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This special “annual highlights” supplement to Oncology News International (ONI)is a compilation of selected news on important advances in the management ofgastrointestinal cancers over the past year, as reported in ONI. Guest Editor, Dr.James L. Abbruzzese, comments on the reports included herein and discussesdevelopments in the clinical management of GI cancers, with a look at the impactof targeted agents with cytotoxic chemotherapy, first-line and adjuvant therapies foradvanced disease, and the role of statins and COX-2 inhibitors in prevention.

This special “annual highlights” supplement to Oncology News International (ONI)is a compilation of selected news on important advances in the management ofgastrointestinal cancers over the past year, as reported in ONI. Guest Editor, Dr.James L. Abbruzzese, comments on the reports included herein and discussesdevelopments in the clinical management of GI cancers, with a look at the impactof targeted agents with cytotoxic chemotherapy, first-line and adjuvant therapies foradvanced disease, and the role of statins and COX-2 inhibitors in prevention.

This special supplement to Oncology News International comprises expertcommentary and selected reports from the 2004 meetings of RSNA andASTRO about new imaging techniques, with a focus on state-of-the-art magneticresonance imaging, positron emission tomography, computed tomography,and complementary modalities for improving the diagnosis, staging, andtreatment of a variety of cancers. Evident in these reports is the increasingcollaboration between the specialties of radiation oncology and diagnosticradiology as imaging technology continues to evolve.

Although patients with lung cancer have benefited from advancesin diagnostic techniques, surgery, chemotherapy, and radiation, infectionfrequently complicates the course of cancer treatment. Infectionmay be caused by the tumor itself, by antineoplastic therapy, or by supportivecare measures. Recognition of risk factors for infection is critical.The relationship between an underlying immune defect and certaininfections is well documented. Diagnosis may be complicated bythe paucity of signs and symptoms or by an atypical presentation. Promptinstitution of empiric antimicrobial therapy is usually warranted, particularlyin life-threatening infections. This review will focus on theepidemiology, diagnosis, and management of particular infections thatcan occur in patients with lung cancer.

Lung cancer is the most commoncause of cancer-relatedmortality in the United Statesand worldwide.[1] In the UnitedStates, lung cancer was responsiblefor an estimated 160,440 deaths in2004. This surpassed the combinedmortality resulting from colorectal,breast, and prostate cancer.

This special supplement to Oncology News International comprises expertcommentary and selected reports from the 2004 meetings of RSNA andASTRO about new imaging techniques, with a focus on state-of-the-art magneticresonance imaging, positron emission tomography, computed tomography,and complementary modalities for improving the diagnosis, staging, andtreatment of a variety of cancers. Evident in these reports is the increasingcollaboration between the specialties of radiation oncology and diagnosticradiology as imaging technology continues to evolve.

This special supplement to Oncology News International comprises expertcommentary and selected reports from the 2004 meetings of RSNA andASTRO about new imaging techniques, with a focus on state-of-the-art magneticresonance imaging, positron emission tomography, computed tomography,and complementary modalities for improving the diagnosis, staging, andtreatment of a variety of cancers. Evident in these reports is the increasingcollaboration between the specialties of radiation oncology and diagnosticradiology as imaging technology continues to evolve.

This special supplement to Oncology News International comprises expertcommentary and selected reports from the 2004 meetings of RSNA andASTRO about new imaging techniques, with a focus on state-of-the-art magneticresonance imaging, positron emission tomography, computed tomography,and complementary modalities for improving the diagnosis, staging, andtreatment of a variety of cancers. Evident in these reports is the increasingcollaboration between the specialties of radiation oncology and diagnosticradiology as imaging technology continues to evolve.

