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Palliative RT Research in Prostate Cancer: Understanding the Past, Anticipating the FutureMoving forward, perhaps no recent development in the use of RT in metastatic prostate cancer has captured greater attention than the use of radium-223 in metastatic castration-resistant prostate cancer (mCRPC).
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Vaccinations Against Infectious Diseases in Hematopoietic Stem Cell Transplant RecipientsBlood and marrow transplantation, a curative treatment for avariety of serious diseases, induces a period of sustained immunosuppressionpredisposing recipients to opportunistic infections. Both forthe protection of the individual transplant recipient and as a matter ofpublic health policy, the US Centers for Disease Control and Prevention(CDC) has developed guidelines for the use of vaccination in theprevention of infectious disease following transplantation. This reviewexamines the primary clinical research supporting vaccinationpolicies in this target population. Widely accepted recommendationsfor transplant recipients based on scientific data are sparse, as fewlarge studies have been conducted in this population. Anecdotalreports, expert advice, summaries, and limited series involving lessthan 50 patients using surrogate end points form the basis of thescientific literature, with the result being a wide variation in practice.Although based largely on inadequate scientific data, the CDC recommendationsoffer a pragmatic approach to the prevention of opportunisticdisease in hematopoietic transplant recipients and serve as auseful starting point for standardization of practice while defining thedirection of future studies in transplant recipients and other immunocompromisedhosts.
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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesConservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]
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Active Surveillance for Low-Risk Localized Prostate CancerIn this review, we summarize contemporary data pertaining to active surveillance, a safe and appropriate strategy for select patients with low-risk cancer characteristics who undergo monitoring at regular intervals.
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Pancreatic Cancer: Recognizing an Hereditary PredispositionAlthough candidate genes for hereditary pancreatic cancer have been identified (Figure 1), namely p16 and BRCA2, pancreatic cancer patients having an inherited predisposition will not be easy to recognize on clinical grounds.
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Development of PARP Inhibitors: An Unfinished StoryIn this issue of ONCOLOGY, Comen and Robson provide a timely overview of poly(ADP-ribose) polymerase (PARP) inhibitors and their potential for the treatment of breast cancer. The authors highlight the recent demonstration of synthetic lethality between PARP inhibition and loss of either of the breast cancer susceptibility genes, BRCA1 and BRCA2, as well as the development of PARP inhibitors that are suitable for clinical therapy. However, many questions pertaining to both the basic biology of PARP inhibition and the potential clinical implications of PARP inhibitors still need to be addressed. In the following commentary, we highlight some of these remaining challenges.
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Propelling Immunotherapy Combinations Into the ClinicThis review summarizes promising new targets and immunotherapy combination strategies currently under clinical development.
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Face-Off: Award Presentations and Event ConclusionJudy concludes the event and presents the awards.
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Minimal Residual Disease–Directed Adjuvant Therapy for Patients With Early-Stage Colon Cancer: CIRCULATE-USIbrahim Halil Sahin, MD, and colleagues, explore, the CIRCULATE-US (NRG-GI008; NCT05174169) investigating postoperative ctDNA dynamics in early-stage colon cancer for treatment selection.
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The Role of Amifostine as a RadioprotectorEffective radiotherapy for patients with cancer should include maximal tumor cell killing with minimal injury to normal tissue. Radiation doses that can be delivered, without causing severe damage to surrounding normal
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Combined Radiation and Chemotherapy for Carcinoma of the Anal CanalSphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown
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Salivary Gland Cancers: The Challenges of Progress in Rare TumorsThe diversity and complexity, combined with the rarity of salivary gland malignancies, lead to definite and distinct challenges in their study, and consequently in advancing treatment options for affected patients.
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Prostate Cancer in a Man With Multiple Previous Cancerspatient is a 67-year-old male with mild obstructive symptoms and an American Urology Association symptom score of 8.[1] He was noted to have a prostate-specific antigen (PSA) level of 3.2 ng/mL. Because this represented a significant increase in his PSA velocity (rate of change over time), he proceeded to have a biopsy, which was positive for prostate cancer. He has no other complaints and visits us for an opinion on the treatment of his prostate cancer.
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Surgical Cytoreduction in Ovarian CancerI would like to compliment the authorson their comprehensive reviewof cytoreductive surgery forovarian cancer. However, some oftheir interpretation of the literaturewarrants amplification, and some conclusionsmerit presentation of an alternativeperspective.
