Oncology Vol 28 No 6

There is a need to learn more about the effect of hypofractionation on an individual patient’s breast cancer outcomes and tissue toxicities, based on both biologic and technical variables, so that the treatment decision is not primarily a matter of dollars and cents.

Customized more aggressive treatments should be given to patients with the worst prognosis. For most of the other breast patients, shorter and often milder treatment is also a humble victory in our daily struggle against cancer.

Standard heart failure regimens remain the mainstay of therapy for chemotherapy-related cardiac dysfunction until newer randomized trials suggest otherwise, and earlier detection of toxicity through judicious surveillance with biomarkers and noninvasive imaging remains the cornerstone of management for the foreseeable future.

Without question, targeted therapies have revolutionized the treatment of cancer across histologies.

Barriers to cost discussions fall into three categories: inaccessible cost data, ethical concerns, and insufficient training.

An 81-year-old Chinese male never-smoker with a medical history of hypertension and hyperlipidemia presented with a productive cough and a 5-lb weight loss over 3 months.

Until anatomic staging and physiologic prediction models improve, induction therapy serves as a useful crutch that can mitigate the weaknesses in both of these important preoperative tasks.

Both esophageal cancer and stomach cancer are aggressive malignancies with contrasting risk factors, histologies, and molecular characteristics-yet for the most part comparable therapeutic approaches.

This review will focus on newer FDA-approved targeted therapies associated with type II chemotherapy-related cardiac dysfunction, or generally reversible cardiotoxicity, and will provide the latest information on the incidence and clinical spectrum of cardiotoxicity associated with each therapy, modifiable risk factors where known, and the mechanisms of cardiotoxicity.

The purpose of this review is to update, present some of the new data on, and outline the controversies regarding neoadjuvant and adjuvant therapy of esophagogastric junction and gastric adenocarcinoma.

Upfront surgery allows for greater freedom to use all secondary treatment options for local and distant control, including adjuvant radiotherapy and ADT, thereby hopefully obviating the significant adverse quality-of-life sequelae from salvage surgery and brachytherapy for local relapse.

Under current conditions for patients with newly diagnosed node-positive prostate cancer, the benefits of surgery, if any, are highly unlikely to outweigh the known harms--less is still more.

In this review we discuss the rationale and underlying radiobiologic concepts for hypofractionation, and review the clinical trials and ASTRO guidelines supporting hypofractionated radiation in the treatment of breast cancer.

To achieve real precision medicine we need not only the right therapy for each patient’s disease, we need the right toxicity management to improve overall health and quality-of-life outcomes.