Contrast-enhanced breast magnetic resonance imaging (MRI) is arelatively new but increasingly used modality for the detection of breastcancer. MRI has demonstrated utility in identifying additional tumorfoci and extent of disease in patients with known breast cancer. This isespecially useful with invasive lobular carcinoma, which is difficult toevaluate on mammography. MRI has been found to identify the primarytumor in 70% to 86% of cases of occult breast cancer. Contrastenhancedbreast MRI has shown some usefulness in the detection ofresidual cancer following surgery but is limited by postoperative changes.In patients who have undergone neoadjuvant chemotherapy, breast MRIis most accurate in those patients in whom there is little or no responseto chemotherapy. The use of contrast-enhanced breast MRI for breastcancer screening is controversial. It has only been used in a few smallstudies of high-risk patients. The limitations of breast MRI includeuptake in benign lesions and normal tissue, sensitivity for ductal carcinomain situ, cost, and availability. This paper will discuss the uses,benefits, and limitations of contrast-enhanced breast MRI in the stagingand screening of breast cancer.

The stated aim of Seo’s article isto focus on the diagnosis andmanagement of infections thatcan occur in patients with lung cancer.Most of the studies of infections in cancer patients over the past 4 decadeshave dealt predominantly withopportunistic infections in immunocompromisedindividuals who havelymphoproliferative malignancies.Less attention has been given to infectionsassociated with solid tumors,so a comprehensive review of theproblem in patients with lung canceris greatly needed.

The article by Dr. Seo providesa comprehensive review of theepidemiology, presentation, andtreatment of infection in lung cancerpatients. Infection is a significant causeof morbidity and mortality in cancerpatients, as a consequence of immunologicabnormalities that result from thecancer itself as well as from cytotoxiccancer therapies. Granulocytopenia andlymphocyte dysfunction commonlyoccur following intensive therapy formany solid tumors such as lung cancer,and these cellular deficiencies particularlypredispose patients to certain infections.Respiratory infections arecommon during the course of lung cancer,often as a result of direct effects onthe lung including radiation therapy andtumor burden causing obstruction, especiallywith bronchogenic carcinomasor carcinoid tumors. Postsurgical infections,following biopsy or thoracotomyfor resection, are also common.Infectious complications are problematicfor both patient and oncologistsbecause they may delay treatment andimpair quality of life.

ROCKVILLE, Maryland-The Food and Drug Administration (FDA) has approved Amgen’s Kepivance (pal-ifermin) for use in decreasing the incidence and duration of severe oral mucositis in hematologic cancer patients undergoing high-dose chemotherapy, with or without radiation, followed by bone marrow transplantation. The drug’s labeling recommends its intravenous administration for 6 days, 3 days before and 3 days after myelotoxic therapy.

As discussed in chapter 6, there are two major subdivisions of lung cancer:small-cell lung cancer (SCLC), for which chemotherapy is the primary treatment,and non-small-cell lung cancer (NSCLC). SCLC is decreasing in frequencyin the United States, with recent data showing it represents only 14%of lung cancers. This chapter provides information on the staging and prognosis,pathology and pathophysiology, treatment, and follow-up of longtermsurvivors of SCLC and concludes with brief discussions on mesotheliomaand thymoma.

Pancreatic cancer is the fifth leading cause of cancer death in the United States.In the year 2005, an estimated 32,180 new cases will be diagnosed, and 31,800deaths will be ascribed to this cancer.

The use of hormonal therapy with external-beam radiation (EBRT)to treat prostate cancer is a topic that has been well explored. The potentialuse of hormonal therapy and brachytherapy in the treatment ofprostate cancer, however, continues to be controversial. This review isbased on our current interpretation of the available literature assessingthe outcomes of patients treated with EBRT and brachytherapy withor without hormonal therapy. Extrapolating from the findings of theRadiation Therapy Oncology Group (RTOG) 9413 trial, there appearsto be a favorable interaction between hormonal therapy and irradiationin the lymph nodes. The benefits demonstrated with whole-pelvicEBRT and hormonal therapy are likely to extend to patients treatedwith brachytherapy as well. Studies suggest that the role of hormonaltherapy in brachytherapy is limited without the application of wholepelvicEBRT due to the inability of brachytherapy to address potentiallymph nodes at risk. The potential role of hormonal therapy in conjunctionwith brachytherapy without pelvic radiotherapy, is limited byinconclusive data and abbreviated follow-up times.

