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Early Detection and Treatment of Spinal Cord CompressionSeveral key areas must be considered in the diagnosis and managementof spinal cord compression. Because the outcome can be devastating,a diagnosis must be made early and treatment initiated promptly.Although any malignancy can metastasize to the spine, clinicians shouldbe aware that this occurs more commonly in certain diseases, ie, lungcancer, breast cancer, prostate cancer, and myeloma. The current algorithmfor early diagnosis of spinal cord compression involves neurologicassessment and magnetic resonance imaging of the entire spine.Treatment generally consists of intravenous dexamethasone followedby oral dosing. Depending on the extent of the metastases, symptomsmay also be managed with nonnarcotic pain medicines, anti-inflammatorymedications, and/or bisphosphonates, with local radiation administeredas needed. Surgery has often led to destabilization of the spine.
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Invasive Staging and Aggressive Surgical Resection: Essential to Management of Central NSCLCIn summary, central lung cancers, when appropriately staged, are optimally treated by surgical resection. Initial evaluation is best done by a multidisciplinary team, involving a trained thoracic surgeon.
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Maximizing Radiation Benefit in Breast CancerWe read with interest the article and reviews of "Current Status of Radiation in the Treatment of Breast Cancer," which appeared in the April 2001 issue of ONCOLOGY.[1] These papers suggest that one of the most controversial areas in this
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Carcinoma of an Unknown Primary SiteCarcinoma of an unknown primary site is a common clinical syndrome, accounting for approximately 3% of all oncologic diagnoses. Patients in this group are heterogeneous, having a wide variety of clinical presentations and pathologic findings.
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Cancer- and Treatment-Related Cognitive Changes: What Can We Do Now? What Lies Ahead?Much of the existing research into the phenomenon commonly referred to as “chemobrain” has been descriptive, and we know enough now to identify some patients at risk for cognitive changes after a diagnosis of cancer.
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Recurrent Urothelial Carcinoma With Pulmonary MetastasisA 56-year-old woman was referred to our institution for a left nephroureterectomy after the diagnoses of a nonfunctioning left kidney and noninvasive papillary urothelial carcinoma of the distal left ureter (Ta grade 1). Following the procedure, surveillance cystoscopy and computed tomography (CT) scan of the abdomen and pelvis demonstrated a large bladder tumor with pan-urothelial extension.
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Strategies for Identification and Clinical Evaluation of Promising Chemopreventive Agentselloff and colleagues have been key players in the recent development of chemoprevention strategies--as initiators of their own studies and minders of others. The succinct summary of their approach is of particular value to oncologists, both because it provides a great deal of data on the current state of chemoprevention research itself and because it draws some useful distinctions between chemoprevention and chemotherapy.
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Primary and Metastatic Brain TumorsIntracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue.
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Cancers of the Gallbladder and Biliary DuctsNeoplasms of the biliary tract tree are uncommon and have a poor overall prognosis. Although numerous risk factors have been identified, little is known about the pathogenesis of these tumors, and no effective screening
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Survivin(g) Adult T-cell Leukemia/LymphomaIn this issue of ONCOLOGY, Tobinai reviews the management of human T-cell lymphotropic virus type 1 (HTLV-1)–associated adult T-cell leukemia/lymphoma (ATL). Although rare in the United States, an estimated 10 to 20 million people are infected with HTLV-1 worldwide and 2% to 5% will develop ATL.[1]
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Commentary (Niederhuber): Pancreatic Cancer in the Older PatientPancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local
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Color Atlas of Clinical Hematology, Third EditionThe third edition of the Color Atlas of Clinical Hematology, authored by Drs. A. Victor Hoffbrand and John E. Pettit, contains 19 chapters covering the entire spectrum of hematology, including normal hematopoiesis, benign and malignant
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Indolent B-Cell Non-Hodgkin’s LymphomasThe indolent B-cell non-Hodgkin’s lymphomas are a diverse group of disorders that differ markedly with respect to presenting features and natural history. This article reviews entities that have generally been encompassed
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Commentary (Sylvester): Integrating Hormonal Therapy With External-Beam Radiation and Brachytherapy for Prostate CancerDrs. Andrews and Roach present an excellent review and discussion of the existing literature regarding the role of androgen ablation therapy in patients being treated with external-beam radiation therapy (EBRT) and prostate brachytherapy. However, the indications for, and optimal timing of androgen ablation with radiation therapy remain controversial, particularly in regard to brachytherapy.
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Irinotecan Plus Cisplatin in Patients With Advanced Non- Small-Cell Lung CancerDuring the 1980s, platinum-based regimens were yielding response rates typically less than 25%, median survival durations of about 25 weeks, and 1-year survival rates less than 25% in patients with advanced non-small-cell lung
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Commentary (Ensley): Nutritional Support of Patients Undergoing Radiation Therapy for Head and Neck CancerPerhaps no other group of malignanciesis more severely affectedby the problems patients havewith establishing or maintaining goodnutrition than those of the upper aerodigestivetract. Nutrition, or malnutrition,is a critical considerationduring all phases of the diagnosis, treatment,and long-term management ofpatients with head and neck malignancies, even following curative therapy.
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Perspectives on COVID-19 Prophylaxis and VaccinationTo close the discussion, panelists reflect on their practices’ guidance on long-acting antibody prophylaxis and vaccination against COVID-19 for patients with graft-versus-host-disease (GVHD).
