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Clinical Status of Laparoscopic Bowel Surgery for GI MalignancyLaparoscopic colorectal surgery is being utilized increasingly for benign diseases. Recent published series have proven that morbidity and mortality from laparoscopic procedures are superior to those seen after traditional open
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Current Status of Retinoid Chemoprevention of Lung CancerClinical trials have suggested that retinoid chemoprevention prevents the development of second primary tumors following head and neck or non-small-cell lung cancer. The findings of these initial studies are now being
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Head and neck tumorsIn 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).
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Improving the Toxicity of Irinotecan/5-FU/ Leucovorin: A 21-Day ScheduleIrinotecan (CPT-11, Camptosar) is one of the new generation ofchemotherapeutic agents that has activity in advanced colorectal cancer.It has antitumor efficacy as a single agent, and also has beencombined with fluorouracil (5-FU) and leucovorin (IFL) to treat thesepatients. Randomized studies have confirmed the superiority of IFL to5-FU and leucovorin alone with regard to patient survival, time toprogression, and tumor response rate. The optimal schedule for combiningthese agents remains uncertain, but in the United States, theschedule of IFL weekly for 4 consecutive weeks repeated every 6 weeks,according to the schedule reported by Saltz et al, has been widely used,although with some toxicity (especially myelosuppression and diarrhea).In an attempt to improve the tolerability of IFL, some haveadvocated modifying the schedule of IFL to weekly for 2 weeks, withrepeated cycles every 21 days. Twenty-three patients with advancedcolorectal cancer have been treated on this schedule at a single institution.Therapy was well tolerated, with 35% of patients experiencinggrade 3/4 neutropenia, two of whom had episodes of febrile neutropenia,and 9% with grade 3/4 diarrhea. The median relative dose intensityof irinotecan administered in the first 18 patients treated with thisregimen was 94%. These data support the hypothesis that modifying theschedule of administration of IFL improves the tolerability and abilityto deliver the regimen, but must be confirmed by randomized prospectivestudies, which may also attempt to evaluate the role of bolus 5-FUin the treatment of advanced colorectal cancer.
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Should IMRT Be the New Standard in Esophageal Cancer?This video discusses the use of intensity-modulated radiation therapy and whether it should be the new standard for treating patients with esophageal cancer.
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Current Treatment of Peripheral T-cell LymphomaThis review article written by Robert Stuver, MD, et al, reviews current and available treatments for peripheral T-cell lymphoma.
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Liver Transplantation for the Treatment of Hepatocellular CarcinomaIn the majority of cases, hepatocellular carcinoma develops in the setting of cirrhosis. Treatment with curative intent is possible in only 20% to 25% of cases and consists of resection or liver transplantation.
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EXAM: Cabozantinib Doubled Survival in Medullary Thyroid Carcinoma With RET M918T MutationIn this video, Steven I. Sherman, MD, discusses the final overall survival analysis of the EXAM study, a randomized, placebo-controlled phase III trial of cabozantinib in medullary thyroid carcinoma patients.
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The Role of PET-CT Fusion in Head and Neck CancerPositron-emission tomography(PET) and computed tomography(CT) fusion imaging is arapidly evolving technique that is usefulin the staging of non–small-celllung cancer (NSCLC), Hodgkin’s disease,ovarian cancer, gastrointestinalstromal tumors, gynecologic malignancies,colorectal malignancies,and breast cancer. In their article,Rusthoven et al[1] describe the roleof PET-CT in head and neck malignanciesand include a review of allcurrently available literature. Accordingto the authors, PET-CT is usefulfor staging head and neck carcinomasand for target volume delineation duringradiation treatment planning.
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Prostate-Specific Antigen: What’s New in 1997In this article, the authors have done an excellent job in reviewing recent findings regarding prostate-specific antigen (PSA) and other methods for the early detection of prostate cancer. This is a fast-moving field, with new results being reported on a weekly basis. Indeed, it is an exciting time to be conducting research in prostate cancer. At the same time, however, it is far too easy to lose sight of some of the basic principles by which we should judge evidence to make research or clinical decisions. Specifically, there are hard-learned epidemiologic lessons about which we need to constantly remind ourselves.
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Update on Adjuvant Interferon Therapy for High-Risk MelanomaDespite more than 2 decades of active clinical study, the use of interferon as adjuvant therapy for high-risk melanoma remains controversial. The controversy has centered on dose, schedule, and toxicity of treatment. Agarwala and Kirkwood superbly summarize the clinical studies to date and highlight many of the salient issues relevant to clinicians.
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Intravesical Therapy for Superficial Bladder CancerThe intravesical instillation of therapeutic agents for the treatment of localized bladder cancer began in 1903 when Herring[1] summarized his experience with silver nitrate. Since then, intravesical chemotherapy and immunotherapy have emerged as
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Advancing Research, Novel Technologies to Deliver Exceptional Cancer CareThe Jack & Sheryl Morris Cancer Center offers “state-of-the-art” surgical suites and advanced radiation technology, says Andrew M. Evens, DO, MBA, MSc.
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An Oncology Perspective on the Supreme Court’s Pending Decision Regarding the Affordable Care ActBeginning on March 26, 2012, the Supreme Court of the United States heard oral arguments regarding challenges to the recent federal health care reform legislation.
