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The recommended primary treatment approach for women with metastatic breast cancer and an intact primary tumor is the use of systemic therapy. Local therapy of the primary tumor is recommended only for palliation of symptoms. However, a series of retrospective studies examining practice patterns for this problem show that about half the women presenting with de novo metastatic disease undergo resection of the primary tumor, and suggest that women so treated survive longer than those who do not undergo resection of the intact primary. In analyses that adjust for tumor burden (number of metastatic sites), types of metastases (visceral, nonvisceral), and the use of systemic therapy, the hazard ratio for death is reduced by 40% to 50% in women receiving surgical treatment of the primary tumor. The benefit of surgical treatment appears to be confined to women whose tumors were resected with free margins. However, these results may simply reflect a selection bias (ie, younger, healthier women with a smaller tumor burden are more likely to receive surgical treatment). In addition, the role of other locoregional therapy such as axillary dissection and radiotherapy is not addressed in these studies. In view of these data, the role of local therapy in women with stage IV breast cancer needs to be reevaluated, and local therapy plus systemic therapy should be compared to systemic therapy alone in a randomized trial.

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Dr. Lamm's review of bacillus Calmette-Guérin (BCG) in the treatment of carcinoma in situ (CIS) of the bladder reflects one of the largest personal experiences of any investigator worldwide, and he should be congratulated for being one of those most responsible for the improved quality of life of many people due to the widespread use of BCG in bladder cancer. It is clear that BCG therapy allows a majority of patients with CIS to avoid cystectomy, and that it prevents progression to muscle involvement in many high-risk patients with papillary tumors.

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Molecular discoveries and clinical advances over the past few decades have made the treatment of chronic myeloid leukemia (CML) one of the great success stories of modern medicine. Before the 1980s, the focus was on maintaining normal white blood cell counts with agents such as hydroxyurea and busulfan. With the use of interferon, treatment strategies turned more toward cytogenetic remission. In 1998, targeted therapy was introduced to this setting with the first studies of imatinib mesylate. Since then, treatment objectives have shifted toward the attainment of molecular remission. In this review, we consider the variety of approaches to treating CML, efforts to minimize treatment failures, and possible future directions in therapy.

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The palliation of symptoms and improvement of quality of life are important aspects of therapy in patients with incurable metastatic cancer. This article describes the preliminary results of a phase I study of uracil and tegafur, an orally available fluorouracil (5-FU) derivative combined with oral leucovorin plus weekly intravenous paclitaxel.

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According to three associated and recently published large randomized studies, while about 75% of cancer patients with major depression do not receive any treatment for their depression, a new system of integrating depression treatment into cancer patient care can transform patient outcomes.

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Preliminary results from phase I trials suggest that the use of docetaxel (Taxotere) and doxorubicin (Adriamycin) is a well tolerated and highly active combination regimen for

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This video reviews recommendations for the prevention and management of thrombosis in patients with cancer.

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In this review article we will discuss the current data on, and future role of, sorafenib in the treatment of hepatocellular carcinoma beyond Child-Pugh A cirrhosis, in conjunction with local therapy, and in a transplant setting.

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Surgery continues to advance with the availability of new technology, knowledge and skills gained through experience, and collaboration between specialties. Some tumors that were unresectable in years past are now resectable. Other tumors that we currently consider beyond our ability to remove may be conquered in the near future.

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Laheru and Jaffee review the potential role of tumor vaccines in the management of gastrointestinal (GI) malignancies, which represent the leading cause of cancer death and are believed to be poorly immunogenic. The authors carefully review the questions and controversies surrounding currently available immunotherapeutic strategies and describe ongoing clinical protocols using tumor vaccine therapy, a few of which deserve special comment.

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Overall, the future of patients with MCL is promising, since therapeutic options have widened. The implementation of universal aggressive treatment is challenged by novel regimens, targeted agents, the use of MRD to guide treatment decisions, and new trials that will directly compare transplant vs non-transplant approaches.

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“How long have I had this cancer, Doctor?” This is a question that patients frequently ask their oncologist.

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Handbook of Gynecologic Oncology, edited by Drs. Barakat, Bevers, Gershenson, and Hoskins, is a first-edition clinical handbook formulated primarily for fellows in gynecologic oncology as well as for interested fellows in medical oncology and radiation oncology. The textbook presents concise summaries of the critical issues in the care of gynecologic cancer patients and would also be of interest to residents preparing for their gynecologic oncology rotations, obstetrician/gynecologists, other physicians who care for gynecologic cancer patients, and practicing gynecologic oncologists.

