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Authors

Richelle Williams, MD
Latest Article

Cancer Age: Can We Reliably Estimate and Apply This Knowledge?

In their article, Patrone et al utilize a modified version of Collins’ law to estimate the age of breast, lung, and colorectal cancers. Collins’ law, which states that the period of risk for recurrence of a tumor is equal to the age of the patient at diagnosis plus 9 months, has been applied primarily to pediatric tumors, in particular embryonal tumors.[1,2] The results from the application of Collins’ law to these tumors have been reasonable, although exceptions have been reported and the law is not applicable to all cancers.[3,4] Its utilization in adults in the manner used in this paper is therefore unique.

Rick Avila
Latest Article

Use of High-Resolution CT Imaging Data in Lung Cancer Drug Development: Measuring Progress

Lung cancer is the leading cause of cancer death throughout the United States.[1] Despite massive efforts, tobacco consumption continues to grow, with a large and predictable impact on premature mortality across the globe.[2]

Rick Kittles, PhD
Latest Article

Addressing the Disparities in Prostate Cancer Care and Outcomes

Dr. Kittles discusses the race-based health disparities in prostate cancer, and one genetic-environmental crossover that is clinically significant.

Rifaat M. Bashir, MD
Latest Article

Update on the Management of Primary CNS Lymphoma

Primary 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 patients

Riichiroh Maruyama, MD
Latest Article

UFT Plus Cisplatin With Concurrent Radiotherapy for Locally Advanced Non–Small-Cell Lung Cancer

A phase II study of combined-modality treatment consisting of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus cisplatin (Platinol) and concurrent radiotherapy was conducted to evaluate the activity of this regimen in

Rikhia Chakraborty, PhD
Latest Article

Langerhans Cell Histiocytosis: Emerging Insights and Clinical Implications

Langerhans cell histiocytosis is a disorder characterized by lesions that include CD207+ dendritic cells along with an inflammatory infiltrate. Langerhans cell histiocytosis has a highly variable clinical presentation, ranging from a single lesion to potentially fatal disseminated disease.

Rima F. Jubran, MD, MPH
Latest Article

Central Nervous System Germ Cell Tumors: Controversies in Diagnosis and Treatment

The variability and complexity of central nervous system germ cell tumors have led to controversy in both diagnosis and management. If a germ cell tumor is suspected, the measurement of cerebrospinal fluid and serum alpha-fetoprotein and beta–human chorionic gonadotropin is essential. A histologic specimen is not necessary if the patient has elevated levels; however, if the tumor markers are negative, a biopsy is needed to confirm the diagnosis of a germinoma. Germinomas are extremelyradiosensitive, enabling 5-year survival rates that exceed 90%. Treatment has traditionally included focal and craniospinal axis irradiation; however, multiple ongoing studies are being conducted to examinethe efficacy of reduction or elimination of radiation therapy with the addition of chemotherapy. Nongerminomatous germ cell tumors, on the other hand, are relatively radioresistant with a poorer outcome. The combination of chemotherapy and irradiation is associated with overall survival rates of up to 60%. This article provides a review of the controversies in diagnosis and treatment of central nervous system germ cell tumors.

Rina Meyer, MD
Latest Article

Consider Thrombotic Microangiopathy in Pediatric and Hematopoietic Stem Cell Transplant Patients

The article by Dr. George is of great use to the practicing clinician, not only in the hematology-oncology setting but also in general practice or emergency medicine.

Risa Zimmerman, PA-C
Latest Article

Infection in a Leukemia Patient

Ms. C is a 41-year-old Hispanic woman that came to our facility regarding her leukemia. She presented in January 2005 with migratory myalgias, headaches, and gingival bleeding. Complete blood count (CBC) revealed a white blood cell count (WBC) of 18.0/µL with 53% blasts, hemoglobin at 8.1 g/dL, and a platelet count of 12/µL. Bone marrow biopsy confirmed a diagnosis of acute lymphocytic leukemia.

Risto Sankila, MD
Latest Article

Survival Advantage Seen for HNPCC Colorectal Cancer

Hereditary nonpolyposis colorectal cancer (HNPCC) is a dominantly inherited syndrome that is estimated to be responsible for between 0.5% to 5% of all colorectal cancers.[1] The syndrome is caused by germline mutations in any of at least four mismatch repair genes.

Rita M. Kramer, MD
Latest Article

The New Generation of Targeted Therapies for Breast Cancer

The article by Drs. Syed andRowinsky is well written andcomprehensive. They introduceseveral biologic pathways that are importantin breast cancer and focus onnew pharmaceutical agents designedto disrupt these pathways. Patients andphysicians hope that agents that targetthe tyrosine kinase signal transductionpathways, block tumor angiogenesis,modulate apoptosis, and inhibithistone deacetylation will be effective,nontoxic therapies for breastcancer. These molecularly targeted approacheshold promise, but deliveringon this promise requires that we movebeyond histologic characterization ofthe disease and rethink the design ofclinical trials.

