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ONCOLOGY Vol 28 No 11

Due to advances in chemotherapy, biologic therapy, and the development of liver-oriented treatment options, the survival of patients with metastatic cancer has more than doubled, and increasing numbers of patients have been cured, even among those with advanced disease.

Developing a scoring system for staging patients with hepatic colorectal metastases is important for prognosis and for identifying those who will benefit from additional systemic therapy.

This article will review the current practice of hepatic resection for colorectal liver metastases, including the possibility of combined resection of hepatic metastases at the time of resection of the primary cancer.

Clinical trial results to date show that men with visceral CRPC metastases do not benefit from ipilimumab, while their counterparts with bone- or node-only metastases do. This suggests that visceral metastases should be a stratification factor for future immunotherapy clinical trials.

While evidence points to benefit from highly active hormonal agents in prostate cancer with visceral involvement, the usefulness of immunotherapy is much less clear.

Although the mechanism(s) underlying the relatively poor prognosis of prostate cancer patients with visceral disease have yet to be fully elucidated, these new findings suggest that the microenvironment of bone lesions may be immunologically distinct from those at other sites.

One should not advise a patient with low- or very-low-risk prostate cancer to undergo a focal ablation. The kindest and gentlest approach is to first do no harm.

In patients with advanced, unresectable NETs, there are several treatment options; which of these may be considered depends on the site of origin of the tumor.

The incorporation of molecular subtypes into the locoregional management of breast cancer has lagged behind its use in systemic therapy. Omission or dose-intensification of RT based on subtypes should be investigated in future trials.

Surgery is not obsolete in the management of breast cancer; it is an essential component for almost all patients in the present treatment paradigm.

This article reviews the current status of local therapy for breast cancer and the likely impact of evolving molecular data on the present paradigm.

American medicine is poised for an expanded conflict over the assumption and consequences of risk in medical care.

The development of CT lung cancer screening, the publication of results from the NLST in 2011, and the grade-B recommendation for CT lung cancer screening in high-risk smokers by the USPSTF raise a number of interesting national health policy issues.

The NLST is a landmark trial demonstrating that implementation of low-dose CT screening lowers lung cancer–related mortality. We must put the study results and cost-effectiveness analyses in the context of the staggering statistics: up to 65% of lung cancer patients present with advanced-stage disease where treatments are often costly, toxic, and only palliative in nature.

NLST data clearly demonstrate that lung cancer screening is effective and safe and reduces lung cancer-specific mortality by at least 20%. There is no possible reason for CMS to further delay or restrict lung cancer screening for those at high risk.

 

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