Authors
Latest:
Role of Sentinel Node Biopsy in the Management of Malignant MelanomaThe use of elective lymph node dissection for intermediate-thickness melanoma has remained controversial. The technique of sentinel node biopsy (intraoperative lymphatic mapping and selective lymphadenectomy) has been
Latest:
The Role of Hematopoietic Stem Cell Transplantation in Myelodysplastic SyndromeSupportive care remains the mainstay of therapy for patients withmyelodysplastic syndrome (MDS). Although allogeneic bone marrowtransplantation is the only known curative therapy for MDS, its risksmake this treatment prohibitive in many patients, who tend to be olderand have other medical problems. With advances in hematopoietic stemcell transplantation (HSCT), we can offer transplant to an increasingnumber of patients. It is, however, necessary to assess each patient andhis or her disease individually and evaluate prognostic factors, treatmentoptions, appropriateness of HSCT, and, if appropriate, type andtiming of HSCT. We will review the data on HSCT in MDS in order toexamine each of these issues and clarify the decision-making process.
Latest:
Corticosteroids in Advanced CancerDespite the fact that there are only a few controlled trials demonstrating the benefits associated with the use of corticosteroids in specific situations, these agents are administered frequently to patients with advanced cancer. Corticosteroids may be used alone or as adjuvants in combination with other palliative or antineoplastic treatments. For example, corticosteroids may help prevent nausea, vomiting, and hypersensitivity reactions to treatment with chemotherapy or radiation. They are also commonly used as appetite stimulants in patients with advanced cancer. In the adjuvant setting, corticosteroids help to alleviate pain in advanced cancer patients, including specific situations such as back pain related to epidural compression. This article reviews the evidence supporting the use of corticosteroids in a broad range of situations seen in patients with advanced cancer. [ONCOLOGY 15(2):225-236, 2001]
Latest:
Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
Latest:
Commentary (Fick/Gutin): Current Management of MeningiomasSurgical resection has been the preferred treatment for meningiomas since the era of the pioneering neurosurgeon, Harvey Cushing. The great majority of these tumors are histologically benign, circumscribed lesions that grow slowly and tend to compress and displace, rather than invade, the surrounding intracranial structures. In contrast to the intrinsic brain tumors of glial origin, most meningiomas have well-defined borders, enabling the surgeon to dissect the tumor capsule from the arachnoid lining of the adjacent brain, blood vessels, and cranial nerves. Consequently, complete removal can be accomplished without needing to sacrifice functional tissue. In these cases, surgery is often curative, and associated with the preservation of, if not improvements in, the neurological condition.
Latest:
A Case of Merkel Cell CarcinomaThe University of Colorado Health Sciences Center holds weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologist. Their history, pathology, and radiographs are reviewed during the multidisciplinary conference, and then specific recommendations are made. These cases are usually challenging, and these conferences provide an outstanding educational opportunity for staff, fellows, and residents in training.
Latest:
Diabetes Management in Cancer PatientsHyperglycemia is a common challenge during cancer treatment and palliation. In addition, many patients with pre-existing type 1 or type 2 diabetes undergoing cancer treatment develop iatrogenic hyperglycemia with unique features.
Latest:
Docetaxel and Vinorelbine Plus GM-CSF in Malignant MelanomaPatients having locoregional or metastatic melanoma have a poorprognosis, with 50% to 100% of patients dying from the disease within5 years. Current chemotherapy regimens offer limited benefits to thesepatients, and more effective and less toxic treatments are needed. Wetherefore piloted a study of docetaxel (Taxotere), vinorelbine(Navelbine), granulocyte-macrophage colony-stimulating factor(GM-CSF, sargramostim [Leukine]), or the DVS regimen, in patientswith stage IV melanoma. Eight patients were treated after previousbiochemotherapy and two patients were given the regimen as an initialtreatment. The DVS regimen consisted of docetaxel at 40 mg/m2 IVover 1 hour, vinorelbine at 30 mg/m2 IV over 6 to 10 minutes every 14days, and GM-CSF at 250 mg/m2 SC on days 2 to 12. No grade 3 or 4toxicities were encountered. Of the 10 patients evaluable for response, 5were partial responders (50% response rate). Time to progression for the10 cases ranged from 2 to 26+ months (median: 8 months). The DVSregimen was active against advanced melanoma in both previously treatedand untreated patients. A larger study to confirm the activity of the DVSregimen for stage IV melanoma is currently under way.
