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Novel Approaches to ‘Borderline Resectable’ Pancreatic TumorsThe authors describe the case of a 40-year-old man with an adenocarcinoma of the pancreatic head with involvement of the superior mesenteric vein–portal vein (SMV-PV) confluence resulting in limited occlusion.
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Synergizing Radiation Therapy and Immunotherapy for Curing Incurable CancersRadiation is often considered immunosuppressive, an activity that is most likely a result of the complex interplay of hormesis and the abscopal effect. The abscopal effect, also called the “distant bystander” effect, is a paradoxical effect of radiation on cellular systems whereby local radiation may have an antitumor effect on tumors distant from the site of radiation.
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Depression in Cancer PatientsDrs. Jeremy Winell and AndrewRoth have provided a niceoverview of the diagnosis andtreatment of depression in cancer patients.The views they express are bothwidely accepted and applicable to otherserious medical illnesses as well.They remind us of the challenge ofmaking a valid diagnosis of depressionin cancer patients, since all of thesomatic symptoms of depression (eg,anorexia, fatigue, insomnia) may insome patients represent symptoms ofcancer or cancer treatment rather thandepression.
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Shared Decision Making and Screening: An Ongoing Dialogue Informed by DataA state of equipoise now exists for various surgical options in the treatment of early lung cancer, underscoring the need for shared decision making.
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Managed Care’s Effects on Community Clinical ResearchManaged care is transforming numerous aspects of health care delivery, and the specialty of oncology, in particular, is being increasingly affected for several reasons.
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Improving the Therapeutic Ratio in Hodgkin Lymphoma Through the Use of Proton TherapyThis review addresses the rationale and evidence for-and the challenges, cost implications, and future development of-proton therapy as an important part of the treatment strategy in Hodgkin lymphoma.
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Current Status and Optimal Use of RadiosurgeryThe field of stereotactic radiosurgery is rapidly advancing as a result of both improvements in radiosurgical equipment and better physician understanding of the clinical applications of stereotactic radiosurgery. This
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Treatment of Acute Myelogenous LeukemiaThere have been significant advances in our understanding of the biology of acute myelogenous leukemia (AML), and to a lesser extent, in its treatment. Dr. Estey has provided an excellent overview of the current state of the clinical management of the disease. He has described both the standard therapeutic approaches, including allogeneic hematopoietic stem cell transplantation, as well as the role of investigational therapy. The present state of clinical research in AML is reviewed in some detail in the context of the broad clinical investigation of the disease at the M. D. Anderson Cancer Center. Dr. Estey makes a strong argument for the early consideration of investigational therapy, focusing on patients for whom "standard" therapy is demonstrably inadequate.
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Emerging Technology in Cancer Treatment: Radiotherapy ModalitiesThis is a period of rapid developments in radiotherapy for malignantdisease. New methods of targeting tumors with computed tomography(CT) virtual simulation, magnetic resonance imaging (MRI), andpositron-emission tomography (PET) fusion provide the clinician withinformation heretofore unknown. Linear accelerators (linacs) withmultileaf collimation (MLC) have replaced lead-alloy blocks. Indeed,new attachments to the linacs allow small, pencil beams of radiation tobe emitted as the linac gantry rotates around the patient, conforming tothree-dimensional (3D) targets as never before. Planning for these deliverysystems now takes the form of "inverse planning," with CT informationused to map targets and the structures to be avoided. In thearea of brachytherapy, techniques utilizing the 3D information providedby the new imaging modalities have been perfected. Permanentseed prostate implants and high-dose-rate (HDR) irradiation techniquestargeting bronchial, head and neck, biliary, gynecologic, and otheranatomic targets are now commonplace radiotherapy tools. CT-guidedpermanent seed implants are being investigated, and a new method oftreating early breast cancer with HDR brachytherapy via a ballooncatheter placed in the lumpectomized cavity is coming to the forefront.Newer modalities for the treatment of malignant and benign diseaseusing stereotactic systems and body radiosurgery are being developed.Targeted radionuclides using microspheres that contain radioemittersand other monoclonal antibody systems tagged with radioemitters havebeen recently approved for use by the Food and Drug Administration.