Rita Wickham, PhD, RN
Latest Article

Vesicant Extravasation From an Implanted Venous Access Port

The patient, “JB,” is a 68-year-old woman who underwent a right lumpectomy and axillary node dissection for stage II breast cancer. Her oncologist suggested adjuvant chemotherapy (four cycles of cyclophosphamide [Cytoxan] at 600 mg/m2 plus doxorubicin [Adriamycin] at 60 mg/m2) followed by local radiation therapy.

Ritsuko Komaki, MD
Latest Article

Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal Cancer

Local-regional carcinoma of the esophagus is often diagnosed inadvanced stages because the diagnosis is established when symptomsare severe. The prognosis of patients with local-regional carcinoma ofthe esophagus continues to be grim. While preoperative chemoradiotherapyincreases the fraction of patients who achieve pathologiccomplete response, that percentage is approximately 25%. In an attemptto increase the number of patients with either no cancer in the surgicalspecimen or only microscopic cancer, we adopted a three-step strategy.The current study utilized up to two 6-week cycles of induction chemotherapywith irinotecan (CPT-11, Camptosar) and cisplatin as step 1.This was followed by concurrent radiotherapy and chemotherapy withcontinuous infusion fluorouracil (5-FU) and paclitaxel as step 2. Oncethe patients recovered from chemoradiotherapy, a preoperative evaluationwas performed and surgery was attempted. All patients signed aninformed consent prior to their participation on the study. A total of 43patients were enrolled. The baseline endoscopic ultrasonography revealedthat 36 patients had a T3 tumor, five patients had a T2 tumor, andtwo had a T1 tumor. Twenty-seven patients had node-positive cancer(N1). Thirty-nine (91%) of the 43 patients underwent surgery; all hadan R0 (curative) resection. A pathologic complete response was noted in12 of the 39 patients. In addition, 17 patients had only microscopic(< 10%) viable cancer in the specimen. Therefore, a significant pathologicresponse was seen in 29 (74%) of 39 taken to surgery or 29 (67%)of all 43 patients enrolled on the study. With a median follow up beyond25 months, 20 patients remain alive and 12 patients remain free ofcancer. Our preliminary data suggest that the proportion of patientswith significant pathologic response can be increased by using thethree-step strategy.

Rob Macrae, MD, FRCPC
Latest Article

Irinotecan and Radiation in Combined-Modality Therapy for Solid Tumors

Irinotecan (CPT-11, Camptosar) is a camptothecin derivative thatis thought to exert its cytotoxic effects by targeting topoisomerase

Robert A. Chapman, MD
Latest Article

Small-Cell Lung Cancer, Mesothelioma, and Thymoma

This management guide covers the symptoms, screening, diagnosis, and treatment of small-cell lung cancer (SCLC), mesothelioma, and thymoma from a surgical, medical, and radiation oncology approach.

Robert A. Kyle, MD
Latest Article

Unusual Myelomas: A Review of IgD and IgE Variants

Although survival of patients with IgD or IgE multiple myeloma is shorter in comparison to those with IgG or IgA multiple myeloma, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.

Robert A. Nagourney, MD
Latest Article

Gemcitabine Plus Cisplatin in Breast Cancer

In recent years, the clinical application of paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine), and trastuzumab (Herceptin) has improved the management of advanced breast cancer. With the introduction of

Robert A. Smith, PhD
Latest Article

Breast Cancer Screening Benefits More Consistent Than Previously Thought

Major studies looking at breast cancer screening with mammography may have more consistent findings than previously thought.

Robert A. Wolff, MD
Latest Article

The War on Pancreatic Cancer: We Are Not There Yet

After 2 decades of disappointing phase III trials and years of single-agent gemcitabine therapy, the pancreatic cancer community is relieved to expand the front-line armamentarium in patients with mPAC. Here we evaluate the current landscape and ask some provocative questions about response rate, dosing, and predictive markers.

Robert A. Zlotecki, MD, PhD
Latest Article

Infusional Chemoradiation for Operable Rectal Cancer: Post-, Pre-, or Nonoperative Management?

Dr. Rich presents a comprehensive overview of adjuvant therapy for advanced operable rectal cancer. He emphasizes the roles of infusional chemoradiation in both the adjuvant setting and as sole therapy. Unless otherwise specified, the following comments pertain to clinically resectable B2-C (T3, N0-N1) adenocarcinoma of the rectum.

