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Positron-emission tomography(PET)–computed tomography(CT) has added a new dimensionto the imaging of cancers andcombination PET-CT scanners are becomingincreasingly universal. Theuse of combination scanners has increasedrapidly over the past 2 years-industry estimates are that the majorityof PET units sold throughout the worldwill be combination PET-CT scanners-and the authors have providedtheir own clinical experience and areview of the literature. While there issubstantial literature on the clinicalutility of PET alone, the use of PETCTis relatively new. The authors suggestthere is incremental benefit tothe addition of structural information(ie, CT) obtained at the same time asthe functional PET imaging.

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The treatment of follicular lymphoma has changed dramatically over the past several years. The availability of newer, novel forms of therapy has enabled the field to continue to evolve. In addition to having tumor-specific activity, these newer agents provide the possibility of a more favorable toxicity profile than conventional chemotherapy.

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Although the prospect is tempting, we do not believe there are sufficient grounds at this time to abandon bone marrow biopsy in patients with lymphoma. It still provides robust prognostic information, and in the majority of patients it remains an indispensable staging tool.

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The treatment of patients with follicular lymphoma is undergoing a substantial shift due to rapid development of highly effective agents targeting lymphoma-specific biologic processes and the tumor microenvironment.

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Radiation is often considered immunosuppressive, an activity that is most likely a result of the complex interplay of hormesis and the abscopal effect. The abscopal effect, also called the “distant bystander” effect, is a paradoxical effect of radiation on cellular systems whereby local radiation may have an antitumor effect on tumors distant from the site of radiation.

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The treatment of advanced non–small-cell lung cancer (NSCLC)has evolved rapidly over the past few years. Systemic chemotherapy isassociated with both quality of life and modest survival benefit for patientswith advanced NSCLC. Platinum-based doublet combinationsare the “standard of care.” The US Food and Drug Administration(FDA) has approved gemcitabine (Gemzar), a pyrimidine analog, to beused in combination with cisplatin for the treatment of advanced NSCLCin the first-line setting. Randomized clinical trials have established comparableefficacy with improved therapeutic index for the carboplatin/gemcitabine regimen when compared with cisplatin/gemcitabine andother platinum doublets. Nonhematologic toxicities occur at a lowerfrequency with carboplatin/gemcitabine combinations compared withother “standard” platinum-based doublets, whereas dose-limitingthrombocytopenia, the most common toxicity, rarely requires therapeuticintervention. Both the 3- and 4-week schedules of carboplatin/gemcitabine result in similar efficacy and toxicity profiles, but the3-week regimen is preferred. The combination of carboplatin andgemcitabine is an effective regimen with an acceptable toxicity profilefor the treatment of advanced NSCLC. This regimen can also be usedas a foundation for the development of innovative combinations withmolecularly targeted agents.

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The soft-tissue sarcomas are a group of rare but anatomically and histologically diverse neoplasms. This is due to the ubiquitous location of the soft tissues and the nearly three dozen recognized histologic subtypes of soft-tissue sarcomas.

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Surgery for cancer carries concerns of tumor dissemination related to tumor manipulation, tumor violation, and wound seeding. Minimally invasive surgery is now standard for several benign conditions, such as symptomatic cholelithiasis and surgical therapy of gastroesophageal reflux. With the minimally invasive surgery explosion of the 1990s, virtually every procedure traditionally performed via laparotomy has been performed successfully with laparoscopic methods, including pancreaticoduodenectomy for cancer. Shortly after the first descriptions of laparoscopic-assisted colectomy, reports of port-site tumor recurrences surfaced, raising concerns of using pneumoperitoneum-based surgery for malignancy. This review covers the development of laparoscopic surgery for cancer. Historical perspectives elucidate factors that helped shape the current state of the art. Theoretical concerns are discussed regarding surgery-induced immune suppression and its potential effects on tumor recurrence with both open and laparoscopic approaches. The concerns of laparoscopic port-site wound metastases are addressed, with a critical evaluation of the literature. Finally, a technical discussion of laparoscopic-assisted resections of hepatic and pancreatic tumors details patient selection, operative approach, and existing data for these operations.

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Locoregional recurrences are a major source of morbidity and mortality for patients with squamous cell carcinomas of the head and neck (HNSCC).

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A total of 332 patients with advanced non-small-cell lung cancer were randomized by the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative

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Calendar age and biological age do not always correspond. Pablo Picasso, source of the quote that begins the title of this commentary, lived a notoriously robust and active life through his later decades, dying in his nineties in the midst of a dinner party. In the oncology community, with the advent of targeted therapeutics and better supportive care, the disparity between the two is likely to be increasingly relevant to both research and practice. In this issue of ONCOLOGY, Chiappori et al review data supporting the idea that even in the context of standard cytotoxic chemotherapy, elderly patients with advanced NSCLC experience similar response rates and similar survival benefits to those seen in younger patients. They note that biases excluding elderly patients from clinical trials result in gaps in our knowledge of how to best treat older patients.

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Exciting advances in understanding the biology of lung cancer have occurred over the last few years.

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It is challenging to diagnose, manage, and treat patients who have kidney disease in addition to cancer. Second to cardiovascular disease, cancer represents a major cause of mortality and morbidity in the kidney disease population.

