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We have reviewed with interestthe article by Drs. Huand Persky and would liketo congratulate them on an excellentand comprehensive overview of theevaluation and management ofparagangliomas of the head and neck.Their review begins with an excellentlydetailed description of thedisease and staging work-up. Withmodern imaging, most paragangliomasare convincingly diagnosed basedon typical location (carotid bifurcation,nodose ganglia of the vagusnerve, middle ear along tympanic plexus,or near jugular bulb) and characteristicradiographic appearance(hypervascular, intensely enhancingmass). A tissue diagnosis is usuallyunnecessary for such lesions.

Paragangliomas most commonly occur in the carotid body, jugulotympanicarea, and vagus nerve but have also been reported in otherareas of the head and neck. These tumors are highly vascular andcharacteristically have early blood vessel and neural involvement,making their treatment particularly challenging. Surgery has traditionallybeen the preferred method of treatment, especially in light of recentadvances in technique. However, compared to radiation therapy, it canresult in a higher incidence of cranial nerve dysfunction. Radiationtherapy has the advantage of avoiding the increased morbidity ofsurgery while offering an equal possibility of cure. Part 1 of this two-partarticle focuses on techniques for diagnosing paraganglioma and theindications for and use of surgery as primary treatment. The complicationscommonly associated with surgery are reviewed, and strategies forrehabilitation of affected patients are presented.

NEW YORK-A low-dose cyclophosphamide/prednisone regimen is effective for treating children with refractory lymphoproliferative disease after a solid organ transplant, according to results of a prospective study including 36 children. The total response rate was 86% for this group, which is the largest series of post-transplant lymphoproliferative disorder (PTLD) patients treated uniformly with chemotherapy. Two-year overall survival was 73%.

CHICAGO-Zoledronic acid (Zometa) significantly decreased skeletal complications and bone pain in men with hormone-refractory prostate cancer and bone metastases, compared with placebo, according to an update of a phase III study presented at the 2003 Annual Meeting of the American Urological Association (abstracts 1472 and 1473).

LOS ANGELES-Efforts to boost cancer screening and education among Asian Americans and Pacific Islanders are growing. Much of the activity is on the West Coast, the heart of Asian-American life in the United States and the main entry point for new immigrants from Asia and the Pacific Islands.

HONOLULU-Salvage therapy with cisplatin (Platinol), etoposide (VP-16), and vincristine (CVV) for recurrent malignant gliomas has moderate activity that may lead to long-term stabilization in heavily pretreated patients, according to H. Lee Moffitt investigators who presented their findings at the 55th Annual Meeting of the American Academy of Neurology (abstract P01.001).

The most common malignant tumorsfrequently metastasize tothe skeleton. Although bonemetastases occur frequently with nearlyall tumors, some cancers (eg, breastand prostate cancer) have a specialpredilection for the skeleton. Complicationsassociated with skeletal metastasessubstantially erode thepatient’s quality of life. These skeletal-related events (SREs) include spinalcord compression, fracture,surgery, radiation therapy, and hypercalcemia.On average, patients withbone metastases experience three tofour SREs per year (one every 3 to 4months). In addition, they frequentlyhave pain and require narcotics, whicherode their quality of life.

Bone is the most frequent andimportant site of metastaticcancer and is responsible foran enormous clinical burden and demandon health-care resources. Blumand colleagues comprehensively reviewthe management of bone metastases,argue for a more integratedcare pathway, and underscore the importanceof bone-specific treatmentsin reducing skeletal complications tomaintain quality of life and physicalfunctioning.

With recent advances in the management of cancer, the clinicalcourse of patients with metastatic bone disease is more likely to beprolonged and accompanied by morbidity, including severe pain, hypercalcemia,pathologic fracture, and spinal cord and/or nerve root compression.The early identification of patients at higher risk for developingbone metastases enables practitioners to be proactive in their diagnosisand treatment. A multidisciplinary approach that integrates the diagnosisand treatment of the cancer, symptom management, and rehabilitationensures optimal care. Bisphosphonates can reduce the number ofskeletal-related complications, delay the onset of progressive disease inbone, and relieve metastatic bone pain caused by a variety of solidtumors with a resulting enhanced quality of life. The complexity of theclinical problem and the need to involve an array of health-careproviders present a logistical and clinical challenge. A strong argumentis made for a thematically integrated bone metastases program as partof the primary care of patients with cancer.