Robert A. Zlotecki, MD, PhDand Jean-Nicolas Vauthey, MD
Latest Article

Squamous Cell Carcinoma of the Anal Margin

Based on our experience and a review of the literature, we conclude that superficial, well- to moderately differentiated T1 cancers of the anal margin may be successfully treated with radiotherapy alone or local

Robert Akbari, MD
Latest Article

Are We Overtreating Some Patients With Rectal Cancer?

The definition of overtreatment of rectal cancer is controversial,and thus it is difficult to accurately quantitate its prevalence. All componentsof rectal cancer treatment are associated with significant potentialfor morbidity and dysfunction that may have a negative impacton the patient’s quality of life. No one would disagree with the tenetthat overtreatment should be avoided whenever possible. Despite thatconsensus, little attention is given in the literature to the issues ofovertreatment of rectal cancer. This review article presents a varietyof clinical scenarios and summarizes available data demonstratingthat overtreatment of some patients with rectal cancer is occurring ona regular basis. It is hoped that this will stimulate clinicians to criticallyreview their own practices to eliminate such overtreatment. Developmentof new clinical trials to determine whether current practiceguidelines are promoting overtreatment of selected rectal cancer patientsis proposed.

Robert Amato, DO
Latest Article

Stereotactic Body Radiotherapy in the Management of Painful Bone Metastases

Bone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.

Robert Asbury, MD
Latest Article

Paclitaxel and Vinorelbine in Non-Small-Cell Lung Cancer

Paclitaxel (Taxol) and vinorelbine (Navelbine) are both microtubule toxins but with opposite mechanisms of action. Paclitaxel promotes the assembly of microtubules, whereas vinorelbine prevents microtuble assembly.

Robert B. Ash, MD
Latest Article

Intraoperative Radiotherapy for Breast Cancer: Its Perceived Simplicity

With many centers seeking to adopt IORT, there are licensing, proctoring, staffing, technical support, and reimbursement issues that need to be considered. We have reviewed the current international experience and describe one community cancer center’s experience with initiating an IORT breast cancer program.

Robert B. Den, MD
Latest Article

The Role of Genomic Techniques in Predicting Response to Radiation Therapy

The understanding of the relationship between genetic variation and an individual patient’s response to radiation therapy has gained significant ground over the past several years. Genetic markers have been identified that could ultimately serve as the foundation for predictive models in clinical practice, and that hold the potential to revolutionize the delivery of precision medicine in oncology.

Robert B. Diasio, MD
Latest Article

Current Status of Oral Chemotherapy for Colorectal Cancer

The treatment of advanced colorectal cancer over the past 4 decades has required the use of intravenous chemotherapy, most typically fluorouracil (5-FU). The possibility of providing

Robert B. Geller, MD
Latest Article

High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient Setting

Intensive outpatient care is rapidly becoming the primary mode of care for selected patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation. Although the traditional inpatient model of care may still be necessary for high-risk patients, published data suggest that outpatient care is safe and feasible during or after administration of high-dose chemotherapy and autologous PBSC transplant. Blood and marrow transplant (BMT) centers have developed programs to provide more outpatient care under three basic models: an early discharge model, a delayed admission model, and a comprehensive, or total, outpatient model. This review will describe these models of care and address the elements necessary for the development of an outpatient BMT program, including patient selection, staff development, and patient and caregiver education. Available supportive care strategies to facilitate outpatient care will also be highlighted.

Robert B. Livingston, MD
Latest Article

Commentary (Livingston): Coming to Grips With Hand-Foot Syndrome

Scheithauer and Blum have madean important contribution to thediscussion of hand-foot syndrome,an increasingly common disorder.They emphasize the occurrenceof hand-foot syndrome in the contextof therapy with capecitabine (Xeloda),a prodrug for fluorouracil (5-FU)that in many ways mimics the continuousinfusion of that compound. Theauthors point out that the only provenmethod for managing hand-foot syndromeis interruption and/or reductionin the dose of the administeredtreatment, and they cite retrospectivedata from completed trials in colorectalcancer to support the hypothesisthat such a policy does not impair treatmentefficacy. We feel that severalpoints deserve further amplification.

Robert B. Marcus, Jr, MD
Latest Article

Pituitary Adenomas: Current Methods of Diagnosis and Treatment

Pituitary adenomas are benign neoplasms that can be effectively managed by a variety of therapeutic options. The clinician's goal in managing patients with these tumors should be to minimize the morbidity of each intervention used in diagnosis and treatment. Standard diagnostic interventions include MRI, hormonal assessment, and tissue diagnosis. Therapies include transsphenoidal surgery, external-beam radiotherapy, newer stereotactic irradiation techniques, and medical management. Appropriate treatment selection requires detailed knowledge of the expected outcomes and side effects of each option. Newer and perhaps less toxic treatment techniques are evolving and require further evaluation. [ONCOLOGY 11(6):791-796, 1997]