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Comparing Radical Prostatectomy and Brachytherapy for Localized Prostate CancerRadical prostatectomy and ultrasound-guided transperinealbrachytherapy are both acceptedtreatment options for men with clinicallylocalized prostate cancer.Investigators continue to argue overthe relative effectiveness of each ofthese procedures, not only from thestandpoint of cure, but also with regardto how each treatment affectsquality of life. With the recent closureof a prospective, randomized trial addressingthese issues (the SurgicalProstatectomy Interstitial RadiationIntervention Trial, or SPIRIT) due tolack of patient accrual, it is unlikelythat a direct comparison of these techniqueswill be performed in the foreseeablefuture.
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Can Risk-Adapted Treatment Recommendations Replace the ‘One Size Fits All’ Approach for Early-Stage Thyroid Cancer Patients?There is uniform agreement that initial treatment of high-risk thyroid cancer should include total thyroidectomy, compartmental neck dissection of clinically involved cervical lymph nodes, and radioactive iodine (RAI) remnant ablation.
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The REMS Publication ParadoxThe introduction of mandatory risk evaluation and mitigation strategy (REMS) programs, in which patients must participate in order to receive a new therapy, provides an opportunity to examine an issue affecting ethical oversight and publication of scientific study results.
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Combined Radiation and Chemotherapy for Carcinoma of the Anal CanalSphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown
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3D Treatment Planning and Intensity-Modulated Radiation TherapyThree-dimensional (3D) image-based treatment planning and new delivery technologies have spurred the implementation of external beam radiation therapy techniques, in which the high-dose region is conformed much
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MD Anderson Manual of Medical OncologyIt is an unusual oncologist in the United States who has not had a patient receive a second opinion at the M. D. Anderson Cancer Center (MDA). Long a respected and well-known force in cancer research and patient care, MDA has exerted significant national and international influence not only with scientific publications but also through its training programs and large clinical operation. This book will add to that influence with concise disease-oriented chapters covering the patient population a medical oncologist will see in practice. The MD Anderson Manual of Medical Oncology is not a small handbook. Rather, it is a hardbound text of more than 1,000 pages authored by nearly 100 MDA clinicians.
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Clinical Relevance of Laboratory and Animal Data on TamoxifenTamoxifen is being evaluated in clinical trials as a preventive agent in women at high risk for breast cancer. This new, potentially long-term therapeutic role has generated some concerns regarding safety, based on the results of
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Benefits of Tamoxifen Outweigh Endometrial Cancer RiskAn expert panel of nine international cancer researchers and practicing oncologists met in Boston to discuss the past, present, and future uses of antiestrogens in the treatment of breast cancer. The first article in this series, based on the symposium presentations, focused on the optimal duration of tamoxifen use (October 1996). This month, the panel explores the noncancer benefits of tamoxifen, as well as the potential risk of endometrial cancer. The symposium was sponsored by Zeneca Pharmaceuticals.
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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It's Time to Have ‘The Talk’: Cost Communication and Patient-Centered CareBarriers to cost discussions fall into three categories: inaccessible cost data, ethical concerns, and insufficient training.
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Current Clinical Trials of Molecularly Targeted Agents in Children With Cancer, Part 2A number of molecularly targeted agents directed at critical cell survival and cell proliferation pathways have recently entered clinical evaluation in children with cancer. These agents offer the potential for more effective anticancer therapy while simultaneously diminishing acute and long-term toxic effects. Systematic evaluations of targeted agents are essential to achieving continued improvements in outcome for children with cancer. Brief summaries of the rationale for conducting studies of several agents in children are provided below. Following these summaries is a listing of phase I, phase I/II, phase II, and pilot studies of these and other agents in pediatric populations.
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Consider Thrombotic Microangiopathy in Pediatric and Hematopoietic Stem Cell Transplant PatientsThe article by Dr. George is of great use to the practicing clinician, not only in the hematology-oncology setting but also in general practice or emergency medicine.
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Principles of Chemoradiation: Theoretical and Practical ConsiderationsChemotherapy agents known to enhance the effects of radiation in preclinical studies have been used concurrently with radiotherapy in numerous clinical trials with the prospect of further enhancing radiation-induced
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Leveraging Artificial Intelligence Evolutions in Prostate Cancer CareAI tools may show utility in areas such as prostate diagnostic imaging, pathology, and treatment outcome predictions.
