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45-Year-Old Female With Gross Hematuria Post Partial NephrectomyA 45-year-old female presents with gross hematuria 5 days after a laparoscopic partial nephrectomy for renal cell cancer. What is your diagnosis?
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Guillain-Barré Syndrome After Treatment With Sunitinib Malate?Sunitinib malate (Sutent, SU011248) is an oral multitargeted tyrosine kinase inhibitor used for treatment of renal cell carcinoma and gastrointestinal stromal tumor. We report a case of a patient who developed Guillain-Barré syndrome after initial treatment with sunitinib, with recurrent symptoms upon reintroducing the drug. This is the first report of such an effect. The literature on chemotherapy-induced Guillain-Barré syndrome is also reviewed. Oncology providers should be aware of this rare but potentially serious possible adverse effect of sunitinib.
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Update on the Management of Primary CNS LymphomaPrimary central nervous system (CNS) lymphoma is a non-Hodgkin’s lymphoma restricted to the nervous system. The incidence of this lymphoma is rising in the immunocompetent population but may be decreasing in
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Comparing Radical Prostatectomy and Brachytherapy for Localized Prostate CancerRadical prostatectomy and ultrasound-guided transperinealbrachytherapy are both commonly used for the treatment of localizedprostate cancer. No randomized trials are available to compare thesemodalities. Therefore, the physician must rely on institutional reportsof results to determine which therapy is most effective. While some investigatorshave concluded that both therapies are effective, others haveconcluded that radical prostatectomy should remain the gold standardfor the treatment of this disease. This article reviews the major seriesavailable for both treatments and discusses the major controversiesinvolved in making these comparisons. The data indicate that for lowriskdisease, both treatments are effective, controlling disease in over80% of the cases, with no evidence to support the use of one treatmentover the other. Similarly, for intermediate-risk disease, the conclusionthat one treatment is superior to the other cannot be drawn. Brachytherapyshould be performed in conjunction with external-beam radiationtherapy in this group of patients. For patients with high-risk disease,neither treatment consistently achieves biochemical control rates above50%. Although radical prostatectomy and/or brachytherapy may playa role in the care of high-risk patients in the future, external-beamradiation therapy in combination with androgen deprivation has thebest track record to date.
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Study Results of Maximum Androgen Blockade Not ClearcutAndrogen suppression, primarily castration, has been the key objective of treatment of metastatic prostate cancer. Surgical castration, achieved by the use of bilateral orchiectomy, produces a short-term symptomatic and objective tumor response in 70% to 80% of patients.[1] Medical castration, by the use of leuteinizing hormone-releasing hormone (LHRH) agonists, produces an almost equivalent effect. However, use of medical or surgical castration eliminates only 90% to 95% of the daily testosterone production. The remainder is produced in the adrenal glands.
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Sinking Health Care Ship Could Bring Down the EconomyOur nation's health care systemis facings an economicmeltdown of unprecedentedproportions. Overthe past 20 years, medicalinflation has averaged double the generalinflation rate.
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Contemporary Management of Small Renal MassesDespite improved understanding of the molecular features of renal tumors, increasing expertise in surgical management of localized renal cancers, and multiple effective systemic therapies for metastatic cancer, mortality from renal cell carcinoma remains largely unchanged.
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Large Bladder Mass and Renal Failure in a 14-Year-Old BoyA 14-year-old, otherwise healthy adolescent male originally presented to his primary care physician with abdominal pain and distention. Ultrasound revealed a complex mass with cystic components along the superior pole of the bladder and bilateral hydroureteronephrosis down to the level of the bladder.
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Easy methods curtail toxins in food linked to cancer in AfricaWASHINGTON, DC- In much of the developing world, exposure to mycotoxins, which are generated by various types of fungus that grow on food, is ubiquitous. Th e most well-known mycotoxin, aflatoxin, is commonly found on nuts and is a known carcinogen, according to the International Agency for Research on Cancer (IARC).
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Gastrointestinal Cancers With Peritoneal Carcinomatosis: Surgery and Hyperthermic Intraperitoneal ChemotherapyThis review focuses on the underlying rationale for the use of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CS + HIPEC) in the treatment of patients with primary gastrointestinal tumors with metastatic peritoneal disease.
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Recommendations for Women With Lobular Carcinoma In Situ (LCIS)This article will review current management trends for women with classical lobular carcinoma in situ (LCIS).
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Prevalence of Complementary and Alternative Medicine Use in Cancer PatientsInterest in complementary and alternative medicine (CAM) has grown dramatically over the past several years. Cancer patients are always looking for new hope, and many have turned to nontraditional means. This study was
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The Complexity of Hereditary Cancer SyndromesCounseling women at high risk for ovarian and uterine cancer is a complex process, from genetic diagnosisto the management of at-risk women. Rimes andcolleagues have presented these challenging issues, andsuggested ways to manage them, very well.
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Fall Risk Assessment and PreventionPatient falls are a common cause of morbidity and are the leading cause of injury deaths in adults age 65 years and older. Injuries sustained as result of falls in a cancer hospital are often severe, regardless of patient age, due to the nature of the underlying cancer.