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Options in BCG-Refractory Bladder Cancer for Radical Cystectomy–Ineligible PatientsThis video examines second-line treatment options for non-muscle invasive bladder cancer patients who relapse after BCG therapy and are not eligible for radical cystectomy.
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Cancer, Unproven Therapies, and MagicCommonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven
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Commentary (Olson): Recent Advances in the Treatment of Pediatric Brain TumorsSri Gururangan and Henry Friedmanpresent a thoughtful reviewof advances in pediatric neurooncology.Coupled with the recent reviewof pediatric brain tumor biologywritten by Richard Gilbertson, thesearticles highlight the value that thepediatric neuro-oncology communityplaces on translating signal transductionmodifiers into clinical practice.[1]The remainder of this commentaryfocuses on the challenges and opportunitiesassociated with developingmore effective and less toxic therapiesfor children with brain tumors.
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Treatment of Metastatic Pancreatic Adenocarcinoma: A ReviewGemcitabine monotherapy has been the standard of care for patients with metastatic pancreatic cancer for several decades. Despite recent advances in various chemotherapeutic regimens and in the development of targeted therapies, metastatic pancreatic cancer remains highly resistant to chemotherapy.
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The Challenge of Designing Clinical Trials for AIDS-Related Kaposi’s SarcomaKaposi’s sarcoma (KS) is a frequent cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Several characteristics of KS pose challenges for the conduct of clinical trials. Kaposi’s
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CYP2D6 Testing for Breast Cancer Patients: Is There More to the Story?The promise of pharmacogenetics is personalization of therapy for individuals through refinement of the risk/benefit profile of pharmaceuticals based on inherited gene mutations. Classic examples of the impact of pharmacogenetics in clinical practice include variants in dihydropyrimidine dehydrogenase and treatment with fluorouracil.
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Concurrent RT With 5-FU/Epirubicin and Cisplatin or Irinotecan for Locally Advanced Upper GI AdenocarcinomaFrom the results of recent studies, it is likely that multimodality therapy with chemotherapy and radiation treatment may improve the overall outcome of locally advanced upper gastrointestinal (GI) malignancies, including esophageal, gastric, pancreatic, and biliary tract carcinomas. However, more effective, more optimal, and less toxic chemotherapy regimen(s) with concomitant radiotherapy are needed beyond the concurrent continuous-infusion fluorouracil (5-FU) with radiation that is commonly applied in general practice. Epirubicin (Ellence), cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy agents in upper GI cancers. Two phase I studies were designed to test the tolerability of the combination of radiotherapy with infusional 5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
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The Role, Timing, and Clinical Use of ADT in Prostate CancerThe role, timing, and clinical use of androgen deprivation therapy (ADT) in prostate cancer remain a controversial topic for clinicians. Drs. Fang, Merrick, and Wallner provide a compelling review of the clinical benefits and side effects of ADT in high-risk prostate cancer. The number of patients presenting with advanced disease remains significant despite the stage migration of prostate cancer during the PSA (prostate-specific antigen) era.
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Impact and Implications of Lung Cancer ScreeningIn this video at ASCO 2018, James Mulshine, MD, discusses CMS coverage of low-dose CT lung cancer screening for selected Medicare beneficiaries, and clinical implications of early detection.
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Systemic Malignancies as a Cause of Unexpected Microangiopathic Hemolytic Anemia and ThrombocytopeniaThis review describes the clinical features that should suggest a search for systemic malignancy as the cause of unexpected microangiopathic hemolytic anemia and thrombocytopenia.
