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Nonepithelial Malignancies of the BreastDrs. Chugh and Baker's concisereview highlights diseaseentities we hear little of, andmay never see, but of which we mustbe cognizant. The article serves as avaluable reminder that not every breastmass that is palpated or detected byradiologic screening represents eithera carcinoma or benign entity such as afibroadenoma. Although rare, the nonepithelialmalignancies must beconsidered in a complete differentialdiagnosis.
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Molecular Markers for Diagnosis, Staging, and Prognosis of Bladder CancerConventional histopathologic evaluation of bladder cancer, encompassing tumor grade and stage, is inadequate to accurately predict the behavior of most bladder tumors. Intense research efforts are under way to identify and
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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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Empiric Antifungal Therapy for the Neutropenic PatientThe article written by Drs. Wingard and Leather presents a thoughtful review of the current approaches to empiric antifungal therapy in neutropenic patients. Empiric antifungal therapy has evolved as a standard of care for the prevention of invasive fungal infections in neutropenic patients who remain persistently febrile despite the use of broad-spectrum antibacterial antibiotics.[1-3] Empiric antifungal therapy in this setting provides early treatment for clinically occult invasive fungal infections and systemic prophylaxis for neutropenic patients at highest risk.
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Hematopoietic Cell TransplantationHematopoietic cell transplantation (HCT) is the IV infusion of hematopoietic stem and progenitor cells designed to establish marrow and immune function in patients with a variety of acquired and inherited malignant and nonmalignant disorders.
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Integrating PARP Inhibitors Into Advanced Prostate Cancer TherapeuticsExperts in the field review integration of approved PARP inhibitors into advanced prostate cancer clinical practice.
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Book Review: Cancer Treatment: 4th EditionThe 1995 Cancer Treatment edited by Dr. Charles Haskell is the fourth edition of his original textbook published in 1980. Cancer Treatment has kept pace with advances in oncology over these 15 years, and the fourth edition includes new
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Reinventing Bone Marrow TransplantationThe therapeutic benefit of allogeneic hematopoietic transplantation is due largely to an immune graft-vs-malignancy effect. Most of the evidence for such an effect has come from studies of allogeneic transplantation in
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Managed Care: To Live and Die in LAIn Los Angeles, the future seems to arrive a little sooner than in the rest of the country. The defense-based economy has crashed and burned, shifting hundreds of thousands of employees into managed care plans, mostly HMOs.
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Multimodal Approach to Anaplastic Thyroid CancerIn this article, we endeavor to clarify the role of radiation therapy and chemotherapy in the treatment of ATC; we note important contributions of the historical literature, and we review more contemporary strategies adopted by several renowned institutions.
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Why Oncologists Should Refer Patients Earlier for Hospice CareIn this article, prognostic data are summarized and a suggested approach for discussing hospice enrollment with patients is presented.
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Stephen M. Ansell, MD, PhD, on Progress of CAR T-Cell TherapyThe Mayo Clinic expert highlights exciting advancements being made in chimeric antigen receptor T-cell therapy for blood cancer.
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Brachytherapy Boost Techniques for Locally Advanced Prostate CancerDr. Vicini and colleagues provide an excellent review of the experience to date utilizing interstitial brachytherapy in the treatment of locally advanced prostate cancer. As the authors mention, ample evidence suggests the existence of a dose-
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Carcinomatous Meningitis: It Does Not Have to Be a Death SentenceCarcinomatous meningitis, specifically leptomeningeal metastases from solid tumors, has a dismal prognosis, with an overall median survival of 2 to 4 months. Lymphomatous meningitis has a better outlook, with a median survival of more than 6 months, but diagnosis may be delayed and treatment is not curative.
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Building Efficiency and Scaling With a Remote Genetic Counseling ProgramSmita K. Rao, MBBS, MS, et al gave an overview of implementing genetic counseling into oncology practices through telemedicine.
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Long-Term Central Venous AccessThe use of multidrug chemotherapy and bone marrow transplantation in cancer treatment has made the utilization of reliable, long-term venous access (LTVA) an essential component of cancer therapy. The placement of LTVA devices not only permits the delivery of these complex therapeutic regimens but also drastically improves patients’ quality of life.