Drs. Andrews and Roach present an excellent review and discussion of the existing literature regarding the role of androgen ablation therapy in patients being treated with external-beam radiation therapy (EBRT) and prostate brachytherapy. However, the indications for, and optimal timing of androgen ablation with radiation therapy remain controversial, particularly in regard to brachytherapy.

This chapter provides a brief overview of the principles of radiation therapy.The topics to be discussed include the physical aspects of how radiation works(ionization, radiation interactions) and how it is delivered (treatment machines,treatment planning, and brachytherapy). Recent relevant techniques of radiationoncology, such as conformal and stereotactic radiation therapy, also willbe presented. These topics are not covered in great technical detail, and noattempt is made to discuss the radiobiological effects of radiation therapy. It ishoped that a basic understanding of radiation treatment will benefit those practicingin other disciplines of cancer management. This chapter does not addressprinciples of radiobiology, which guide radiation oncologists in determiningissues of treatment time, dose, and fractionation or in combining radiationwith sensitizers, protectors, and chemotherapy or hormones.

In this issue of ONCOLOGY, Dr.Ruckdeschel addresses a subjectthat, fortunately, is not very common,but unfortunately for those inwhom the problem occurs, the outcomesare almost universally poor.The subject is probably one of themost dreaded complications of advancedcancer-malignant spinalcord compression. On a positive note,since Dr. Patchell's plenary sessionpresentation at the 2003 AmericanSociety of Clinical Oncology Annualmeeting,[1] interest in metastatic spinalcord compression has been renewedand there is hope that futurepatients with this problem will farebetter.

Icommend the authors for their excellent review and discussion regarding the integration of hormonal therapy with permanent prostate implants. They address several important issues relating to the sequence and duration of hormonal therapy in combination with externalbeam radiation therapy (EBRT) and its underlying relationships with permanent prostate implants.

Esophageal cancer frequently expresses cyclooxygenase-2 (COX-2)enzyme. In preclinical studies, COX-2 inhibition results in decreasedcell proliferation and potentiation of chemotherapy and radiation. Wereport preliminary results of a phase II study conducted by the HoosierOncology Group in patients with potentially resectable esophageal cancer.All patients received cisplatin at 75 mg/m2 given on days 1 and 29and fluorouracil (5-FU) at 1,000 mg/m2 on days 1 to 4 and 29 to 32with radiation (50.4 Gy beginning on day 1). Celecoxib (Celebrex) wasadministered at 200 mg orally twice daily beginning on day 1 untilsurgery and then at 400 mg orally twice daily until disease progressionor unexpected toxicities, or for a maximum of 5 years. Esophagectomywas performed 4 to 6 weeks after completion of chemoradiation. Theprimary study end point was pathologic complete response (pCR). Secondaryend points included response rate, toxicity, overall survival, andcorrelation between COX-2 expression and pCR. Thirty-one patientswere enrolled from March 2001 to July 2002. Respective grade 3/4 toxicitieswere experienced by 58%/19% of patients, and consisted of granulocytopenia(16%), nausea/vomiting (16%), esophagitis (10%), dehydration(10%), stomatitis (6%), and diarrhea (3%). Seven patients (24%)required initiation of enteral feedings. There have been seven deathsso far, resulting from postoperative complications (2), pulmonary embolism(1), pneumonia (1), and progressive disease (3). Of the 22 patients(71%) who underwent surgery, 5 had pCR (22%). We concludethat the addition of celecoxib to chemoradiation is well tolerated. ThepCR rate of 22% in this study is similar to that reported with the use ofpreoperative chemoradiation in other trials. Further follow-up is necessaryto assess the impact of maintenance therapy with celecoxib onoverall survival.

ATLANTA, Georgia-Children with low-risk Hodgkin’s disease (HD) who have a complete remission after chemotherapy can forego radiation therapy without an increased risk of recurrence, according to a trial presented at the 46th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 3).

