Ronald H. Blum, MD

In the following sections, we will first review the radiotherapy techniques that have been investigated. We will then review the progressive advances achieved with the addition of chemotherapeutic strategies to RT in an attempt to achieve better outcomes.

Precise mediastinal staging of non-small-cell lung cancer is extremely important, as mediastinal lymph node metastases generally indicate unresectable disease. Reliance on computed tomography (CT) and positron-emission tomography (PET) alone to stage and determine resectability is limited by false-positive results. Whenever possible, pathologic confirmation of metastases is desirable. Mediastinoscopy and transbronchial fine-needle aspiration are widely established but imperfect modalities. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) has emerged as a diagnostic and staging tool because of its safety, accuracy, and patient convenience. We reviewed 13 prospective studies evaluating the comparative performance of EUS for staging lung cancer. We conclude that EUS is a valuable staging modality. Further studies of the role of EUS compared to other modalities such as integrated PET/CT and endobronchial ultrasound (EBUS) are forthcoming.

Drs. Perez and Muss provide acomprehensive review of therole of adjuvant chemotherapyin the management of breast cancerpatients. The benefits of anthracyclinevs nonanthracycline regimens are discussed,the taxanes are reviewed indetail, and data regarding dose intensity,dose density, and optimal numberof chemotherapy cycles areexplored. Data on newer agents andbiologic agents also are presented.Debate continues regarding the subsetsof patients who will derive thegreatest benefit from chemotherapyand which regimen is most appropriate.While the review indicates theefficacy of several regimens as definedby randomized clinical trials, itdoes not emphasize patient-specificfactors in determining the optimaltherapy for a given patient.

Combined-modality positronemissiontomography (PET)–computed tomography (CT) isbecoming the imaging method ofchoice for an increasing number ofoncology indications. The goal of thispaper is to review the evidence-basedliterature justifying PET-CT fusion.The best evidence comes from prospectivestudies of integrated PETCTscans compared to other methodsof acquiring images, with histopathologicconfirmation of disease presenceor absence. Unfortunately, veryfew studies provide this kind of data.Retrospective studies with similarcomparisons can be used to provideevidence favoring the use of integratedPET-CT scans in specific clinicalsituations. Also, inferential conclusionscan be drawn from studies whereclinical rather than pathologic dataare used to establish disease presenceor absence.

With recent advances in the management of cancer, the clinicalcourse of patients with metastatic bone disease is more likely to beprolonged and accompanied by morbidity, including severe pain, hypercalcemia,pathologic fracture, and spinal cord and/or nerve root compression.The early identification of patients at higher risk for developingbone metastases enables practitioners to be proactive in their diagnosisand treatment. A multidisciplinary approach that integrates the diagnosisand treatment of the cancer, symptom management, and rehabilitationensures optimal care. Bisphosphonates can reduce the number ofskeletal-related complications, delay the onset of progressive disease inbone, and relieve metastatic bone pain caused by a variety of solidtumors with a resulting enhanced quality of life. The complexity of theclinical problem and the need to involve an array of health-careproviders present a logistical and clinical challenge. A strong argumentis made for a thematically integrated bone metastases program as partof the primary care of patients with cancer.

The physician-patient relationship is based on effective communication. In oncology, higher expectations for communication are driven by increased media attention to cancer, patient-directed pharmaceutical advertising, and

Anthracycline antibiotic use is limited by cardiac toxicity. The risk factors are cumulative dose, radiation to the chest and mediastinum, age, and preexisting myocardial impairment. Dexrazoxane (Zinecard) can prevent