Latest:
Role of Sentinel Node Biopsy in the Management of Malignant MelanomaThe use of elective lymph node dissection for intermediate-thickness melanoma has remained controversial. The technique of sentinel node biopsy (intraoperative lymphatic mapping and selective lymphadenectomy) has been
Latest:
How We Treat Tumor Lysis SyndromeWhen tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.
Latest:
Infectious ComplicationsInfections are among the most common, potentially serious complications of cancer and its treatment.
Latest:
The Adjuvant Treatment of Stage III Colon Cancer: Might Less Be More?In this article, we review the findings of the IDEA study and discuss the optimal duration of oxaliplatin-based adjuvant chemotherapy using patient-based risk factors.
Latest:
Giving Honest Information to Patients With Advanced Cancer Maintains HopeOncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
Latest:
Novel Approaches to ‘Borderline Resectable’ Pancreatic TumorsThe authors describe the case of a 40-year-old man with an adenocarcinoma of the pancreatic head with involvement of the superior mesenteric vein–portal vein (SMV-PV) confluence resulting in limited occlusion.
Latest:
Synergizing Radiation Therapy and Immunotherapy for Curing Incurable CancersRadiation 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.
Latest:
Depression in Cancer PatientsDrs. Jeremy Winell and AndrewRoth have provided a niceoverview of the diagnosis andtreatment of depression in cancer patients.The views they express are bothwidely accepted and applicable to otherserious medical illnesses as well.They remind us of the challenge ofmaking a valid diagnosis of depressionin cancer patients, since all of thesomatic symptoms of depression (eg,anorexia, fatigue, insomnia) may insome patients represent symptoms ofcancer or cancer treatment rather thandepression.
Latest:
Shared Decision Making and Screening: An Ongoing Dialogue Informed by DataA state of equipoise now exists for various surgical options in the treatment of early lung cancer, underscoring the need for shared decision making.
Latest:
Managed Care’s Effects on Community Clinical ResearchManaged care is transforming numerous aspects of health care delivery, and the specialty of oncology, in particular, is being increasingly affected for several reasons.
Latest:
Improving the Therapeutic Ratio in Hodgkin Lymphoma Through the Use of Proton TherapyThis review addresses the rationale and evidence for-and the challenges, cost implications, and future development of-proton therapy as an important part of the treatment strategy in Hodgkin lymphoma.
Latest:
Current Status and Optimal Use of RadiosurgeryThe field of stereotactic radiosurgery is rapidly advancing as a result of both improvements in radiosurgical equipment and better physician understanding of the clinical applications of stereotactic radiosurgery. This
Latest:
Treatment of Acute Myelogenous LeukemiaThere have been significant advances in our understanding of the biology of acute myelogenous leukemia (AML), and to a lesser extent, in its treatment. Dr. Estey has provided an excellent overview of the current state of the clinical management of the disease. He has described both the standard therapeutic approaches, including allogeneic hematopoietic stem cell transplantation, as well as the role of investigational therapy. The present state of clinical research in AML is reviewed in some detail in the context of the broad clinical investigation of the disease at the M. D. Anderson Cancer Center. Dr. Estey makes a strong argument for the early consideration of investigational therapy, focusing on patients for whom "standard" therapy is demonstrably inadequate.
