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Does Neck Stage Predict Local Control After Irradiation for Head and Neck Cancer?The review by Mendenhall et al presents selected papers pertinent to the effect of metastatic nodes on local control in patients with head and neck cancer. These data are retrospective and, as the authors point out, do not resolve the matter.
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Ductal Lavage: What We Know and What We Don’tThe success of the National SurgicalAdjuvant Breast and BowelProject (NSABP) trial P-01at showing that we now have an effectivemeans to prevent breast cancerposes larger and more seriousquestions: Who should receivechemoprevention, and at what pointin life should this occur? The designof the P-01 study allowed many womento enroll who, according to Gailmodel calculations, were at a less than 1% per year risk of subsequent breastcancer during the expected 5-yeartreatment period. These lower-risk individualsseemed to have less benefitthan those patients at much higherrisk. Other similar prevention studiesseem to confirm this observation.
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Current Surgical Management of Metastatic Spinal DiseaseDespite 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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Breast Reconstruction in the Setting of Postmastectomy Radiotherapy: Controversies and DisparitiesBreast reconstruction improves quality of life, but providers must be aware of the risks and benefits of each reconstruction approach in the setting of postmastectomy radiotherapy.
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Diagnostic Dilemma: GI DiseaseThis 47-year-old man underwent surveillance colonoscopy for a history of an adenomatous polyp. He has a history of hemorrhoids and occasional bright red blood on the toilet tissue. There is no history of diarrhea, constipation, or abdominal pain.
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Polypharmacy in View of Advances in Cancer TreatmentAdvances in science have prolonged the average life span, and people are living relatively longer than before. Nevertheless, we have much to achieve to prolong the "healthy life span." People in old age suffer from multiple chronic ailments, and many of them succumb to death by heart disease, cancer, or stroke.[1] To survive these diseases, patients continuously depend on concurrent multiple medications-also referred to as polypharmacy-and with that comes the responsibility of appropriate selection, administration, and monitoring of therapeutic modalities.
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Issues in the Management of Cancer-Related ThrombocytopeniaCancer-related thrombocytopenia is a clinical problem. Unfortunately, the qualitative nature and quantitative extent of the problem has been poorly defined to date. Without knowing these two parameters, the risk/benefit ratio of any management option for cancer-related thrombocytopenia is impossible to calculate accurately. Drs. Goodnough and DiPersio have done an excellent job of delineating many of the potential risks of managing the problems associated with platelet transfusions.
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Drug Shows 10-Month Survival Improvement in SarcomaIn this video, Dr. Tap discusses a randomized phase Ib/II trial that found that adding olaratumab to doxorubicin dramatically improved survival in patients with advanced soft-tissue sarcoma.
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Treating Prostate Cancer in Older PatientsThis video reviews the management approach for prostate cancer in older patients, including when screening is appropriate and how geriatric assessments can guide treatment decisions.
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Individualized Local Treatment Strategies for In-Transit MelanomaFor localized in-transit disease, less is more, with local destruction, excision, and intralesional therapy being the cornerstones of treatment. If local therapies fail or if distant disease arises, isolated limb perfusion and systemic therapy remain effective options.
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ACR Appropriateness Criteria® Borderline and Unresectable Pancreas CancerThese 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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Unanswered Questions About SBRT in Bone MetastasesThe goal of palliative radiotherapy is to treat symptoms as rapidly and efficiently as possible, with the fewest side effects.[1] For many years, pain medication, radiotherapy, and surgery were the only tools available for the treatment of bone metastases. This has changed significantly over the past 15 years. New systemic agents, including bisphosphonates such as zoledronic acid (Reclast, Zometa), are available to prevent the development of new lesions, strengthen the bone, and improve symptoms. In addition, targeted treatments directed at achieving tumor ablation now include radiofrequency ablation and stereotactic body radiation therapy (SBRT).
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Commentary (Pirl): Psychiatric Assessment and Symptom Management in Elderly Cancer PatientsDrs. Winell and Roth provide agood overview of the commonpsychiatric disorders andcancer-related symptoms in elderly individualswith cancer. Because of thelarge and growing percentage of cancerpatients who are over age 65, theauthors duly highlight the importanceof this topic. The article is highly relevantto the clinical practice of oncologyand detailed information is includedto help guide treatment options formajor depression, anxiety, delirium,and other cancer-related symptoms.
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Radiation Therapy in Resectable/Resected Pancreatic Adenocarcinomas: Clearing Up the FogSurgical resection remains the sole modality that has proven capable of "curing" pancreatic cancer.
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Clinical Hypnosis for the Palliative Care of Cancer PatientsClinical hypnosis has been defined as a mind-body therapy that involves a deeply relaxed state, individualized mental imagery, and therapeutic suggestion.