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UFT Plus Oral Calcium Folinate/Vinorelbine for Advanced Breast CancerThis phase I study was undertaken to define the maximum tolerated dose, dose-limiting toxicity, and recommended dosage of UFT (uracil and tegafur) plus oral calcium folinate (Orzel) and vinorelbine (Navelbine) in
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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The Role of Radiotherapy in Node-Positive Prostate CancerThis article summarizes the existing literature on use of radiotherapy for node-positive prostate cancer, as well as the associated outcomes.
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Current Role of Retroperitoneal Lymph Node Dissection in Testicular CancerProgress in managing testicular cancer over the last 2 decades has produced survival rates of well over 90% using a multidisciplinary approach that serves as a model for other tumors. Improved imaging techniques permit more accurate clinical staging, allowing the clinician to select, for each patient, the sequence of surgical and chemotherapeutic modalities that maximizes survival while keeping morbidity within tolerable limits. Current investigators are attempting to refine treatment protocols so as to maintain or improve survival while reducing morbidity and costs.
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Indolent B-Cell Non-Hodgkin’s LymphomasThe indolent B-cell non-Hodgkin’s lymphomas are a diverse group of disorders that differ markedly with respect to presenting features and natural history. This article reviews entities that have generally been encompassed
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Commentary (Brockstein/Vokes): Revisiting Induction Chemotherapy for Head and Neck CancerArgiris et al present a comprehensivereview of inductionchemotherapy for head andneck cancer, and should be lauded fortheir meticulous work. This papercarefully delineates and categorizesmost of the relevant induction chemotherapystudies in head and neckcancer performed over the past 3 decades.The authors have sought to answerquestions regarding the optimalnumber of chemotherapy cycles (acritical factor when one uses responseto induction chemotherapy to determineeligibility for organ preservationor in an attempt to enhance curerates), the optimal chemotherapyregimen, and the possibility of a sitespecificbenefit to induction chemotherapy.The paper assesses benefitbased on treatment intent-that is, organpreservation vs survival benefit.Importantly, by excavating the layersof the past, the authors provide aframework with which to construct anew paradigm of treatment for headand neck cancer that may again incorporateinduction chemotherapy.
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Management of Locally Advanced or Unresectable Head and Neck CancerIn the following sections, we will first review the radiotherapy techniques that have been investigated. We will then review the progressive advances achieved with the addition of chemotherapeutic strategies to RT in an attempt to achieve better outcomes.
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Between the Lines Podcast: Tazemetostat in Relapsed/Refractory Follicular LymphomaExpert oncologist/hematologists Bruce Cheson, MD, FACP, and Steven Park, MD, discuss findings from the E7438-G000-101 trial and consider the efficacy of tazemetostat as treatment for relapsed or refractory follicular lymphoma.
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MRI-Based Treatment Decision Making for Rectal CancerThere are a number of clinicopathologic variables that predict outcome in rectal cancer. In the era of postoperative chemoradiation treatment, these were more easily identified and were used to help select patients for adjuvant therapy.
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Oral 5-FU Alternatives for the Treatment of Head and Neck CancerThe common clinical presentations of head and neck cancer include early (stage I or II) disease, locally or regionally advanced (stage III or IV, M0) disease, and recurrent or metastatic disease (< 5% of patients).
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Commentary (Hillner): Bisphosphonates in the Prevention and Treatment of Bone MetastasesIn this issue, Ramaswamy and Shapiroprovide another excellent reviewof the recent literature on therole of bisphosphonates in the managementof bone metastases frombreast cancer and selected other cancers.Bisphosphonates and bone metastaseshave been the subject ofnumerous similar publications. In aquick Medline search of papers publishedsince January 2002, I found 12different review articles including asimilar manuscript in this journal.[1]
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Autocrine Growth Factors and Neuroendocrine Markers in the Development of Small-Cell Lung CancerTwo different clinical trials using biological agents directed against an autocrine growth factor and a surface marker of neuroendocrine differentiation have been used for patients with relapsed small-cell lung cancer. In a
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Commentary (Pollock): Radiation Therapy in the Management of Brain Metastases From Renal Cell CarcinomaBrain metastases from renal cell carcinoma (RCC) cause significant morbidity and mortality. More effective treatment approaches are needed. Traditionally, whole-brain radiotherapy has been used for palliation. With advances in radiation oncology, stereotactic radiosurgery and hypofractionated stereotactic radiotherapy have been utilized for RCC brain metastases, producing excellent outcomes. This review details the role of radiotherapy in various subgroups of patients with RCC brain metastases as well as the associated toxicities and outcomes. Newer radiosensitizers (eg, motexafin gadolinium [Xcytrin]) and chemotherapeutic agents (eg, temozolomide [Temodar]) used in combination with radiotherapy will also be discussed.
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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement 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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Immunotherapy in Renal Cell CarcinomaVery little has changed in the management of advanced renal cell carcinoma since the approval of interleukin-2 (IL-2, aldesleukin [Proleukin]) in 1992 by the FDA for the systemic treatment of this disease. Dr. Bukowski succinctly reviews the
