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Surgical Management of Pancreatic CancerPancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection.
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Cognitive Function After Systemic Therapy for Breast CancerAnecdotal reports of cognitive compromise among patients treated with chemotherapy are relatively common among breast cancer survivors and may play an important role in adversely affecting functioning in multiple domains. As noted by Dr. Olin,
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Hepatic Colorectal Metastasis: Current Status of Surgical TherapyMetastatic colorectal cancer to the liver develops in over 50,000 US patients each year and is rapidly fatal if untreated. Even the most active chemotherapeutic agents rarely prolong survival for more than 3 years. Liver
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Use of Hematopoietic Hormones for Bone Marrow Defects in AIDSAnemia is a common complication of HIV infection. Erythropoietin (Procrit, Epogen) can correct anemia. When given to patients with HIV infection, erythropoietin ameliorates anemia and improves quality of life. Given these three facts, one wonders why an effective drug such as erythropoietin is not used appropriately in patients with HIV infections.
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Management of Metastatic Cutaneous MelanomaAlthough chemotherapy regimenscan produce objectiveresponses in patients withmetastatic melanoma, curative responsesare extremely rare. It is thereforeof significant interest that themajority of complete responses to immunotherapywith high-dose interleukin(IL)-2 (Proleukin) alone aredurable and probably curative.[1]
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Adjuvant Chemotherapy for Colon Cancer in the Elderly: Moving From Evidence to PracticeStates population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.
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A Pharmacoeconomic Comparison of UFT and 5-FU Chemotherapy for Colorectal Cancer in South AmericaThe escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact
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Paclitaxel and UFT Plus Oral Calcium Folinate in Pretreated Metastatic Breast CancerThis phase I study was designed to determine the maximum tolerated dose (MTD) and dose-limiting side effects of combination treatment with paclitaxel (Taxol) and UFT (uracil and tegafur in a 4:1 molar ratio) plus oral
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Malignant Angiomyolipoma: a Rare Entity With Unusual BiologyThe authors present an interesting case of a very rare renal neoplasm, malignant epithelioid angiomyolipoma (AML), which belongs to a family of mesenchymal tumors known as perivascular epithelioid tumors (PEComas).
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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
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Myelodysplastic Syndromes: Where Do We Go From Here?The review by Dr. Akhtari outlines the diagnosis, prognosis, and treatment options for patients with myelodysplastic syndromes (MDS), and touches on the current challenges in treating patients suffering from MDS.
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Adjuvant/Neoadjuvant Chemoradiation for Gastric and Pancreatic CancerBoth gastric and pancreatic cancer remain leading causes of cancer death in the United States and worldwide. While surgical resection continues to be required for long-term cure of both these neoplasms, 5-year survival
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Substance Abuse Issues in Cancer Patients:The relationship between the therapeutic use of potentially abusable drugs for symptom control and the multifaceted nature of abuse and addiction is extremely complex. Research is only beginning to elucidate the
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Clinical Status of Laparoscopic Bowel Surgery for GI MalignancyLaparoscopic colorectal surgery is being utilized increasingly for benign diseases. Recent published series have proven that morbidity and mortality from laparoscopic procedures are superior to those seen after traditional open
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Current Status of Retinoid Chemoprevention of Lung CancerClinical trials have suggested that retinoid chemoprevention prevents the development of second primary tumors following head and neck or non-small-cell lung cancer. The findings of these initial studies are now being
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Head and neck tumorsIn 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).
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Improving the Toxicity of Irinotecan/5-FU/ Leucovorin: A 21-Day ScheduleIrinotecan (CPT-11, Camptosar) is one of the new generation ofchemotherapeutic agents that has activity in advanced colorectal cancer.It has antitumor efficacy as a single agent, and also has beencombined with fluorouracil (5-FU) and leucovorin (IFL) to treat thesepatients. Randomized studies have confirmed the superiority of IFL to5-FU and leucovorin alone with regard to patient survival, time toprogression, and tumor response rate. The optimal schedule for combiningthese agents remains uncertain, but in the United States, theschedule of IFL weekly for 4 consecutive weeks repeated every 6 weeks,according to the schedule reported by Saltz et al, has been widely used,although with some toxicity (especially myelosuppression and diarrhea).In an attempt to improve the tolerability of IFL, some haveadvocated modifying the schedule of IFL to weekly for 2 weeks, withrepeated cycles every 21 days. Twenty-three patients with advancedcolorectal cancer have been treated on this schedule at a single institution.Therapy was well tolerated, with 35% of patients experiencinggrade 3/4 neutropenia, two of whom had episodes of febrile neutropenia,and 9% with grade 3/4 diarrhea. The median relative dose intensityof irinotecan administered in the first 18 patients treated with thisregimen was 94%. These data support the hypothesis that modifying theschedule of administration of IFL improves the tolerability and abilityto deliver the regimen, but must be confirmed by randomized prospectivestudies, which may also attempt to evaluate the role of bolus 5-FUin the treatment of advanced colorectal cancer.
