarget of rapamycin (mTOR), tumorangiogenesis, apoptosis, andhistone deacetylases. The list shouldalso be expanded to include differentiatingagents and inhibitors of invasionand metastasis. It is critical toemphasize the future of customizedtherapy and the use of biologic agentsalone, together, or in combination withchemotherapy for the treatment ofbreast cancer.

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At the outset of their article, Drs. Gerszten and Welch state that their primary goal is to review factors that affect surgical intervention in patients with metastatic spinal disease. On their way to achieving this goal, the authors touch on some of the

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Song and colleagues deliver athorough and fair review of theinitial clinical investigations ofa new paradigm in radiotherapy mostrecently called stereotactic body radiationtherapy (SBRT).[1] Oncology observers may take exception withthe use of the designation “new paradigm.”After all, from a tumor controlpoint of view, skeptics might say,“radiotherapy is radiotherapy.” Recentadvances in radiotherapeutictechnology such as three-dimensionsal(3D) conformal therapy and intensity-modulated radiotherapy (IMRT)have made treatments less toxic, butnot particularly more effective in curingcancer.

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Whole-breast external-beam radiation therapy (EBRT) involves a 6-week course of fractionated treatments. In

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In their article, Drs. Whisenant andVenook review data regarding thevalue of hepatic arterial infusion(HAI) chemotherapy for hepatic colorectalmetastases. In fact, their analysisreveals the absence of anymaterial progress in HAI therapy sincethe first reports of continuous infusionof chemotherapy through the hepaticartery.[1] During the sameperiod, there has been dramatic improvementin hepatic imaging, outcomefrom hepatic resection, systemicchemotherapy, and survival followingtreatment of hepatic colorectalmetastases. Failure of HAI therapy toadvance in parallel with other treatmentsfor liver metastases-whetherused prior to or after resection, or asdefinitive treatment for unresectabledisease apparently confined to the liver-suggests a limited role for HAItherapy in this disease. Several pointswarrant discussion.

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Managing the infectious complications associated with pentostatin (Nipent), used alone or in combination with other agents in patients with low-grade lymphomas, poses a significant problem for clinicians. Since there is limited

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Looking toward the future management of metastatic HSPC, experts consider the results of triplet combination trials like ARASENS and PEACE-1.

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The incidence of ovarian carcinoma increases with advancing age,peaking during the 7th decade of life and remaining elevated until age80 years. Despite the high prevalence of ovarian cancer in the elderly,the management of these patients is often less aggressive than that oftheir younger counterparts. As a result, many elderly cancer patientsreceive inadequate treatment. However, data do not support the conceptthat age, per se, is a negative prognostic factor. In fact, the majority ofelderly patients are able to tolerate the standard of care for ovariancancer including initial surgical cytoreduction followed by platinumand taxane chemotherapy. Because functional status has not demonstrateda reliable correlation with either tumor stage or comorbidity,each patient’s comorbidities should be assessed independently. Forelderly patients with significant medical comorbidity, the extent ofsurgery and aggressiveness of chemotherapy should be tailored to theextent of disease, symptoms, overall health, and life goals. In addition,enhanced cooperation between geriatricians and oncologists may assistthe pretreatment assessment of elderly patients and improve treatmentguidelines in this population.

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Bone metastases are common in advanced breast cancer, and may be associated with serious morbidity, including fractures, pain, nerve compression, and hypercalcemia. Through optimum multidisciplinary management and the use of bone-targeted treatments, patients with advanced breast cancer have experienced a major reduction in skeletal complications, less bone pain, and an improved quality of life.