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ONCOLOGY Vol 16 No 10

The emerging era of targeted cancer therapies has focused laboratory scientists and clinicians on the need to define and understand molecular targets of novel drugs. For breast cancer patients and doctors, this trend is not news-efforts have been under way for decades to identify the estrogen and progesterone receptors and define the value of these markers as predictors of response to hormonal therapy.

Drs. Quon and Harrison have written an excellent review on the role of brachytherapy in the management of head and neck cancer. Brachytherapy is a time-honored technique, and the authors have carefully reviewed the pertinent literature extolling its virtues. However, there are many papers that fail to document efficacy of brachytherapy over conventional techniques, demonstrating that, similar to surgery, the technique is both patient- and operator-dependent.

Malignant small bowel tumors are extremely rare, accounting for 0.1% to 0.3% of all malignancies. Fewer than 2,400 new cases of small bowel malignancy are reported in the United States each year.[1] Malignant tumors, which account for about two-thirds of all primary small bowel tumors, consist of four primary subtypes: adenocarcinoma, carcinoid tumor, lymphoma, and sarcoma (or gastrointestinal [GI] stromal tumor). Each malignancy is characterized by unique predisposing factors, anatomy, and biology. The prevalence, pattern, and relevance of both regional lymph node and distant metastases differ. As a result, the study of malignant small bowel tumors, taken as an aggregate, is fraught with difficulty.

Dr. Kummar and her coauthors have tackled the difficult task of reviewing small bowel adenocarcinoma so that we might have a better understanding of this uncommonly encountered malignancy. The task is unusually difficult, not because of the need to critically review reams of publications on the topic, but rather because so little literature exists on the topic of optimal management. Nonetheless, the authors have succeeded in educating the reader on several important issues, including the need for close follow-up of patients with small bowel adenocarcinoma, who are not only at risk for recurrence but also have a relatively high risk of other gastrointestinal tumors. Additionally, the authors identify factors associated with poor prognosis, including age > 75 years, lack of surgical resection, advanced disease stage, and tumor arising in the duodenum.