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Carcinomatous Meningitis: It Does Not Have to Be a Death SentenceCarcinomatous meningitis, specifically leptomeningeal metastases from solid tumors, has a dismal prognosis, with an overall median survival of 2 to 4 months. Lymphomatous meningitis has a better outlook, with a median survival of more than 6 months, but diagnosis may be delayed and treatment is not curative.
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Building Efficiency and Scaling With a Remote Genetic Counseling ProgramSmita K. Rao, MBBS, MS, et al gave an overview of implementing genetic counseling into oncology practices through telemedicine.
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Long-Term Central Venous AccessThe use of multidrug chemotherapy and bone marrow transplantation in cancer treatment has made the utilization of reliable, long-term venous access (LTVA) an essential component of cancer therapy. The placement of LTVA devices not only permits the delivery of these complex therapeutic regimens but also drastically improves patients’ quality of life.
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Ovarian Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal CancerLocal-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.
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Oral Complications of Cancer TherapyThe mouth is a frequent site of complications arising from drug or radiation cancer therapy, with mucositis, xerostomia, osteoradionecrosis, and local infections being the most common. From the standpoint of dose
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Breast Cancer Screening: The Evolving EvidenceIn this paper, the historic and recent evidence supporting the value of breast cancer screening will be described, along with the underpinnings of the current debate over the relative and absolute benefit of regular mammography screening.
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Current Role of Retroperitoneal Lymph Node Dissection in Testicular CancerThis paper is a very nice review of the history of the development of modern urologic surgical procedures for the treatment of testicular germ-cell tumors and their current indications. I agree with virtually everything the authors say. I will emphasize several points that they make and highlight a few small areas of disagreement.
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Toward a Breast Cancer Vaccine:Work in ProgressAs outlined in the review byDrs. Emens and Jaffee entitled“Toward a Breast CancerVaccine: Work in Progress,” the developmentof anticancer vaccines hasclosely paralleled advances in the fieldof immunology. Basic immunologyhas provided and will continue toprovide important insights intohuman immunity that directly relateto the design and study of immunotherapeutics.To date, the mostimportant scientific observations applicableto immunotherapy include thefollowing:
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A Shifting Paradigm for Patients with Head and Neck Cancer: Transoral Robotic Surgery (TORS)The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. The introduction of transoral robotic surgery (TORS) improves upon current transoral techniques to the oropharynx and supraglottis. This review will report on the evolution of robotic-assisted surgery: We will cover its applications in head and neck surgery by examining early oncologic and functional outcomes, training of surgeons, costs, and future directions.
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Commentary (Kleinberg et al): Primary Combined-Modality Therapy for Esophageal CancerBased on positive results from the Radiation Therapy Oncology Group (RTOG) 85-01 trial, the conventional nonsurgical treatment of esophageal carcinoma is combined-modality therapy. Dose intensification of the RTOG 85-01 regimen, examined in the Intergroup (INT)-0123/RTOG 94-05 trial, did not improve local control or survival. Areas of clinical investigation include the development of combined-modality therapy regimens with newer systemic agents, the use of 18F-fluorodeoxyglucose positron-emission tomography to assist in the development of innovative radiation treatment planning techniques, and the identification of prognostic molecular markers. The addition of surgery following primary combined-modality therapy apparently does not improve survival, but this finding is controversial.
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Integrins and CancerIntegrins play an important physiologic role in cell adhesion, and accumulating evidence suggests that they also regulate cell growth, proliferation, migration, and apoptosis. A number of congenital and acquired disease states have been associated with integrins, and small- molecule integrin inhibitors have been approved for treatment of benign hematologic diseases. In cancer, aberrant expression with normal functioning rather than dominant genetic variations of genes coding for integrins has generally been observed. This aberrant expression is mediated through "bidirectional" receptor signaling and interaction with corresponding signals from growth factor signaling pathways, leading to inhibition of apoptosis, induction of cell proliferation, extracellular matrix remodeling, migration, and angiogenesis. From a clinical perspective, a growing number of molecules targeting integrins have been developed for treatment and imaging purposes; clinical studies in melanoma, prostate cancer, and other malignancies are underway. This review summarizes the biology of integrins, the signal transduction pathways they regulate, and their role in different stages of carcinogenesis. Furthermore, it provides a synopsis on the clinical advancements in integrin targeting for therapeutic and imaging purposes in cancer.