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Imaging experts weigh in on screening controversyDespite the hubbub, breast imaging researchers saw nothing new in the findings of Dr. Esserman’s group. Daniel Kopans, MD, a professor of radiology at Boston’s Massachusetts General Hospital, called her observation about mammography catching nonlethal cancers but missing aggressive ones “a fundamental concept that is older than I am. Mammography saves lives by finding moderate- and slow-growing cancer that will kill in five or more years without diagnosis and treatment,” according to Dr. Kopans.
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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Perioperative Tyrosine Kinase Inhibitors for GIST: Standard . . . or an Idea That Needs Further Investigation?Excellent safety, efficacy, and tolerability profiles have resulted in the rapid integration of oral tyrosine kinase inhibitors into most facets of the treatment of gastrointestinal stromal tumors (GIST).
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Nonionizing Electromagnetic Fields and Cancer: A ReviewThe paper by Salvatore et al discusses a very broad, complex subject, which, in some aspects, is quite controversial. The review touches on many different topics but not always in enough detail to provide clarity. Pertaining to the debated link between 50 to 60 Hz power line field exposure and cancer, the authors characterize their article as "... a review of the basic science that points to this possible association [with cancer]." However, the "basic science" that "points to" occupies much of their presentation, while some major types of evidence and reasoning that "points away" is not mentioned.
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Epidemic Kaposi’s SarcomaKaposi’s sarcoma (KS) is the most common malignancy associated with human immunodeficiency virus-1 (HIV-1) infection and can result in significant morbidity. The clinical course of KS is quite variable, although for the
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Gastrointestinal Neuroendocrine Tumors: Slow but Steady ProgressIn spite of recent encouraging developments in the setting of GI neuroendocrine tumors, many clinical questions remain to be answered and will be highlighted in this commentary.
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UFT Plus Leucovorin vs 5-FU Plus Leucovorin for Metastatic Colorectal CancerAn open-label, randomized phase III trial has been established to compare the efficacy and safety profile of tegafur and uracil (UFT) plus leucovorin with fluorouracil (5-FU) plus leucovorin as first-line chemotherapy for
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Anti-Angiogenesis Therapy in Gynecologic MalignanciesThe purpose of this paper is to provide a review of site-specific treatment options that involve the targeting of angiogenesis in gynecologic malignancies.
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Chemotherapy for Resectable and Advanced Pancreatic CancerThis article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single
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Prophylactic Cranial Irradiation for Patients With Locally Advanced Non–Small-Cell Lung CancerProphylactic cranial irradiation(PCI) in patients with locallyadvanced non–small-cell lungcancer (NSCLC) remains an area ofcontroversy. Dr. Gore has provided areview of the literature, including randomizedand nonrandomized studiesand, in particular, the ongoing RadiationTherapy Oncology Group trial(RTOG 0214), which is randomizingNSCLC patients to PCI or observation.
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Management of Barrett's EsophagusBarrett's esophagus represents replacement of normal distal esophageal squamous epithelium with specialized columnar epithelium containing goblet cells. Typically arising in the setting of chronic gastroesophageal reflux disease, the presence of Barrett's esophagus carries a 50- to 100-fold increased risk of developing esophageal cancer. Risk factors include male sex, smoking history, obesity, Caucasian ethnicity, age > 50 and > 5-year history of reflux symptoms. Aggressive medical or surgical antireflux therapy may ameliorate symptoms, but have not yet been proven to affect the risk of developing esophageal adenocarcinoma in randomized trials. Although dysplasia is an imperfect biomarker for the development of subsequent malignancy, random sampling of esophageal tissue for dysplasia remains the clinical standard. There have been no studies to establish that endoscopic screening/surveillance programs decrease the rates of death from cancer. Fit patients with Barrett's esophagus and high-grade dysplasia should undergo esophagectomy to prevent the risk of developing esophageal adenocarcinoma. For non–operative candidates, endoscopic ablative approaches may represent a reasonable therapeutic alternative.
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Stress and Burnout in OncologyThis article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house
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Metastatic Malignant Melanoma From an Unknown Primary Presenting as a Large Axillary MassThe patient is an otherwise healthy male transferred from an outside hospital with a newly diagnosed melanoma from an unknown primary presenting as a large, left axillary mass.
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Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA LevelDrs. Forman and Velasco provide a timely and thorough review of the maturing concept of applying radiation therapy to the prostatic fossa after radical prostatectomy. The guidelines for therapy continue to evolve because of the increasing reliance on blood prostate-specific antigen (PSA) level for both detecting a recurrence of disease and evaluating response to radiotherapy.
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Clinical Uses of RadiosurgeryRadiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). This article reviews the most common