Latest:
Emerging Technology in Cancer Treatment: Radiotherapy ModalitiesThis is a period of rapid developments in radiotherapy for malignantdisease. New methods of targeting tumors with computed tomography(CT) virtual simulation, magnetic resonance imaging (MRI), andpositron-emission tomography (PET) fusion provide the clinician withinformation heretofore unknown. Linear accelerators (linacs) withmultileaf collimation (MLC) have replaced lead-alloy blocks. Indeed,new attachments to the linacs allow small, pencil beams of radiation tobe emitted as the linac gantry rotates around the patient, conforming tothree-dimensional (3D) targets as never before. Planning for these deliverysystems now takes the form of "inverse planning," with CT informationused to map targets and the structures to be avoided. In thearea of brachytherapy, techniques utilizing the 3D information providedby the new imaging modalities have been perfected. Permanentseed prostate implants and high-dose-rate (HDR) irradiation techniquestargeting bronchial, head and neck, biliary, gynecologic, and otheranatomic targets are now commonplace radiotherapy tools. CT-guidedpermanent seed implants are being investigated, and a new method oftreating early breast cancer with HDR brachytherapy via a ballooncatheter placed in the lumpectomized cavity is coming to the forefront.Newer modalities for the treatment of malignant and benign diseaseusing stereotactic systems and body radiosurgery are being developed.Targeted radionuclides using microspheres that contain radioemittersand other monoclonal antibody systems tagged with radioemitters havebeen recently approved for use by the Food and Drug Administration.
Latest:
Options in BCG-Refractory Bladder Cancer for Radical Cystectomy–Ineligible PatientsThis video examines second-line treatment options for non-muscle invasive bladder cancer patients who relapse after BCG therapy and are not eligible for radical cystectomy.
Latest:
Cancer, Unproven Therapies, and MagicCommonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven
Latest:
Commentary (Olson): Recent Advances in the Treatment of Pediatric Brain TumorsSri Gururangan and Henry Friedmanpresent a thoughtful reviewof advances in pediatric neurooncology.Coupled with the recent reviewof pediatric brain tumor biologywritten by Richard Gilbertson, thesearticles highlight the value that thepediatric neuro-oncology communityplaces on translating signal transductionmodifiers into clinical practice.[1]The remainder of this commentaryfocuses on the challenges and opportunitiesassociated with developingmore effective and less toxic therapiesfor children with brain tumors.
Latest:
Treatment of Metastatic Pancreatic Adenocarcinoma: A ReviewGemcitabine monotherapy has been the standard of care for patients with metastatic pancreatic cancer for several decades. Despite recent advances in various chemotherapeutic regimens and in the development of targeted therapies, metastatic pancreatic cancer remains highly resistant to chemotherapy.
Latest:
The Challenge of Designing Clinical Trials for AIDS-Related Kaposi’s SarcomaKaposi’s sarcoma (KS) is a frequent cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Several characteristics of KS pose challenges for the conduct of clinical trials. Kaposi’s
Latest:
CYP2D6 Testing for Breast Cancer Patients: Is There More to the Story?The promise of pharmacogenetics is personalization of therapy for individuals through refinement of the risk/benefit profile of pharmaceuticals based on inherited gene mutations. Classic examples of the impact of pharmacogenetics in clinical practice include variants in dihydropyrimidine dehydrogenase and treatment with fluorouracil.
Latest:
Concurrent RT With 5-FU/Epirubicin and Cisplatin or Irinotecan for Locally Advanced Upper GI AdenocarcinomaFrom the results of recent studies, it is likely that multimodality therapy with chemotherapy and radiation treatment may improve the overall outcome of locally advanced upper gastrointestinal (GI) malignancies, including esophageal, gastric, pancreatic, and biliary tract carcinomas. However, more effective, more optimal, and less toxic chemotherapy regimen(s) with concomitant radiotherapy are needed beyond the concurrent continuous-infusion fluorouracil (5-FU) with radiation that is commonly applied in general practice. Epirubicin (Ellence), cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy agents in upper GI cancers. Two phase I studies were designed to test the tolerability of the combination of radiotherapy with infusional 5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
