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Active Surveillance for Prostate Cancer: How to Do It RightIn this review of active surveillance for favorable-risk prostate cancer, we will discuss the rationality of this approach, the biological evidence for employing active surveillance in Gleason pattern 3 and 4 prostate cancer, patient selection for active surveillance, clinical trial data on active surveillance, and the role of prostate cancer biomarkers and imaging studies for clinical decision making in patients with low-risk disease.
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POEMS Syndrome: Still an Enigma?Because of challenges in making the correct diagnosis and the physician’s reluctance to administer chemotherapy for a disease characterized by such a low tumoral mass, patients may experience a delay in the initiation of appropriate treatment.
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Symptom Self-Management for Adolescents/Young Adults With CancerIn this interview, we discuss symptom self-management strategies reported by adolescents and young adults with cancer, including some of the most common symptoms affecting this patient population and effective self-management techniques.
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Unexpected N2 Lymph Node Involvement Found During Surgery for Early-Stage NSCLCDuring investigation of an episode of self-limiting abdominal pain, a 63-year-old Caucasian female never-smoker was found to have an asymptomatic right lower lobe pulmonary mass. A positron-emission tomography/computed tomography (PET/CT) scan revealed the right lower lobe mass to be 25 × 32 mm with a standardized uptake value (SUV) of 10.2, without evidence of hilar or mediastinal lymphadenopathy or of distant metastases.
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Laurie H. Sehn, MD, MPH, Discusses the Extension Arm of the Phase 2 GO29365 Trial in DLBCLThe ongoing GO29365 study of combination regimens containing polatuzumab vedotin (Polivy) for patients with relapsed or refractory diffuse large B-cell lymphoma added an additional 106 patients to confirm preliminary findings of safety and efficacy.
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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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Avoiding Stress and Burnout in Cancer CareOver the past 8 years, I have led discussions and had private conversations about stress and burnout with oncologists of all stripes. Several common themes have emerged with regard to what it is that stresses and burns out oncologists and what helps them the most.
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Limited-Field and Whole-Breast Hypofractionated RadiotherapyWith the publication of mature experiences using accelarated partial breast irradiation (APBI) and accelerated whole breast irradiation (AWBI), the use of shortened courses of radiotherapy has become increasingly popular.
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Improved Metastatic Uterine Papillary Serous Cancer Outcome With Treatment of Mast Cell Activation SyndromeA 71-year-old woman not on hormone replacement therapy presented with uterine bleeding. Dilation and curettage revealed complex hyperplasia with atypia, focal clear-cell features, and endocervicitis. Endometrial intraepithelial carcinoma was suspected.
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How Long Have I Had My Cancer, Doctor?“How long have I had this cancer, Doctor?” This is a question that patients frequently ask their oncologist.
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An Overview of Radiotherapy Trials for the Treatment of Brain MetastasesA review of the English literature was undertaken to (1) determine the efficacy of radiation therapy for the treatment of brain metastases, (2) identify prognostic factors, and (3) ascertain whether there is an effect of treatment technique on outcome. Critical analysis of relevant randomized trials indicated that radiation therapy can effectively palliate the symptoms of brain metastases.
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A Review of Novel Intralesional Therapies for Melanoma, With an Emphasis on a Potential Combination ApproachPerhaps the greatest attraction and chief benefit of intratumoral therapies is their ability to synergize with systemic checkpoint therapies and accelerate the development of a lymphoid infiltrate and perhaps secondary lymphoid structures in vivo, which in turn can result in systemic mobilization of a T-cell response: the local injection–global effect model.
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Commentary (Hochberg/Cher): Current Management of Primary Central Nervous System LymphomaDr. DeAngelis provides a succinct analysis of primary central nervous system lymphoma and its management. This malignancy remains a puzzle because of its unusual behavior, being widely disseminated within the CNS, and yet rarely involving the systemic compartment. Patients who develop primary central nervous system lymphoma need to be divided into two groups: Those who are immunocompetent and those who are immunocompromised, including patients with HIV infection and transplantation recipients.
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AIDS Malignancies in the Era of Highly Active Antiretroviral TherapyThe introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to dramatic
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Liver, Gallbladder, and Biliary Tract CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of liver, gallbladder, and biliary tract cancers using radiation, surgery, and medical treatment.
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Immunotherapy Prior to Stem Cell Transplant in Multiple MyelomaIn a 12-patient multiple myeloma pilot study, researchers demonstrated that anti-CD3 and anti-CD20 bispecific antibody (CD20Bi) activated both cellular and humoral anti-myeloma immunity that was detectable after patients received an autologous stem cell transplant.
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Current Advances in Novel Proteasome Inhibitor–Based Approaches to the Treatment of Relapsed/Refractory Multiple MyelomaThe introduction of new therapies has led to improved survival of patients with multiple myeloma (MM), even those with relapsed and/or refractory (R/R) disease.