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Contemporary Issues Surrounding Small Renal Masses: Evaluation, Diagnostic Biopsy, Nephron Sparing, and Novel Treatment ModalitiesIn this review, we summarize the diagnosis of small renal masses, the role of renal mass biopsy, different treatment strategies, and future directions, including emerging molecular biomarkers.
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Head and Neck CancerHead and neck cancers are a diverse group of diseases, each with its own distinct epidemiologic, anatomic, and pathologic features, natural history, and treatment considerations. Despite improvements in diagnosis and local management, long-term survival rates for patients with this disease have not increased significantly over the past 30 years and are among the lowest for the major cancers.
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Problems in Lymphoma Management: Special Sites of PresentationThe article by Dr. Connors is an excellent overview of lymphomas involving five sites: the eye, central nervous system (CNS), sinuses, testes, and stomach. The author emphasizes that these lymphomas present unique management challenges even to the experienced oncologist. The tumors are difficult to diagnose, resistant to treatment, or, in the case of gastric lymphoma, occasionally associated with a causative organism that warrants antibiotic treatment.
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Oral Complications of Cancer TherapyDrs. Sonis and Fey provide a nice description of the problems associated with oral mucositis, information available regarding its etiology, and the cost generated by its treatment.
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Current Concepts in Surgical Management of Neck Metastases from Head and Neck CancerThis article will address modified, selective, and radical neck dissection as well as other surgical considerations, and will review the surgical techniques currently available for neck treatment.
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Can Effective Cancer Care Become Affordable Again?Chemotherapy regimens that 10 years ago cost $30,000 have now increased ten-fold. Could a new research facility help make cancer care affordable again?
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Cytoreductive Nephrectomies for Renal Cell CarcinomaDrs Thomas Hutson and Scott Tykodi explain when to consider a debulking surgery for patients with renal cell carcinoma.
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Clinical Trials in Soft Tissue SarcomasSoft tissue sarcomas in adults are rare malignancies with diverse histologies that have historically been classified together, mostly for convenience. In truth,
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ProstACT GLOBAL Results May Support “Open” Decisions in Metastatic CRPCFindings from prior studies, such as the phase 3 VISION trial, may support the notion of combining radiopharmaceuticals with best supportive care.
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Recommendation for the Management of Patients With Chemotherapy-Induced DiarrheaRecommendation for the Management of Patients With Chemotherapy-Induced Diarrhea
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Malignant Mesothelioma of the Pleural SpaceMalignant pleural mesothelioma is an aggressive tumor associated with exposure to asbestos. Although this disease is rare, with an annual incidence in the United States of 2,000 to 3,000 cases, a steady rise in cases has
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Beyond Survival: Economic Analyses of Chemotherapy in Advanced, Inoperable NSCLCResearch shows that chemotherapy for inoperable non-small-cell lung cancer (NSCLC) improves survival. The economic implications of this treatment choice may be substantial. This paper reviews studies examining the cost-
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Lung Cancer Management in 2010Exciting advances in understanding the biology of lung cancer have occurred over the last few years.
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Current Management of Opioid-Related Side EffectsThe optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient’s
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The Need to Engage Stakeholders in Defining, Designing, and Implementing Clinical TrialsIn the conclusion to the article “Proton Radiation Therapy for Lung Cancer: Is There Enough Evidence?” Dr. David Bush puts his finger on the critical issue underlying most debates about the value of new medical technologies. He notes that “The evidence required to bring new technology into clinical practice is poorly defined.”[1] In the specific context of this article, the answer to the question of whether or not there is enough evidence depends entirely on how one chooses to define “enough.” Some experts believe that biological modeling based on dose distributions is sufficient to conclude that proton therapy improves health outcomes. Others have argued that the evidence is only adequate once randomized clinical trials have been completed to directly compare alternative interventions. Whatever one’s position on this issue, the lack of clarity on the question of adequacy of evidence is a major contributor to the gaps in knowledge about the comparative effectiveness of many widely used clinical interventions. Accelerating the rate at which this knowledge is generated will require a serious and sustained effort to define these evidence thresholds. This would allow more energy to be channeled into generating the needed evidence and less energy to be devoted to debating whether or not the evidence we have today is good enough.
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Alternatives to Oral Opioids for Cancer PainAlthough the optimal route of administration of opioids is by mouth, some patients may require alternative routes during the course of their illnesses for several reasons. These include bowel obstruction, severe emesis, or severe