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New task force guideline returns PSA screening to center stageWhen the U.S. Preventive Services Task Force reported that routine prostate cancer screening for older men appears to result in little benefit, the announcement raised more than a few eyebrows in the urologic medical community.
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Clinical Uses of RadiosurgeryRadiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). This article reviews the most common
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Endoscopic Diagnosis and Management of Gastrointestinal MalignancyThe endoscopic diagnosis, staging, and therapy of gastrointestinal (GI) malignancies has advanced rapidly and dramatically over the past 15 years. Video-endoscopy has generally replaced fiberoptic endoscopy, and the digitally based fidelity, sharper resolution, and improved magnification of the video-endoscopic image offers a potentially better approach for the evaluation of mucosal abnormalities.
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Romiplostim for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn August 22, 2008, the US Food and Drug Administration (FDA) granted marketing approval (licensure) to romiplostim (Nplate, Amgen Inc) for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
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High-Dose Therapy and Transplantation of Haematopoietic Stem CellsThe field of hematopoietic stem cell transplantation is evolving rapidly. Observations made in the laboratory can now be swiftly translated into clinical trials. The role of hematopoietic stem cell transplantation in older patients, the appropriate use of
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Anthracycline Cardiotoxicity: Why Are We Still Interested?Anthracycline cardiotoxicity has been of clinical concern for more than 3 decades. Many hundreds of papers have been written about this unusual form of toxic cardiomyopathy, and yet, we are still putting pieces of the puzzle together. Our cumulative knowledge helps us to predict the risk of cardiac damage with fair accuracy for most patients, but others demonstrate an unpredictable sensitivity to anthracyclines and suffer devastating consequences. Strategies to prevent anthracycline cardiotoxicity have been developed but are underutilized.
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New Developments in the Management of Chemotherapy-Induced Emesis: Do They Impact on Existing Guidelines?Guidelines for the management of chemotherapy-induced emesisare necessary to help clinicians match the emetogenicity of antineoplasticagents with the abundance of antiemetic agents now available. Numerousguidelines for antiemetic therapy currently exist, but compliancewith them is inconsistent, in part because optimal antiemetic protectionis not yet possible, even with the best guidelines. For this reason,guidelines must be dynamic and evolve as knowledge increases.Revision of antiemetic guidelines should be prompted by changes ingeneral principles of treatment, not changes in specific details. Recentrecognition of the unique benefits of incorporating selective neurokinin-1 receptor antagonists into regimens for the prevention of nauseaand vomiting caused by highly emetogenic chemotherapy, particularlyin delayed emesis, justifies modification of existing antiemeticguidelines.
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Commentary (Keller): Surgical Staging of Lung CancerAs Matin and Goldberg note, the accurate staging of non-small-cell lung cancer (NSCLC) is necessary to provide patients with correct information regarding prognosis and appropriate treatment recommendations. Therefore, physicians who treat
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Radioiodine-Resistant Differentiated Thyroid Cancer: Hope for the FutureIn this helpful review, the authors catalog a number of the novel molecular agents now being examined for treatment of radioiodine-resistant, metastatic differentiated thyroid cancer. They also call for increased systematic study of outcomes through recruitment of patients into large-scale trials.
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Oncocytic Neoplasm on Renal Mass Biopsy: A Diagnostic ConundrumA 56-year-old man presented with a 4.5-cm leftsided renal mass incidentally discovered on an ultrasound performed for workup of lupus nephritis. On dedicated contrast-enhanced magnetic resonance imaging (MRI), the tumor was found to be avidly enhancing.
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The Real CER: Lost in Translation“Comparative effectiveness research, ” or CER, has become a loaded term in our ongoing wrangling over healthcare policy. Often, however, what even knowledgeable people understand by CER is significantly at odds with what actual policy makers have in mind.
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Colon, Rectal, and Anal CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of colorectal and anal cancers.
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Economic and Quality of Life Outcomes: The Four-Step Pharmacoeconomic Research ModelIncreasingly, economic data are being considered in formulary decisions. In oncology, pharmacoeconomic evaluations are essential to help decision makers weigh the associated costs and outcomes of competing
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Commentary (Deitcher): Thromboembolic Complications of MalignancyThe two-part article, "ThromboembolicComplications ofMalignancy," by Drs. Linenbergerand Wittkowsky, provides a contemporaryand clear review of thepathogenesis, prevention, and treatmentof cancer-associated hypercoagulabilityand venous thrombosis. Questionsabout the cancer and coagulation connectioncontinue to abound and greatlyoutnumber evidence-based answers. Asthe relationship between cancer and coagulationgains attention from the medicaland surgical oncology communities(ie, not only from the coagulation community),the gap between questions andanswers will likely close.
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Applications of QOL Measurements: A Managed Care PerspectiveThe current application of QOL measurements and outcomes in managed care organizations is minimal, but potential applications are significant, since a fundamental goal of managed care is to optimize member/patient
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Esophagogastric Junction and Gastric Adenocarcinoma: Neoadjuvant and Adjuvant Therapy, and Future DirectionsThe purpose of this review is to update, present some of the new data on, and outline the controversies regarding neoadjuvant and adjuvant therapy of esophagogastric junction and gastric adenocarcinoma.
