The choices that patients and clinicians make when dealing with cancer are dictated by time, whether they are arranging for screening mammography and colonoscopy, compiling treatment plans, or determining follow-up intervals and the age of freedom from follow-up.
The use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly noninvasive, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its noninvasive and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.
Repeat lumpectomy and retreatment radiotherapy following ipsilateral breast tumor recurrence (IBTR) by either external-beam irradiation or brachytherapy in lieu of salvage mastectomy is an area of significant recent clinical interest. Multiple authors have reported their results, with encouraging numbers of patients avoiding mastectomy.[1‑4]
Inoperable pancreatic adenocarcinoma is a dilemma that oncologists frequently encounter. Only 15% to 20% of patients are diagnosed when cancer of the pancreas is still surgically resectable. However, pancreaticoduodenectomy is the only curative option for this disease and should be offered to all patients who meet resection criteria and do not have significant comorbidities. For inoperable pancreatic cancer, the goals of treatment are to palliate symptoms and prolong life. Improved survival in locally advanced disease has been demonstrated with chemoradiation plus fluorouracil or with gemcitabine (Gemzar) alone. In metastatic disease, single-agent gemcitabine has been associated with improvement in symptoms and survival. Trials combining various chemotherapeutic agents with gemcitabine have not had a significant impact on overall survival, although meta-analyses suggest a small benefit. The targeted agent erlotinib (Tarceva) has shown a modest improvement in overall survival in combination with gemcitabine. This combination is another option for first-line therapy in patients with locally advanced or metastatic disease. Despite these recent advances, survival for patients with inoperable pancreatic cancer continues to be poor. Future investigations need to focus on understanding the molecular nature of this malignancy, with the goal of developing interventions based on this knowledge.
ONCOLOGY® recently sat down with David R. Gandara, MD, director of the thoracic oncology program and senior advisor to the director of the University of California (UC) Davis Comprehensive Cancer Center, to discuss the impact of the pandemic on the current management and treatment of patients with lung cancer, as well as the future of education and patient care in a post–COVID-19 world.
Neurotoxicity is a well-describedside-effect of paclitaxeltherapy, often characterizedas a peripheral sensory neuropathy.Neuropathy is a dose-dependenteffect, occurring with cumulative cyclesand higher doses. Occasionally,this may be dose-limiting for patientswho are benefiting from treatment, aswell as problematic for subsequenttherapies. Another well-recognizedthough less-described neurotoxic effectof paclitaxel is myopathy. Myopathy,consisting of myalgias andarthralgias, can be at least as commonwith standard paclitaxel regimens andequally troubling for patients. In thisissue of ONCOLOGY, Garrison andcolleagues review paclitaxel-associatedmyopathy and offer suggestionsfor patient management.
This video highlights studies on HPV-positive head and neck cancer presented at the 2017 ASTRO Annual Meeting.
Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore,
The article by Calhoun and colleagues, published in this issue of ONCOLOGY, is a timely review of one of the more controversial questions in thoracic oncology: whether or not patients with stage IB non–small-cell lung cancer (NSCLC) should receive adjuvant chemotherapy.
Management of patients with neoplastic disease has shifted from searchand-destroy approaches employing radical surgery, chemotherapy,and radiotherapy to novel strategies that target specific molecular orgenetic characteristics or modify growth factors, angiogenesis, and cell-cell interactions.Attention has also been focused on modifying the production and function ofcertain enzymes pivotal to the genesis of disseminated disease.
Intraperitoneal (IP) chemotherapy is a preferred treatment option that should be offered to all women for front-line treatment of stage III optimally debulked ovarian cancer. Patients should be provided with information on the survival and toxicity for both IP and intravenous (IV) therapies, as well as practical information about the administration of each regimen, so that they may play an active role in the decision-making process. When making a decision between IP and IV therapeutic options, the experience and preference of the oncologist are critical factors in determining appropriate therapy for each woman.
In this review, we discuss recent clinical investigations that highlight the effects of novel compounds targeting EGFR, ALK, and other receptor oncogenes, as well as the promise of immunotherapy in lung cancer CNS disease.