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Adult Medulloblastoma, From Spongioblastoma Cerebelli to the Present Day: A Review of Treatment and the Integration of Molecular MarkersHere we present the history, staging system, and treatment of medulloblastoma, reviewing the prognostic value and clinical application of molecular subtyping while highlighting the differences between adult and pediatric disease.
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Current Therapy in Cancer, Second EditionIn their new book entitled Current Therapy in Cancer, Drs. Foley, Vose, and Armitage endeavor to provide a short and concise presentation of various cancers. Their purpose is to aid clinicians in presenting a succinct overview of individual
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Controversies in the Management of Intracranial GerminomasPaulino et al provide an excellent summary of the literature on primary germinoma of the central nervous system (CNS). As the authors note, germ-cell tumors of the CNS are rare, comprising about 1% of all brain tumors in patients in the Western
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Hepatic Imaging With Iron Oxide Magnetic Resonance ImagingThe management of hepatic tumors presents a challenging problem. The natural history of primary and metastatic liver lesions portends a poor prognosis. However, surgical resection and newer ablative techniques have had a
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Venetoclax With Rituximab Improves Survival in Relapsed/Refractory CLLIn this interview, we discuss the results of the phase III MURANO trial, which tested the combination of venetoclax with rituximab in relapsed/refractory CLL.
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Prostate Cancer, PSA, and Questions That Can Only Be Answered By Clinical TrialsRising prostate-specific antigen (PSA) in nonmetastatic prostate cancer occurs in two main clinical settings: (1) rising PSA to signal failed initial local therapy and (2) rising PSA in the setting of early hormone-refractory prostate cancer prior to documented clinical metastases. Most urologists and radiation oncologists are very familiar with the initial very common clinical scenario, commonly called "biochemical recurrence." In fact, up to 70,000 men each year will have a PSA-only recurrence after failed definitive therapy. The ideal salvage therapy for these men is not clear and includes salvage local therapies and systemic approaches, of which the mainstay is hormonal therapy. Treatment needs to be individualized based upon the patient's risk of progression and the likelihood of success and the risks involved with the therapy. It is unknown how many men per year progress with rising PSA while on hormonal therapy without documented metastases. This rising PSA disease state is sometimes called, "PSA-only hormone-refractory prostate cancer." As in the setting of initial biochemical recurrence, evidence-based treatment options are limited, and taking a risk-stratified approach is justified. In this article, we will explore these prostate cancer disease states with an emphasis on practical, clinically applicable approaches.
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Controversies in the Management of Stage I SeminomaCurrent controversies in the treatment of stage I seminoma center on the relative roles of surveillance, adjuvant radiotherapy (RT), and adjuvant single-agent chemotherapy. Surveillance has been studied in over 800 patients,
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Book Review:Wintrobe’s Clinical Hematology, 10th EditionThe 10th edition of Wintrobe’s Clinical Hematology is a two volume, multiauthored work that spans the ever-expanding discipline of hematology in over 2,600 pages. The book is appropriately introduced by an excellent short chapter written previously by Dr. Wintrobe on “The Diagnostic and Therapeutic Approach to Hematologic Problems.” There follows a valuable series of six chapters totaling 133 pages devoted to laboratory hematology, including blood and bone marrow examination, immunodiagnosis, clinical flow cytometry, cytogenetics, clusters of differentiation, and molecular genetics. These chapters contain ample illustrations, diagrams, tables, and references.
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Commentary (Baraboutis/Noskin): Management of Health-Care–Associated Infections in the Oncology PatientDrs. Guinan, McGuckin, andNowell have nicely reviewedthe risk factors associatedwith increased susceptibility to hospital-acquired infection in oncologypatients and also discussed preventivesteps to attenuate those risks.We agree that patients with malignanciespresent a challenge to thehealth-care provider, as infection willdevelop at some point in almost allcancer patients[1] and may be associatedwith significant mortality.[2]
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Barrett's Esophagus: Rapidly Evolving Management OptionsBarrett'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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Commentary (Crowther/Kelton): Thromboembolic Complications of MalignancyAdvances in cancer treatmentover the past 50 years havecured or prolonged the life expectancyof many patients with cancer.These advances have accelerated overthe past 2 decades. Increasingly, physicianswho manage patients with cancerare turning their attention to the managementof the complications of malignancy,since these complications areoften avoidable, can shorten life spans,and can reduce quality of life.
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Influence of Anticonvulsants on the Metabolism and Elimination of IrinotecanThe hepatic metabolism and biliary secretion of irinotecan (CPT-11, Camptosar) and metabolites is complex and involves cytochrome P450 isoenzymes, carboxylesterases, glucuronosyltransferase, and the ATP-dependent export pumps MRP-2 and MXR. Enzyme-inducing antiepileptic drugs (EIAEDs) such as phenytoin and carbamazepine are known to induce several of the metabolic pathways relevant to ininotecan’s elimination. The North American Brain Tumor Consortium phase I study is designed to determine the maximum tolerated dose and pharmacokinetics of irinotecan given every 3 weeks to patients who are receiving EIAEDs.
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Graft Purging in Autologous Bone Marrow Transplantation: A Promise Not Quite FulfilledThe analysis, “Graft Purging inAutologous Bone MarrowTransplantation: A Promise NotQuite Fulfilled,” by Drs. Joseph Alvarnasand Stephen Forman, is verytimely. The authors’ conclusion is succinctlypresented in their title.
