ONCOLOGY Vol 24 No 8

This article defines the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and makes recommendations with regard to radiotherapy volume and dose.

Hammerich et al. report a case of synchronous bilateral germ cell tumors (GCT) of different histologies occurring in a patient with a history of cryptorchidism. There are several interesting aspects of this case and the authors’ management and discussion that warrant commentary.

Osteoporosis in elderly cancer patients is an increasing problem, yet it remains under-recognized and under-managed. We commend Dr. Balducci for writing a comprehensive review of the bone complications associated with cancer and its treatment in the elderly.

Dr. Balducci has presented a timely and useful overview of bone health in elderly patients undergoing cancer treatment. This topic has important implications, not only within geriatric oncology but also throughout the entire age spectrum. Dr. Balducci’s focus on the elderly population is especially relevant, as this group is at particularly high risk for bone complications over the course of cancer therapy. In his review, Dr. Balducci provides an introduction to the physiology of bone reabsorption and formation, and discusses risk factors for the interruptions in usual physiologic homestasis that lead to osteoporosis.

Advances in our understanding of the underlying molecular mechanisms in the development of breast cancer have been at the forefront of recent clinical research. Many of the ASCO 2010’s hottest sessions featured clinical trials that looked at combination therapies with targeted agents as well as clinical improvements in standard-of-care in breast cancer.

As outlined in the excellent, comprehensive review by Drs. Liu and Matulonis, ovarian cancer is the most lethal gynecologic malignancy in the United States, with approximately 16,000 deaths and 22,000 new cases yearly.[1] The vast majority of patients present with intra-abdominal spread of disease at the time of diagnosis, resulting in low overall cure rates. As outlined, patients are primarily managed with primary surgical resection and subsequent platinum-based chemotherapy.

Epithelial ovarian cancer is the leading cause of death from gynecologic malignancy in the United States, with approximately 15,000 deaths per year. Platinum/taxane doublets have long been considered the standard treatment regimen for advanced-stage disease; however, recent studies have sought to improve on the outcome from this therapy. Intraperitoneal (IP) chemotherapy has been shown to yield superior progression-free survival (PFS) and overall survival (OS); however, logistical problems and toxicities have limited more widespread adoption. Recent studies have also suggested that a “dose-dense” schedule of paclitaxel in combination with carboplatin may result in improved outcomes, and the impact of biological therapies in the first-line setting is under active investigation. In the setting of recurrent disease, preliminary results suggest that novel doublet regimens such as carboplatin and pegylated liposomal doxorubicin may have similar activity to standard platinum/taxane doublets while carrying a reduced risk of allergic reactions. Additionally, targeted therapy remains an active area of investigation, with evidence of activity from agents such as PARP inhibitors, anti-angiogenics, and PI3 kinase inhibitors. Here, we review recent advances in our understanding of ovarian cancer and its treatment in both the newly diagnosed and recurrent settings.

A 36-year-old male with a history of cryptorchidism of the right side, treated with orchidopexy at the age of 4, presented with bilateral testicular swelling. Investigations included laboratory workup, ultrasound of both testes, as well as CT-scan of the chest, abdomen, and pelvis. Initial treatment was bilateral orchiectomy.

Osteopenia and osteoporosis are increasingly common in cancer patients, owing to the aging of the population and to new forms of cancer treatment. Androgen and estrogen deprivation, as well as some forms of cytotoxic chemotherapy, may lead to osteopenia and osteoporosis. Patients at risk for osteoporosis include those treated with aromatase inhibitors and with androgen deprivation for more than 1 year. In addition, all patients 65 years of age and older are at risk of osteoporosis when treated with cytotoxic agents, and so should be screened for bone loss. Several treatments have been effective in the prevention and management of osteoporosis. In patients at risk for this complication, it is recommended to obtain a bone density evaluation and to start appropriate treatment. This may include calcium and vitamin D supplementation for mild forms of osteopenia, and bisphosphonate therapy or denosumab (Prolia) for more advanced osteopenia and osteoporosis.

Saw palmetto, a small, slow-growing palm, is prevalent in the southeastern United States. Its berries are a rich source of fatty acids and phytosterols, and were used by Native Americans as food and also as medicine to treat urinary tract problems.

After years of maintaining the status quo in ovarian cancer treatment, a number of recent advances have challenged the paradigm based on intravenous (IV) taxane and platinum as the therapy of choice for advanced ovarian cancer. These new data are summarized concisely by Liu and Matulonis in this issue.

Despite the common use of postoperative radiotherapy (RT) in patients managed initially with radical prostatectomy (RP), a number of questions remain. Raldow and colleagues build their arguments around three randomized trials that indicated a significant benefit of immediate adjuvant radiotherapy in patients with high-risk features.

In their article, Raldow et al provide an excellent summary of the issues surrounding the use of salvage radiotherapy for a post-prostatectomy recurrence. For practicing clinicians, the pressing issue is how to appropriately select patients for treatment with salvage radiotherapy.