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Ovarian Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal CancerLocal-regional carcinoma of the esophagus is often diagnosed inadvanced stages because the diagnosis is established when symptomsare severe. The prognosis of patients with local-regional carcinoma ofthe esophagus continues to be grim. While preoperative chemoradiotherapyincreases the fraction of patients who achieve pathologiccomplete response, that percentage is approximately 25%. In an attemptto increase the number of patients with either no cancer in the surgicalspecimen or only microscopic cancer, we adopted a three-step strategy.The current study utilized up to two 6-week cycles of induction chemotherapywith irinotecan (CPT-11, Camptosar) and cisplatin as step 1.This was followed by concurrent radiotherapy and chemotherapy withcontinuous infusion fluorouracil (5-FU) and paclitaxel as step 2. Oncethe patients recovered from chemoradiotherapy, a preoperative evaluationwas performed and surgery was attempted. All patients signed aninformed consent prior to their participation on the study. A total of 43patients were enrolled. The baseline endoscopic ultrasonography revealedthat 36 patients had a T3 tumor, five patients had a T2 tumor, andtwo had a T1 tumor. Twenty-seven patients had node-positive cancer(N1). Thirty-nine (91%) of the 43 patients underwent surgery; all hadan R0 (curative) resection. A pathologic complete response was noted in12 of the 39 patients. In addition, 17 patients had only microscopic(< 10%) viable cancer in the specimen. Therefore, a significant pathologicresponse was seen in 29 (74%) of 39 taken to surgery or 29 (67%)of all 43 patients enrolled on the study. With a median follow up beyond25 months, 20 patients remain alive and 12 patients remain free ofcancer. Our preliminary data suggest that the proportion of patientswith significant pathologic response can be increased by using thethree-step strategy.
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Oral Complications of Cancer TherapyThe mouth is a frequent site of complications arising from drug or radiation cancer therapy, with mucositis, xerostomia, osteoradionecrosis, and local infections being the most common. From the standpoint of dose
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Breast Cancer Screening: The Evolving EvidenceIn this paper, the historic and recent evidence supporting the value of breast cancer screening will be described, along with the underpinnings of the current debate over the relative and absolute benefit of regular mammography screening.
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Current Role of Retroperitoneal Lymph Node Dissection in Testicular CancerThis paper is a very nice review of the history of the development of modern urologic surgical procedures for the treatment of testicular germ-cell tumors and their current indications. I agree with virtually everything the authors say. I will emphasize several points that they make and highlight a few small areas of disagreement.
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Toward a Breast Cancer Vaccine:Work in ProgressAs outlined in the review byDrs. Emens and Jaffee entitled“Toward a Breast CancerVaccine: Work in Progress,” the developmentof anticancer vaccines hasclosely paralleled advances in the fieldof immunology. Basic immunologyhas provided and will continue toprovide important insights intohuman immunity that directly relateto the design and study of immunotherapeutics.To date, the mostimportant scientific observations applicableto immunotherapy include thefollowing:
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A Shifting Paradigm for Patients with Head and Neck Cancer: Transoral Robotic Surgery (TORS)The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. The introduction of transoral robotic surgery (TORS) improves upon current transoral techniques to the oropharynx and supraglottis. This review will report on the evolution of robotic-assisted surgery: We will cover its applications in head and neck surgery by examining early oncologic and functional outcomes, training of surgeons, costs, and future directions.
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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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Integrins and CancerIntegrins play an important physiologic role in cell adhesion, and accumulating evidence suggests that they also regulate cell growth, proliferation, migration, and apoptosis. A number of congenital and acquired disease states have been associated with integrins, and small- molecule integrin inhibitors have been approved for treatment of benign hematologic diseases. In cancer, aberrant expression with normal functioning rather than dominant genetic variations of genes coding for integrins has generally been observed. This aberrant expression is mediated through "bidirectional" receptor signaling and interaction with corresponding signals from growth factor signaling pathways, leading to inhibition of apoptosis, induction of cell proliferation, extracellular matrix remodeling, migration, and angiogenesis. From a clinical perspective, a growing number of molecules targeting integrins have been developed for treatment and imaging purposes; clinical studies in melanoma, prostate cancer, and other malignancies are underway. This review summarizes the biology of integrins, the signal transduction pathways they regulate, and their role in different stages of carcinogenesis. Furthermore, it provides a synopsis on the clinical advancements in integrin targeting for therapeutic and imaging purposes in cancer.
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingOutpatient bone marrow transplant (BMT) strategies, as reviewed by Dix and Geller, have evolved for various reasons—from social to medical. If high-dose approaches are to become a viable treatment for common cancers, such as breast cancer, the refinement of transplants to a “kinder and gentler” approach is essential.
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Commentary (Parker)-Stereotactic Breast Biopsy: Indications and ResultsA decade has passed since the first stereotactic-guided histologic breast biopsy was performed. Initially, the large-scale implementation of this technique met with a great deal of resistance from most surgeons, and more surprisingly, from many breast radiologists in academia.
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ASCO: Controversies in Phase I Clinical TrialsSteve Joffe, MD discusses the ethical challenges and controversies in phase I clinical cancer trials.
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Lymphoma science meets patient careAs a young candy striper at a Los Angeles hospital, lymphoma researcher Alexandra M. Levine, MD, MACP, experienced a portentous moment, although she didn’t necessarily realize it at the time. An older patient, feeling alone and lonely, waved the teenager to his bedside for a chat and she obliged. “He thanked me profusely for having helped him,” she said. “I didn’t understand what I had done, but it was one of those moments that was huge.”
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Management of Asymptomatic Rising PSA After Prostatectomy or Radiation TherapyControversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.