Despite recent therapeutic advances, lung cancer continues to be one of the leading causes of cancer-related mortality. Of the various histologic subtypes, non–small-cell lung cancer (NSCLC) is the most common-accounting for approximately 85% of all lung cancers-and will be the focus of this article. In general, the treatment of lung cancer may include surgery, radiation therapy, systemic therapy (eg, chemotherapy with or without targeted therapy), or a combination of the above. Surgery continues to offer the best chance of long-term cure. The initial treatment of stage I and II NSCLC usually entails surgical resection, whereas stage IV disease is primarily treated with systemic agents, in light of the lack of curative potential with surgery and/or radiation therapy alone. It is locally advanced NSCLC, including stage IIIA and IIIB disease, that continues to pose a therapeutic dilemma, given its heterogeneous nature.
The simple answer, according to some, is that lung cancer screening’s time has come. However, in my opinion, the answer is not that simple.
In this review, we will discuss adjuvant chemotherapy in non-metastatic colon cancer, the existing prognostic and predictive molecular biomarkers in the field, and how to integrate these molecular biomarkers into the decision about whether to administer adjuvant therapy.
B-cell non-Hodgkin’s lymphomas (NHL) are an increasingly common cause of cancer morbidity and mortality. In 1996, approximately 52,700 new cases of NHL were diagnosed, representing a marked increase in incidence. Indeed, the incidence rose from 8.5 per 100,000 population in 1973 to 15.1 per 100,000 in 1992.[1] About 20% to 30% of these are NHLs of the indolent varieties.
Dr. Colasanto and his associatesare to be commended forskillfully and comprehensivelyreviewing the issues concerning theprovision of nutritional support to patientsundergoing radiation therapy.Their recommendations are well supportedby review of scientific studies,and the article is written in such a wayas to be accessible to those not fullyversed in prescribing nutritional support.There remain a few points thatdeserve discussion.
Whether CAR T-cell therapy or T-cell engagers should dominate the multiple myeloma landscape may be hard to determine, says David S. Siegel, MD.
Tobacco use, particularly smoking, remains the number 1 cause of preventable disease and death in the United States. This report of the Surgeon General on smoking and health is the first to offer a composite review of the various methods used to
Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I
This management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of colorectal and anal cancers.
Carcinoma of the epithelial lining (endometrium) of the uterine corpus is the most common female pelvic malignancy. Factors influencing its prominence are the declining incidence of cervical cancer, longer life expectancy, and earlier diagnosis.
This look ahead at hematologic malignancies in 2017 focuses on new agents being studied for the treatment of multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma, and myeloproliferative neoplasms.
Many patients with cancer often seek some means of connecting their mental activity with the unwelcome events occurring in their bodies, via techniques such as imagery and hypnosis. Hypnosis has been shown to be an
Patients with epithelial ovarian cancer must receive optimal surgical care and state-of-the-art chemotherapy in the primary treatment setting. The salvage treatment of women with recurrent or persistent ovarian cancer remains a
In 2009 approximately 8,510 new cases of Hodgkin lymphoma (HL) will be diagnosed in the United States. Over the past 4 decades, advances in radiation therapy and the advent of combination chemotherapy have tripled the cure rate of patients with HL. In 2009, more than 80% of all newly diagnosed patients can expect a normal, disease-free life span.
In this interview we discuss the recent CMS decision to cover low-dose CT screening for lung cancer in patients who fit specific criteria.
The authors challenge the notion that men with prostate cancer exhibit little psychological difficulty. In fact, we do not know much about actual distress rates in men with prostate cancer because few studies have directly measured distress in this population. Likewise, we do not know if the distress experienced by prostate cancer patients is qualitatively different from that of other cancer patients. By assuming that all men with prostate cancer "do well," we, as clinicians and researchers, may fail to ask patients important questions.
Dr. Scadden discusses which blood cancer patients are eligible for stem cell transplantation, as well as the latest advances in the field.
This article discusses features that predict local recurrence and distant metastasis in rectal cancer, and how to use MRI to guide treatment decisions.