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Getting a Handle on Posttransplant Recurrence of HCCIn this issue of ONCOLOGY, Kim et al discuss adjuvant therapy after liver transplantation to decrease recurrence of hepatocellular carcinoma (HCC). Liver transplantation offers the best overall and recurrence-free survival for the treatment of stage I and II HCC. The landmark study in 1996 by Mazzaferro demonstrated that liver transplantation of patients with one lesion less than 5 cm or with up to three lesions but all less than 3 cm (the Milan criteria) resulted in low recurrence rates and similar survival to patients without HCC.[1]
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ACR Appropriateness Criteria® Nonsurgical Treatment for Locally Advanced Non–Small-Cell Lung Cancer: Good Performance Status/Definitive IntentThe treatment of inoperable stage III non–small-cell lung cancer (NSCLC) remains a challenge due to high rates of distant metastasis, local recurrence, and toxicity associated with definitive therapy.
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Current Surgical Management of Metastatic Spinal DiseaseThe article by Drs. Gerszten and Welch is a broad, general, and philosophic review of the surgical options that are currently available for the care of our unfortunate patients with metastatic spinal disease. The authors document the poor outcomes of
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Building on the Promise of RadioimmunotherapyTositumomab/iodine-131 tositumomab (Bexxar) and ibritumomab tiuxetan (Zevalin) are radioimmunoconjugates targeting the CD20 antigen. Both agents are approved in the United States for use in relapsed or refractory, indolent or transformed, B-cell lymphoma. These agents are well tolerated and have the highest levels of single-agent activity observed in these histologies. This review will summarize the key trials that led to approval of both I-131 tositumomab and ibritumomab tiuxetan, and then focus on four novel therapeutic concepts in radioimmunotherapy: retreatment, therapy of de novo indolent lymphoma, therapy of aggressive histologies, and incorporation in high-dose therapy programs utilizing autologous stem cell support.
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Prostate Cancer in a Man With Multiple Previous Cancerspatient is a 67-year-old male with mild obstructive symptoms and an American Urology Association symptom score of 8.[1] He was noted to have a prostate-specific antigen (PSA) level of 3.2 ng/mL. Because this represented a significant increase in his PSA velocity (rate of change over time), he proceeded to have a biopsy, which was positive for prostate cancer. He has no other complaints and visits us for an opinion on the treatment of his prostate cancer.
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Clinical Scenario: Implementation of Bispecific Therapy for Relapsed Refractory Multiple Myeloma in a Community CenterPanelists discuss how community centers can effectively implement bispecific antibody therapy for patients with relapsed/refractory multiple myeloma, addressing challenges such as staff training, patient monitoring, and managing potential adverse events in a non-academic setting.
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Head and Neck TumorsThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of head and neck cancers (including tumors of the oral cavity, oropharynx, hypopharynx, larynx, supraglottis, glottis, subglottis, and nasopharynx) using radiation, surgery, and medical treatment.
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Colorectal Cancer: Chemotherapy Treatment OverviewFluorouracil (5-FU) has remained the standard therapy for the treatment of advanced colorectal cancer for over 40 years. Unfortunately, only a minority of patients experience objective clinical response.
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Photodynamic Therapy in Lung CancerAs a practicing physician, Dr.Ost’s perspective on the use of photodynamic therapy (PDT) in the treatment of lung cancer is informative and helpful, particularly regarding its application in the multimodality setting. My comments represent the viewpoint of a scientist involved in the clinical use of PDT in an academic tertiary referral institution.
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It’s Tough to Make Predictions, Especially About the Future ... of Rectal CancerBy adjusting the sequencing of currently available treatments, improved compliance with therapy is ensured, and novel scientific and clinically relevant hypotheses can be further explored.
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Smoking Cessation: Recent Developments in Behavioral and Pharmacologic InterventionsSmoking kills more than 430,000 people each year in the United States and is currently estimated to be responsible for 30.5% of all cancer-related deaths in our society. The majority of these deaths could be prevented,
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How Do Targeted Therapies Change the Management of Indolent Lymphomas?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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Commentary (Sequist/Lynch): EGFR Inhibitors in Lung CancerThe review by Jan Buter andGiuseppe Giaccone in this issueof ONCOLOGY is an excellentoverview of the current statusof the anti–epidermal growth factorreceptor (EGFR) agents gefitinib (Iressa),erlotinib (Tarceva), and cetuximab(Erbitux). The authors addresssome of the most important issuesregarding anti-EGFR agents currently in clinical development. Key amongthese are the importance of patientselection and drug dosage in the successand failure of various clinicaltrials. This article raises several veryinteresting questions in the developmentof this class of agents.