CHICAGO-After breast-conserving surgery, patients who receive intensity-modulated radiation therapy (IMRT) shaped to the outline of the targeted tumor bed, as determined by three-dimensional (3D) CT imaging, achieve good results with a reduced radiation dose, according to a clinical study reported at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America (abstract 335). The technique is known as forward planning IMRT (see images).

CHICAGO-A low daily dose of venlafaxine (Effexor)-an antidepressant agent that affects reuptake of serotonin and norepinephrine-resulted in a 60% reduction in the "median hot flash score," a measure of the severity and frequency of hot flashes. The therapeutic dose range for treatment of depression is 75 to 225 mg/d; the 60% reduction in the hot flash score was achieved with only 75 mg/d. Charles Loprinzi, MD, director of medical oncology, Mayo Clinic, Rochester, Minnesota, reported the results at the Lynn Sage Breast Cancer Symposium.

SAN ANTONIO-A retrospective analysis of data from the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-24 suggests that estrogen-receptor (ER) expression predicts response to tamoxifen (Nol-vadex) among patients with ductal carcinoma in situ (DCIS).

NEW ORLEANS-In patients undergoing laparoscopic procedures for gynecologic lesions, complications and conversion to laparotomy can be predicted based on several risk factors, according to the 10-year experience of Memorial Sloan-Kettering Cancer Center investigators, presented at the 34th Annual Meeting of the Society of Gynecologic Oncologists (SGO abstract 74).

HOLLYWOOD, Florida-The National Comprehensive Cancer Network (NCCN) has added an oxaliplatin (Eloxatin)-containing regimen for the treatment of advanced colorectal cancer to its updated 2003 guidelines for colorectal cancer treatment, as well as new recommendations for the use of radiation therapy (see box).

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.City Hall in Philadelphia, Pennsylvania

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

In this issue of ONCOLOGY,Chaudhary and Hull succinctlysummarize historical trends andcurrent thinking regarding the role ofcytoreductive nephrectomy in patientswith metastatic kidney cancer.Before the era of immunotherapy,there was little evidence that the naturalhistory of metastatic renal cellcarcinoma was improved by cytoreductivenephrectomy.[1] Patientswith metastatic cancer generally diefrom complications related to theirsites of tumor spread and not fromthe primary tumor; thus, on face value,it seems illogical to surgicallyremove the primary tumor in thesepatients.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.

This special supplement to Oncology NewsInternational includes updated results ofstudies with anti-CD20 therapy and othertargeted therapies in the treatment oflymphomas, chronic lymphocytic leukemia,and immune thrombocytopenic purpura. Theresults were presented at the American Societyof Hematology 44th Annual Meeting inPhiladelphia, December 6 to 10, 2002.City Hall in Philadelphia, Pennsylvania

CHICAGO-According to early experience at one imaging center in Massachusetts, whole-body screening CT is attracting individuals who may benefit from early detection of disease, such as current or former smokers and persons with other risk factors for cancer and heart disease. These researchers found that whole-body screening CT is not, as some have feared, leading to additional unnecessary invasive and expensive testing. However, a California study found that nearly half of persons with an abnormality found on screening required follow-up testing.

Two cancer-related issues-evidence-based cancer screening andpain control in advanced cancer-are among 20 priority areasthat an Institute of Medicine (IOM) committee has urged publicand private organizations to focus on as a way of transforming healthcare in the United States. Goals regarding screening, especially forcolorectal and cervical cancer, the report said, are "to increase thenumber of people who receive screenings and to provide timely followup."Regarding pain control in patients with advanced cancer, thecommittee urged efforts to "emphasize cooperation in protocols acrosscare settings, advance planning for changes in settings, as well asheightened pain, and public education regarding the merits of opioidmedications in this area."

Confronted with essentially stagnant budgets in coming years, theNational Cancer Institute (NCI) is initiating an unprecedentedeffort to solicit the views of the cancer community about settingits future research priorities. NCI wants greater input from its own staff andadvisory groups, cancer researchers and clinicians, advocates, and othergroups that fund cancer research as it decides where to focus its futureefforts, according to a briefing document provided to the National CancerAdvisory Board (NCAB) subcommittee on budget and planning.