This article reviews the pathology and current evidence on systemic therapies for the management of advanced salivary gland cancers that are not amenable to local therapy.
Apar Kishor Ganti, MD, MS
Exciting advances in understanding the biology of lung cancer have occurred over the last few years.
Despite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease. Surgery has not played a major part in the management of SCLC, but emerging data suggest that resection may have a role in earlier stage disease. While the frontline treatment of SCLC has not changed significantly in the past decade, newer agents that are currently being investigated provide hope for better treatment of relapsed/refractory disease for the future.
Almost 40% of patients with newly diagnosed small-cell lung cancer (SCLC) have disease confined to the ipsilateral hemithorax and within a single radiation port, ie, limited-stage disease. The median survival for this group of patients after treatment is approximately 15 months, with one in every four patients surviving 2 years. Current optimal treatment consists of chemotherapy with platinum/etoposide, given concurrently with thoracic radiation. Surgery may represent an option for very early-stage disease, but its added value is uncertain. Prophylactic cranial irradiation (PCI) is used for patients with limited-stage SCLC who have achieved a complete response following initial therapy, as it decreases the risk of brain metastases and provides an overall survival benefit. Newer targeted agents are currently being evaluated in this disease and hold the promise of improving current outcomes seen in patients with early-stage disease.
The role of screening in order to
detect lung cancer at an earlier
stage has been widely debated
for the past 4 decades. In this review,
Dr. Mulshine focuses on the current
issues in lung cancer screening in light
of the findings of the International
Early Lung Cancer Action Project
(I-ELCAP) As the article mentions, the
diagnosis of lung cancer is often made
at a stage when the disease is no longer amenable to cure. This is probably the
most important cause for the dismal
outcomes of patients with lung cancer
The most common indolent lymphoma, follicular lymphoma comprises
35% of adult non-Hodgkin’s lymphoma (NHL) in the United
States and 22% worldwide. Features associated with adverse outcome
include age, male gender, disease stage, and performance status, with
the International Prognostic Index being the most widely used risk classification
system. Long-term disease-free survival is possible in select
patient subgroups after treatment, but very late relapses suggest that
quiescent lymphoma cells might be harbored for long periods of time.
Radiation therapy is the mainstay of treatment for limited-stage follicular
lymphoma, but there is some experience with chemotherapy and
combined chemoradiation. When to initiate treatment in patients with
advanced disease is controversial, but options include various combined
chemotherapy regimens, monoclonal antibodies, radiolabeled antibodies,
and bone marrow or stem cell transplantation. Future directions in
the treatment of follicular lymphoma include vaccines, antisense
therapy, and proteasome inhibitors.