Andre A. Konski, MD, MBA, MA

Value in its essence is preference or outcome divided by cost, or described in terms of a mathematical equation, value = outcome (preference)/cost. It follows, then, that value is increased by holding outcome constant and reducing cost, or by improving outcome while holding cost constant.

These guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.

For resectable gastric cancer, perioperative chemotherapy or adjuvant chemoradiation with chemotherapy are standards of care. The decision making for adjuvant therapeutic management can depend on the stage of the cancer, lymph node positivity, and extent of surgical resection.

The management of rectal cancer in patients with metastatic disease at presentation is highly variable. Although chemoradiation is standard for patients with stage II/III rectal cancer, its role in the metastatic setting is controversial.

Hypofractionated external beam WBI seems like a great option until the APBI data mature from NSABP 39/RTOG 0413. In the meantime, we will have to see whether the ACA’s mission to bend the cost curve in the face of added demand for cancer care will succeed and how our treatment decisions will be affected by this new healthcare model.

In this issue of ONCOLOGY, Aneja and colleagues explore the beneficial aspects of the use of hypofractionated radiotherapy in the treatment of adenocarcinoma of the prostate.

In this issue of Oncology, Dr. Kilbridge details the incorporation of nontraditional outcome measures in the evaluation of cancer therapies-the importance of which is underscored by the passage of the sweeping healthcare reform bill that will alter the landscape of healthcare delivery for years to come.

In this issue of ONCOLOGY, Dr. Czito and colleagues from Duke University School of Medicine and the University of Texas Southwestern describe the potential benefit of incorporating intensity-modulated radiation therapy (IMRT) into the combined-modality treatment of anal canal cancer.[1] As the authors well delineate, the treatment of anal canal cancer has progressed from radical surgery to organ preservation with the use of definitive chemoradiotherapy.