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The changing clinical dynamics of prostate cancer have resulted in a broadening of the research focus of the Genitourinary (GU) Cancer Committee of the Southwest Oncology Group (SWOG). Beginning with an emphasis on hormone-refractory disease in its early years, SWOG prostate cancer trials now cover the entire spectrum of the disease: localized, locally advanced, metastatic and hormone-refractory disease. As the world's largest GU cancer research group, the GU committee of SWOG has pioneered studies in combined androgen therapy for metastatic disease, quality-of-life (QOL) assessments for patients with localized and advanced disease, adjuvant therapy models, and prostate cancer chemoprevention. The committee has also formed the GU Global Group, whose purpose is to convene the chairs of the GU committees of all the major national and international oncology cooperative groups. Meeting semiannually, this group discusses activities within their respective organizations, plans collaborative strategies and protocols, and establishes global strategy in prostate cancer clinical research. The future directions of national and international prostate cancer trials will build on this broad foundation of well-conceived, logically sequenced studies. [ONCOLOGY 11(8):1155-1170, 1997]

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Radiation therapy has an essential role for certain patients with DLBCL. It is hoped that ongoing and future trials will identify the patients who will benefit from this treatment and those for whom it is unnecessary.

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In this issue of ONCOLOGY, Damron and Pritchard discuss combined therapy for high-grade osteosarcoma. This is a nice review of the current status of osteogenic sarcoma, certainly from the point of view of modern surgical management, and for

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Early presentation of endometrial cancer permits effective managementwith excellent clinical outcome. The addition of hysteroscopy todilatation and curettage (D&C) in the evaluation of postmenopausalbleeding adds little to the detection of malignancy. Imaging studies suchas computed tomography, magnetic resonance imaging, and positronemissiontomography may be of use in determining the presence ofextrauterine disease in patients medically unfit for surgical staging.However, these studies are not sufficiently sensitive to replace surgicalstaging and have little role in routine preoperative evaluation. Clinicalstaging alone is clearly inadequate, as 23% of preoperative clinicalstage I/II patients are upstaged with comprehensive surgical staging.Preoperative tumor grade from D&C or office biopsy may be inaccurateand lead to an underestimate of tumor progression if used to determinewhich patients should be surgically staged. Clinical estimationof depth of invasion, with or without frozen section, is inaccurate andmay lead to underestimation of disease status when surgical staging isnot performed. The practice of resecting only clinically suspicious nodesshould be discouraged as it is no substitute for comprehensive surgicalstaging. Comprehensive surgical staging provides proper guidance forpostoperative adjuvant therapy, avoiding needless radiation in 85% ofclinical stage I/II patients. Finally, resection of occult metastasis withsurgical staging may improve survival.

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The panel discusses the efficacy of belantamab mafoditin and where the treatment fits in the multiple myeloma treatment landscape.

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The liver is a frequent site of metastatic colorectal disease. Over the past 20 years, improvements in systemic chemotherapy and surgical techniques have improved the survival of patients with hepatic metastases. For 4 decades, fluorouracil and leucovorin were the only drugs available to treat metastatic colorectal cancer, but several new drugs and a variety of novel regimens are now available. Further improvements in results have been seen with the delivery of chemotherapy via the hepatic artery. Surgical resection of liver metastases has been encouraged when possible, and recent advances in surgery such as portal vein embolization, have made liver resection a possibility for more patients. This review considers the timing and sequence of chemotherapy and surgery in this setting, as well as the roles of cryoablation, radiofrequency ablation, and radiation therapy.

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The 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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Dr. O’Connell has done a remarkablejob of discussingmodalities available for patientswith intermediate- to high-riskfully resected large bowel malignancies.Indeed, the title “Current Statusof Adjuvant Therapy for ColorectalCancer” is an underestimate of thearticle’s contents, as he nicely detailsthe past development of standard-ofcareadjuvant (and neoadjuvant, whenappropriate) treatments as well. As isclearly pointed out in the article, adjuvanttherapy works. Adding fluorouracil(5-FU) with or without radiationto surgery already saves thousandsof lives each year, and the enticing possibilityof throwing newer chemotherapeuticagents (eg, oxaliplatin)and/or targeted therapies (bevacizumab[Avastin]) into the mix makespotential future successes even greater.

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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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Plastic surgical reconstruction extends the capabilities of surgical and radiation therapy for cancer patients. Resection defects that are large, involve functional structures, aesthetically sensitive areas, and/or are at increased risk for wound healing complications are successfully reconstructed with a wide variety of techniques. Cancer and the complications of cancer treatment can involve virtually any area of the body, and to address every potential circumstance, the breadth of oncologic reconstruction must be extensive. A multidisciplinary team approach is the optimal method of cancer treatment, and plastic surgical reconstruction has become a critical component of that treatment, with the ability to restore form and function to the involved areas.

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Gastric cancer is more common than esophageal cancer in Western countries but is less fatal. More than 21,130 new cases of gastric cancer will be diagnosed in the United States in the year 2009, with 10,620 deaths expected. Worldwide, gastric cancer represents approximately 930,000 new cases and accounts for more than 700,000 deaths. The incidence and mortality of gastric cancer have been declining in most developed countries, including the United States; the age-adjusted risk (world estimate) fell 5% from 1985 to 1990.

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The autosomal, dominantly inherited multiple endocrine neoplasia (MEN) syndromes provide some of the best examples of the practical application of advancing technology, not only in the detection and treatment of neoplastic disease but also in the understanding of the mechanisms involved in the initiation and progression of malignancies.

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Drs. Chandler and Silva providean excellent review ofthe technical aspects of tumorextirpation in their article, “ExtendedTransbasal Approach to Skull BaseTumors.” The authors describe the subtletiesof the approach in a clear andconcise manner. As they note, the extendedtransbasal approach allows forexcellent access, which can be modifiedto meet the specific surgical need.

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Because many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that

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The article by Drs. Merrick,Wallner, and Butler providesan excellent overview of issuespertaining to sexual dysfunctionfollowing prostate brachytherapy.The authors were the first to addressthe historical and current problemswith diagnosing sexual dysfunction.They make a strong case for developinga quality-of-life (QOL) instrumentthat is specific for prostatebrachytherapy.