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Should IMRT Be the New Standard in Esophageal Cancer?This video discusses the use of intensity-modulated radiation therapy and whether it should be the new standard for treating patients with esophageal cancer.
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Current Treatment of Peripheral T-cell LymphomaThis review article written by Robert Stuver, MD, et al, reviews current and available treatments for peripheral T-cell lymphoma.
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Liver Transplantation for the Treatment of Hepatocellular CarcinomaIn the majority of cases, hepatocellular carcinoma develops in the setting of cirrhosis. Treatment with curative intent is possible in only 20% to 25% of cases and consists of resection or liver transplantation.
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EXAM: Cabozantinib Doubled Survival in Medullary Thyroid Carcinoma With RET M918T MutationIn this video, Steven I. Sherman, MD, discusses the final overall survival analysis of the EXAM study, a randomized, placebo-controlled phase III trial of cabozantinib in medullary thyroid carcinoma patients.
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The Role of PET-CT Fusion in Head and Neck CancerPositron-emission tomography(PET) and computed tomography(CT) fusion imaging is arapidly evolving technique that is usefulin the staging of non–small-celllung cancer (NSCLC), Hodgkin’s disease,ovarian cancer, gastrointestinalstromal tumors, gynecologic malignancies,colorectal malignancies,and breast cancer. In their article,Rusthoven et al[1] describe the roleof PET-CT in head and neck malignanciesand include a review of allcurrently available literature. Accordingto the authors, PET-CT is usefulfor staging head and neck carcinomasand for target volume delineation duringradiation treatment planning.
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Prostate-Specific Antigen: What’s New in 1997In this article, the authors have done an excellent job in reviewing recent findings regarding prostate-specific antigen (PSA) and other methods for the early detection of prostate cancer. This is a fast-moving field, with new results being reported on a weekly basis. Indeed, it is an exciting time to be conducting research in prostate cancer. At the same time, however, it is far too easy to lose sight of some of the basic principles by which we should judge evidence to make research or clinical decisions. Specifically, there are hard-learned epidemiologic lessons about which we need to constantly remind ourselves.
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Update on Adjuvant Interferon Therapy for High-Risk MelanomaDespite more than 2 decades of active clinical study, the use of interferon as adjuvant therapy for high-risk melanoma remains controversial. The controversy has centered on dose, schedule, and toxicity of treatment. Agarwala and Kirkwood superbly summarize the clinical studies to date and highlight many of the salient issues relevant to clinicians.
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Intravesical Therapy for Superficial Bladder CancerThe intravesical instillation of therapeutic agents for the treatment of localized bladder cancer began in 1903 when Herring[1] summarized his experience with silver nitrate. Since then, intravesical chemotherapy and immunotherapy have emerged as
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Book Review: Cancer SurgeryThe study of oncology and the management of patients with cancer are becoming increasingly complex. The amount of information necessary for clinicians to assimilate is staggering. This is particularly true for surgical oncologists, who must not only keep up with the most recent advances in cancer diagnosis and therapy but also with the most up-to-date surgical procedures. Cancer Surgery is a reference that provides this important material in a comprehensive and logically organized format.
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An Oncology Perspective on the Supreme Court’s Pending Decision Regarding the Affordable Care ActBeginning on March 26, 2012, the Supreme Court of the United States heard oral arguments regarding challenges to the recent federal health care reform legislation.
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New task force guideline returns PSA screening to center stageWhen the U.S. Preventive Services Task Force reported that routine prostate cancer screening for older men appears to result in little benefit, the announcement raised more than a few eyebrows in the urologic medical community.
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Clinical Uses of RadiosurgeryRadiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). This article reviews the most common
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Endoscopic Diagnosis and Management of Gastrointestinal MalignancyThe endoscopic diagnosis, staging, and therapy of gastrointestinal (GI) malignancies has advanced rapidly and dramatically over the past 15 years. Video-endoscopy has generally replaced fiberoptic endoscopy, and the digitally based fidelity, sharper resolution, and improved magnification of the video-endoscopic image offers a potentially better approach for the evaluation of mucosal abnormalities.