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Prostate Cancer Focal Therapy Has Made Great Strides and the Future Remains BrightThomas J. Polascik, MD, reflects on a manuscript written by his colleagues regarding the use of focal therapy to treat localized prostate cancer.
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The State of Prostate MRI in 2013Our aims in this article are to describe the various imaging sequences that comprise the multiparametric MRI exam, as well as to review current literature on the strengths/weaknesses of these sequences; to delineate strategies for standardizing interpretation and reporting of MRI results; and to expound on the role of prostate MRI in clinical practice.
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Strategies for Addressing Cancer Patients’ Complaints of FatigueCancer-related fatigue is a common, albeit complex, symptom experienced by many cancer patients. Identification of fatigue and assessment of its severity should be a part of routine office care and can be performed using simple, one-question screening tools.
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A Colorectal Surgeon’s Perspective on the Current Surgical Options for Rectal Cancer After ChemoradiationA prospective trial needs to be done in order to create a safe and responsible environment in which to offer patients the watch-and-wait option for rectal cancer.
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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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Local Excision for Rectal Cancer: An Uncertain FutureAdenocarcinoma of the rectum remains a significant public health challenge, with 39,000 new cases and 8,500 deaths predicted for 1998. Radical surgery, the current standard therapy, frequently necessitates the formation of
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Current Application and Research Directions for Partial-Breast IrradiationBreast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.
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PSA Screening in Men Newly Diagnosed With Colorectal Cancer: Each According to His Group’s Means?Once a patient has been appropriately educated by an informed healthcare provider about the possible benefits of PSA screening, then patient preference as part of shared decision making regarding PSA screening should be considered in all cases.
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Will Current Clinical Trials Answer the Most Important Questions About Prostate Adenocarcinoma?Despite a heightened focus of the medical and research community on prostate cancer, many important questions about this disease remain unanswered. These include questions about the possible prevention of prostate cancer, as well as the optimal treatment approaches for localized, locally advanced, metastatic, and hormone-refractory disease. A whole host of prospective, well-designed clinical trials are currently in progress that should answer many of these questions. This review briefly explores some of these unresolved issues and describes ongoing trials designed to address them. [ONCOLOGY 11(8):1-11, 1997]
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Cancer and Healthcare Reform: Making the Pieces FitCancer service leaders must create the vision, embrace the change agenda, and drive the roadmap in order to make the strategic and clinical changeover to value.
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Radiotherapy Is NOT Essential to Cure Diffuse Large B-Cell Non-Hodgkin LymphomaDLBCL of any stage remains a systemic disease with early hematogenous spread. Thus, arguments advocating the role of IFRT do not truly address disease biology, and all future efforts to cure patients will require improved systemic therapy.
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Commentary (Byrne): Early Detection and Treatment of Spinal Cord CompressionAs outlined by Dr. Ruckdeschel,the evaluation and management of metastatic spinal metastasesand associated epidural spinalcord compression have been simplifiedby the advent of magnetic resonanceimaging (MRI), which is muchmore sensitive and specific than plainx-rays and radionuclide bone scanning.Furthermore, because most patientscan now undergo MRI ratherthan invasive myelography, thethreshold for diagnosing epiduralmetastatic disease has been lowered.Accordingly, it has become the test ofchoice for evaluating most patientswith suspected spinal metastases.
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Management of Intermediate-Grade LymphomasIntermediate-grade lymphomas are defined by the Working Formulation to include four histologic subgroups: follicular large-cell, diffuse small-cleaved-cell, diffuse mixed small- and large-cell, and diffuse large cell (Groups
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Practice Apoptosis: When Partners RetireKicking off the first in a series of podcasts, a noted healthcare consultant discusses how retirement can fracture a practice.
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A 54-Year-Old Woman With Recurrent Headaches and SeizuresThe patient’s medical history is remarkable only for asthma and mild emphysema. The family history included a grandmother with gastric cancer. The patient had been taking estrogen replacement therapy since menopause 3 years earlier, and she was
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Emerging Data and Future Directions in UCExperts highlight emerging data and novel regimens that have the biggest potential to impact treatment and management of patients with urothelial cancer.
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Sentinel Lymph Node Biopsy in a Young Child With Thick Cutaneous MelanomaHead and neck melanoma is a rare and aggressive childhoodmalignancy. Surgery remains the primary treatment, with lymphaticinvolvement determined by neck dissection. In the adult population,sentinel lymph node biopsy has emerged as a less morbid yet accuratemethod of staging regional lymph nodes. This innovative technique canalso be used in the pediatric population.