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The goal of identifying a set of pretreatment risk-stratifying factors for patients with localized prostate cancer is to be able to individualize treatment and optimize patient selection for clinical trials. Low-risk patients are most likely

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Michael Wang, MD, gives an overview of the progress that has been made in mantle cell lymphoma research and where research should be focused on new treatment strategies and improved understanding of the disease.

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During 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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Prior to the advent of targeted therapies, there were few options other than chemotherapy for the treatment of patients with indolent B-cell lymphomas or chronic lymphocytic leukemia.

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About 30,000 new cases of thyroid cancer are diagnosed annually in the United States.[1] The incidence among men has risen more dramatically than any other malignancy in recent years (2.4% annual increase).[2] Thyroid cancers arise from one of two cell types, namely follicular and parafollicular cells.

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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.

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Intratumor heterogeneity is one of the biggest challenges in cancer diagnosis and treatment. Despite morphologic and clinical recognition of tumor heterogeneity, an understanding of it at a molecular level has only begun to emerge in recent years.

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To investigate the potential use of adjuvant hormonal therapy, a randomized, prospective trial was conducted among patients with locally advanced prostate cancer, comparing irradiation alone, with irradiation plus hormonal treatment with goserelin, an agonist anologue of gonadotropin-releasing hormone that reduces testosterone secretion. A total of 415 men under 80 years old with locally advanced disease and no previous treatment for prostate cancer were initially recruited, with data available for analysis on 401 of these patients. Preliminary results at 33-months’ follow-up suggested that goserelin started at the onset of external irradiation improved both local control and 5-year survival. Updated results at 45 months confirm these data. The overall 5-year survival rate for those treated with goserelin in addition to radiotherapy was 79%, compared to 62% in the radiotherapy only group. The localized control rate was 97% in the combined treatment group compared to 77% in the radiotherapy only group. [Oncol News Int 6(Suppl 3):21-22, 1997]

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This was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.

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Childbearing is one of the most important life goals for many women, and fertility preservation is a very important factor in the overall quality of life of cancer survivors. Cervical cancer frequently affects young women; because some women tend to delay childbearing, fertility preservation must be considered when treatment options are discussed. Over the past decade, the radical trachelectomy procedure has become a well established fertility-preserving option for young women with early-stage cancer; this procedure is associated with low morbidity, good oncologic outcome, and a high proportion of pregnancies that reach the third trimester and babies that are delivered at term. This article will review available literature on the vaginal radical trachelectomy procedure and data from other surgical approaches, such as the abdominal radical trachelectomy. In addition, the potential future application of neoadjuvant chemotherapy followed by fertility-preserving surgery in patients with locally advanced cervical cancer will be examined. Finally, ultraconservative surgical approaches (eg, conization alone with or without laparoscopic lymphadenectomy) in very early-stage disease will be discussed.

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Ganti et al present quite an extensive overview of follicular lymphoma, with most of their emphasis on clinical practice. Many of the issues they touch upon demonstrate that we cannot draw firm conclusions about the superiority of various treatments over others, due to a variety of study limitations. These challenges to interpretation include the indolent course of the disease in most patients (and thus the long follow-up needed to draw firm conclusions), the often small number of patients in this category, the retrospective nature of most studies, differences in risk factors, and the relative lack of randomized studies. As is also the case with efficacy, the most beneficial treatment strategy in follicular lymphoma remains to be established.

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However, it is becoming ever clearer that tumor characteristics can change during the course of disease. Given this change over time, other supporting techniques for guiding therapy would be of value. Molecular radionuclide imaging with positron emission tomography (PET) can potentially fulfill this need.

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The majority of individuals diagnosed with lung cancer in theUnited States are 70 years of age and older. Defining appropriatetherapy for older patients with non–small-cell lung cancer (NSCLC) isbecoming a major focus of clinical research. In this article, we reviewthe available data on clinical predictors of risk and benefit for elderlyNSCLC patients receiving treatment via a variety of modalities, includingsurgery, radiotherapy, combined radiotherapy and chemotherapy,and chemotherapy alone. The data demonstrate that subgroups ofelderly patients benefit from appropriately selected treatment. Participationof older patients in clinical trials designed to assess efficacy,toxicity, and quality-of-life outcomes for recently developed treatmentmodalities in this population is critical.

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In this video we discuss the results of a phase III trial that studied upfront high-dose chemotherapy plus autologous stem cell transplantation (ASCT) compared to chemotherapy alone and bortezomib in newly diagnosed multiple myeloma.

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Management of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.

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In July 2003, an asymptomatic 40-year-old man presented to his primary care physician for routine care and was found to have a palpable right axillary lymph node.