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Commentary (Palesty et al)-Imatinib Mesylate: A Molecularly Targeted Therapy for Gastrointestinal Stromal TumorsDr. Eisenberg has produced anexcellent, concise, yet comprehensivereview of the evolutionof the KIT inhibitor imatinibmesylate (Gleevec) and the preoperativeand postoperative treatmentdilemmas surrounding mesenchymalgastrointestinal stromal tumors(GISTs), particularly in the face ofadvanced disease and recurrences. Thefocus of the article is on the naturalhistory of GISTs, from a molecularand pathobiologic perspective, toclarify the rationale for the use ofimatinib.
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Management of Infections in Patients With Acute LeukemiaSeveral recent studies have addressed the management of infectious problems in patients with acute leukemia. Although those studies have served to emphasize the fundamental management principles formulated and proven
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Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 2Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a
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Cancer Management Chapter 31: Chronic lymphocytic leukemiaChronic lymphocytic leukemia (CLL) is a clonal malignancy that results from expansion of the mature lymphocyte compartment. This expansion is a consequence of prolonged cell survival, despite a varied cell. The affected lymphocytes are of B-cell lineage in 95% of cases, and the remaining cases involve T lymphocytes, representing a distinct disorder.
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Chemotherapy in Soft-Tissue Sarcoma: Where Do We Go From Here?While the future is bright for the development and investigation of novel chemotherapeutics for treatment of soft-tissue sarcoma, investigators will need to gain better insight into the molecular drivers of pathogenesis, and give continued thoughtful consideration to clinical trial design.
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Ovarian Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Genetic Prostate Cancer Studies Are Needed to Push the Needle ForwardRobust genetic testing guidelines in the prostate cancer space must be supported by strong clinical research before they can be properly implemented, says William J. Catalona, MD.
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Treating Prostate Cancer: Where Do We Draw the Line?While there is no doubt that many indolent prostate cancers have been treated, it is unclear where one should draw the line between indolent and aggressive tumors.
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Physical Function in Men and Women With CancerFatigue is an extraordinarily common consequence of cancer and its treatment. Fatigue can result in diminished cognitive and physical functional capacity and may be the result of multiple causes.
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Novel Neoadjuvant Treatment Strategies for Triple-Negative Breast CancerExperts review the current landscape and potential use of neoadjuvant chemotherapy with additional novel agents for patients with localized TNBC.
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The Key to Improving Survival in Ovarian Cancer: Better Screening of Women With Vague Symptoms, Leading to Earlier Diagnosis, More Effective SurgeryAlthough the combination of CA-125 and HE4 appears indicated for use in symptomatic patients or in patients with an adnexal mass, there is no evidence that it would be indicated as a screening test in asymptomatic patients.
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Modulation of Dose Intensity in Aerodigestive Tract Cancers: Strategies to Reduce ToxicityThe population dynamics of cellular entry, traverse, and exit, through and from each phase of the cell cycle is coordinated throughout the day in the tissue of the human body. This coordination is particularly robust-ie, the daily peaks and valleys are particularly high and low-in tissues with the greatest average daily cellular proliferation. These tissues are also the most severely damaged by cancer treatments, most prominently cytotoxic drugs and ionizing irradiation.
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Successful Treatment of Melanoma Metastatic to the Left Atrium Using External Beam Radiation TherapyThe successful treatment of a patient with primary nasal melanoma metastatic to the lung, pulmonary vein, and left atrium using radiation therapy is described. The patient was effectively treated with a conventional external beam radiation fractionation scheme (rather than a more commonly used hypofractioned regimen) that was utilized to minimize risk of arterial embolus of the tumor or rupture of a vessel wall. A post-treatment CT demonstrated a significant decrease in the caliber of the right pulmonary vein and tumor thrombus. The patient never developed cardiac valvular dysfunction or acute life-threatening massive embolism of tumor from the atrium. Unfortunately, the patient experienced clinical decline secondary to the massive progression of intra-abdominal disease and subsequently died from multiple liver metastases and liver failure. Numerous studies and this case report demonstrate that radiation therapy can be very effective in the treatment of malignant melanoma, especially when only small volumes of disease need to be treated and adequate total doses are used. Therefore, radiation therapy appears to play an important yet underutilized role in the treatment of metastatic melanomas.
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New Insights Into the Cost-Effectiveness of Lung Cancer TreatmentDespite growing evidence that patients with advanced non–small-cell lung cancer have improved survival and better symptom control with modern systemic therapy, there is still resistance to the use of chemotherapy because
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Commentary (Oh/Kantoff): The Role of Cytotoxic Chemotherapy in Prostate CancerIn this review, we describe how clinical investigators addressed some of the challenges in prostate cancer chemotherapy trials 20 years ago, and we indicate what has evolved in the field since that time. We consider the impact that prostate-specific antigen measurement had in this setting, evolving clinical paradigms, multidisciplinary programs, and the current armamentarium of cancer treatment, including targeted molecular therapy, for patients with hormone-refractory disease.