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The Current Clinical Value of the DCIS ScoreThe DCIS Score provides clinically relevant information about personal risk that can guide patient discussions and facilitate shared decision making.
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Commentary (Kleinberg et al): Primary Combined-Modality Therapy for Esophageal CancerBased on positive results from the Radiation Therapy Oncology Group (RTOG) 85-01 trial, the conventional nonsurgical treatment of esophageal carcinoma is combined-modality therapy. Dose intensification of the RTOG 85-01 regimen, examined in the Intergroup (INT)-0123/RTOG 94-05 trial, did not improve local control or survival. Areas of clinical investigation include the development of combined-modality therapy regimens with newer systemic agents, the use of 18F-fluorodeoxyglucose positron-emission tomography to assist in the development of innovative radiation treatment planning techniques, and the identification of prognostic molecular markers. The addition of surgery following primary combined-modality therapy apparently does not improve survival, but this finding is controversial.
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Update on Hepatic Intra-Arterial ChemotherapyTheoretically, effective regional cancer chemotherapy should afford the opportunity to deliver a significantly higher concentration of a cytotoxic agent than is possible with systemic administration of the same agent. Furthermore, regional chemotherapy should cause its greatest stress on the site of administration, producing a lesser burden of toxicity on the whole body.
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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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Will We Be Able To Care For Cancer Patients In The Future?The number of cancer patients and cancer survivors continues to increase rapidly amid predictions of a shortfall in physicians to care for them. In addition, newer cancer therapies have become increasingly complex and resource-intensive, compounding the impending workforce shortage. Simultaneously, the growing understanding of the biologic heterogeneity of cancer and the development of pharmacogenomics have opened up the possibility of personalized approaches to cancer diagnosis and treatment. Such personalization has been promulgated as a means of decreasing the cost of drug development, improving the efficacy of treatments, and reducing treatment toxicity. Although there have been notable successes, the fulfillment of these promises has been inconsistent. Providing care for future cancer patients will require the development of innovative delivery models. Moreover, new approaches to clinical research design, to the assessment of therapeutic value, and to the approval of and reimbursement for diagnostics and treatments are needed.
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Principles of Radiation TherapyThis chapter provides a brief overview of the principles of radiation therapy. The topics to be discussed include the physical aspects of how radiation works (ionization, radiation interactions) and how it is delivered (treatment machines, treatment planning, and brachytherapy). Recent relevant techniques of radiation oncology, such as conformal and stereotactic radiation therapy, also will be presented. These topics are not covered in great technical detail. It is hoped that a basic understanding of radiation treatment will benefit those practicing in other disciplines of cancer management. This chapter does not address the principles of radiobiology, which guide radiation oncologists in determining issues of treatment time, dose, and fractionation or in combining radiation with sensitizers, protectors, and chemotherapy or hormones.
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Addressing the Challenge of Managing Radiation Use in Medical Imaging: Paradigm Shifts and Strategic PrioritiesThe rise in utilization of medical imaging-especially computed tomography and nuclear medicine-and the issues of perceived, potential, theoretical, and known risks associated with ionizing radiation exposure from imaging have come to the forefront of public and professional awareness, raising concerns and controversies.
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Issues in the Management of Cancer-Related ThrombocytopeniaThrombocytopenia remains a significant clinical problem for patients with cancer. Management approaches include watchful waiting, platelet transfusions, and the use of pharmacologic agents. Although platelet
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Management of Young Breast Cancer Patients With de Novo Genetic MutationsA 24-year-old woman presents to her primary care provider with a mass in her left breast. Examination confirms a 2.2-cm mass in the upper outer quadrant, with a single mobile axillary node that is firm to palpation.
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Influenza Vaccination in Patients With Cancer: an OverviewInfluenza infection is a potential cause of additional morbidity and mortality in patients who are immunocompromised because of cancer or its treatment. Of particular note, influenza infection may delay or interrupt chemotherapy and necessitate hospitalization. Successful immunization depends on an intact immune system that can produce antibodies in response to antigen exposure. Patients with cancer often have a suppressed immune system, resulting from their disease and/or immunosuppressive therapies, and as a consequence they may have a suboptimal serologic response to influenza vaccination. Since vaccination is the only proven method for preventing influenza infection, the Advisory Committee on Immunization Practices recommends seasonal influenza vaccination for adults without contraindications who have disease- or medication-related immunosuppression. Patients with cancer should be given the trivalent inactivated vaccine. Preliminary data suggest that administering the vaccine between cycles of chemotherapy may yield the best results.
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What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?There is ample evidence suggesting that physical activity and exercise can be therapeutic tools for patients with prostate cancer. Patients diagnosed with localized disease should be advised to stay physically active; furthermore, patients who are undergoing radiation therapy and/or treatment with ADT appear to benefit from regular aerobic and resistance exercise to alleviate side effects.