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingOutpatient bone marrow transplant (BMT) strategies, as reviewed by Dix and Geller, have evolved for various reasons—from social to medical. If high-dose approaches are to become a viable treatment for common cancers, such as breast cancer, the refinement of transplants to a “kinder and gentler” approach is essential.
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Commentary (Parker)-Stereotactic Breast Biopsy: Indications and ResultsA decade has passed since the first stereotactic-guided histologic breast biopsy was performed. Initially, the large-scale implementation of this technique met with a great deal of resistance from most surgeons, and more surprisingly, from many breast radiologists in academia.
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ASCO: Controversies in Phase I Clinical TrialsSteve Joffe, MD discusses the ethical challenges and controversies in phase I clinical cancer trials.
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Lymphoma science meets patient careAs a young candy striper at a Los Angeles hospital, lymphoma researcher Alexandra M. Levine, MD, MACP, experienced a portentous moment, although she didn’t necessarily realize it at the time. An older patient, feeling alone and lonely, waved the teenager to his bedside for a chat and she obliged. “He thanked me profusely for having helped him,” she said. “I didn’t understand what I had done, but it was one of those moments that was huge.”
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Management of Asymptomatic Rising PSA After Prostatectomy or Radiation TherapyControversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.
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Surgical Management of Pancreatic CancerPancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection.
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Cognitive Function After Systemic Therapy for Breast CancerAnecdotal reports of cognitive compromise among patients treated with chemotherapy are relatively common among breast cancer survivors and may play an important role in adversely affecting functioning in multiple domains. As noted by Dr. Olin,
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Hepatic Colorectal Metastasis: Current Status of Surgical TherapyMetastatic colorectal cancer to the liver develops in over 50,000 US patients each year and is rapidly fatal if untreated. Even the most active chemotherapeutic agents rarely prolong survival for more than 3 years. Liver
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Use of Hematopoietic Hormones for Bone Marrow Defects in AIDSAnemia is a common complication of HIV infection. Erythropoietin (Procrit, Epogen) can correct anemia. When given to patients with HIV infection, erythropoietin ameliorates anemia and improves quality of life. Given these three facts, one wonders why an effective drug such as erythropoietin is not used appropriately in patients with HIV infections.
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Management of Metastatic Cutaneous MelanomaAlthough chemotherapy regimenscan produce objectiveresponses in patients withmetastatic melanoma, curative responsesare extremely rare. It is thereforeof significant interest that themajority of complete responses to immunotherapywith high-dose interleukin(IL)-2 (Proleukin) alone aredurable and probably curative.[1]
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Adjuvant Chemotherapy for Colon Cancer in the Elderly: Moving From Evidence to PracticeStates population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.
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A Pharmacoeconomic Comparison of UFT and 5-FU Chemotherapy for Colorectal Cancer in South AmericaThe escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact
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Paclitaxel and UFT Plus Oral Calcium Folinate in Pretreated Metastatic Breast CancerThis phase I study was designed to determine the maximum tolerated dose (MTD) and dose-limiting side effects of combination treatment with paclitaxel (Taxol) and UFT (uracil and tegafur in a 4:1 molar ratio) plus oral
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Malignant Angiomyolipoma: a Rare Entity With Unusual BiologyThe authors present an interesting case of a very rare renal neoplasm, malignant epithelioid angiomyolipoma (AML), which belongs to a family of mesenchymal tumors known as perivascular epithelioid tumors (PEComas).
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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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Myelodysplastic Syndromes: Where Do We Go From Here?The review by Dr. Akhtari outlines the diagnosis, prognosis, and treatment options for patients with myelodysplastic syndromes (MDS), and touches on the current challenges in treating patients suffering from MDS.
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Adjuvant/Neoadjuvant Chemoradiation for Gastric and Pancreatic CancerBoth gastric and pancreatic cancer remain leading causes of cancer death in the United States and worldwide. While surgical resection continues to be required for long-term cure of both these neoplasms, 5-year survival
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Substance Abuse Issues in Cancer Patients:The relationship between the therapeutic use of potentially abusable drugs for symptom control and the multifaceted nature of abuse and addiction is extremely complex. Research is only beginning to elucidate the