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Endocrine Therapy in 2009: Consideration of the Tumor and the HostBreast cancer is the most common female malignancy in the Western world. Two-thirds of all breast cancers are estrogen receptor (ER)-positive, a phenotypic characteristic that is prognostic of disease-free survival and predictive of response to endocrine therapy.
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Topoisomerase I Inhibitors in the Treatment of Head and Neck CancerTraditionally, the role of chemotherapy in the treatment ofsquamous carcinoma of the head and neck has been confined to patients with
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Taxanes in Adjuvant and Neoadjuvant Therapies for Breast CancerPaclitaxel (Taxol) is a diterpene originally obtained from the bark of the Pacific Yew Tree, Taxus Brevifolia. Its mechanism of action is unique. it stabilizes microtubule polymerization, thus blocking cells in the G2/M phase of
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From the Early Days in Oncology to NowIn this interview Dr. Armitage discusses his early career and what led him to specialize in the treatment of lymphoma, and shares his thoughts on the future of cancer treatment.
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Promoting Smoking Cessation Among Cancer Patients: A Behavioral ModelThe article, Promoting Smoking Cessation Among Cancer Patients, is an excellent complement to the clinical practice guideline on smoking cessation recently published by the Agency for Health Care Policy and Research (AHCPR).[1] The guideline presented considerable detail for clinicians on how to help smokers who are prepared to quit. For the approximately 80% of smokers who are not prepared, the guideline included only a few paragraphs. The approach of Prokhorov, Hudman, and Gritz, seasoned clinicians and scientists, can help clinicians become much more confident when counseling all smokers, including those in the precontemplation and contemplation stages.
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Silicone Breast Implants: An Oncologic PerspectiveIn 1992, the FDA decided that silicone gel-filled breast implants would be available only through controlled clinical studies, despite the fact that they had been used for mammoplasty in millions of women around the world
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Extended Transbasal Approach to Skull Base TumorsA variety of novel surgical approaches have been developed in recentyears to manage disease of the cranial base. Few offer the widthand depth of exposure achievable with the extended transbasal approach.This approach combines a bifrontal craniotomy with anorbitonasal or orbitonasoethmoidal osteotomy, and potentially asphenoethmoidotomy to provide broad access to malignancies of theanterior, middle, and posterior skull base. The approach enables the enbloc resection of tumors within the frontal lobes, orbits, paranasal sinuses,and sphenoclival corridors without brain retraction and mayobviate the need for transfacial access. This can be combined with additionalapproaches, based on the tumor's epicenter. Reconstruction isaccomplished with the use of pericranium, and in some instances, atemporalis muscle pedicle or a gracilis microvascular free flap. Complicationsinclude cerebral spinal fluid leakage, pneumocephalus, infection,and cranial neuropathies. However, the morbidity and mortalityassociated with this approach is low. The extended transbasal approachis a relatively novel exposure that enables the skilled cranialbase surgeon to safely excise many malignant lesions previously felt tobe unresectable.
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Comparison Studies of CT and MRI in Patients With Hepatic MetastasesThe increasing use of systemic and directed liver therapy for patients with hepatic metastases has created a demand for improved accuracy of noninvasive imaging techniques. Computed tomography (CT) and magnetic
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Irinotecan and UFT/Leucovorin in Patients With Advanced CancersThe combination of irinotecan and fluorouracil (5-FU) is synergistic when applied to human colon cancer cell lines in vitro and appears to be schedule-dependent: maximal activity occurs when irinotecan is administered prior to 5-FU. In this phase I study, irinotecan is administered in combination with UFT and leucovorin in patients with advanced solid tumors.
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Managing Toxicities Following BCMA-Directed Immunotherapy for MyelomaPatients treated with BCMA-directed immunotherapies for myeloma may experience susceptibility to severe infections following treatment.
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Hereditary Cancer Litigation: A Status ReportThe issues, cases, decisions and situations discussed by Severin indicate that, fortunately in one area and unfortunately in another, the more things change, the more they stay the same. Furthermore, his article raises an important medicolegal policy issue.