Adjuvant therapy, almost bydefinition, overtreats patients.It is the holy grail of those ofus involved in adjuvant therapy to definethe patients who are going to failso that we can decrease the incidenceof tumor recurrence and avoid givingadditional therapy to patients who havebeen cured by their primary treatment.

Depression is seen in many cancer patients. It is an especially importantissue in palliative care, as depression can be more common inpatients who are at the end of life. Accurate assessment and treatmentcan have a powerful impact on improving a patient's quality of life.This article reviews the definition and the differential diagnosis of depressionin cancer patients. It then focuses on some of the treatmentoptions available, including pharmacotherapy and psychotherapy.

The term “supportive oncology” refers to those aspects of medical careconcerned with the physical, psychosocial, and spiritual issues facedby persons with cancer, their families, their communities, and their healthcareproviders. In this context, supportive oncology describes both those interventionsused to support patients who experience adverse effects caused by antineoplastictherapies and those interventions now considered under the broad rubric of palliativecare. At its core, palliative care is concerned with providing the maximumquality of life to the patient/family unit.

Delirium is highly prevalent in cancer patients with advanced disease.Frequently a preterminal event, the condition is a sign of significantphysiologic disturbance, typically involving multiple medical etiologiesincluding infection, organ failure, adverse medication effects,and in rare situations, paraneoplastic syndromes. Unfortunately, deliriumis frequently underrecognized or misdiagnosed and, therefore,inappropriately treated or untreated in terminally ill patients. The clinicalfeatures of delirium are numerous and encompass a variety of neuropsychiatricsymptoms common to other psychiatric disorders. Threeclinical subtypes of delirium, based on arousal disturbance and psychomotorbehavior, have been described: hyperactive, hypoactive, andmixed. The differential diagnosis for delirium includes depression,mania, psychosis, and dementia. Numerous instruments have been developedto aid the clinician in rapidly screening for the disorder. Standardmanagement requires an investigation of the etiologies, correctionof the contributing factors, and management of symptoms. Symptomaticand supportive therapies, including numerous pharmacologicapproaches, are important, but several aspects of the use of neurolepticsand other agents in the management of delirium in the dying patientremain controversial.

Severe, debilitating fatigue is common in cancer patients. For many,it is the symptom that interferes most with normal routines. Virtuallyevery modality used to treat cancer may cause fatigue, as can complicationsof the disease such as sleep disturbances, infections, malnutrition,hypothyroidism, and anemia. There is a significant overlap betweendepression and fatigue in many patients. Given the high prevalenceof cancer-related fatigue, frequent assessment of patients is essential.The evaluation should include an attempt to identify reversiblecauses of fatigue, and screening for depression. However, many cancerpatients suffer from fatigue even in the absence of any identifiable,reversible cause. For these patients, consideration can be given to suitableexercise programs, educational support and counseling, and energyconservation strategies. A trial of a stimulant medication is alsoreasonable. Given the heterogeneity of patients, individualized approachesare needed. For anemic patients undergoing chemotherapy,erythropoietic agents can increase hemoglobin levels. The impact ofthese drugs on fatigue and quality of life is uncertain. Recent reports ofincreased mortality and thrombotic events in cancer patients treatedwith epoetin require further investigation.

The treatment of breast cancer has progressed substantially overthe past 15 years. Data from randomized adjuvant trials have shownthat the risk of disease recurrence and death is significantly reducedwhen adjuvant chemotherapy and/or hormonal therapy is added to treatment.As new strategies are incorporated, one of the continued controversiesin patient management is whether adjuvant anthracyclinesshould be the preferred treatment for all patients. Data from randomizedand translational clinical trials have become available and arehelping to elucidate the proper role of anthracyclines, as well as their acuteand long-term toxicities. In most situations, an anthracycline is currentlypreferred, but other single and combination chemotherapies arecurrently under evaluation and appear promising for use in the adjuvantsetting. Continued breast cancer research using molecular markers(such as topoisomerase II–alpha and gene clusters) as predictors oftreatment response, could help individualize decisions regardingwhether to incorporate anthracyclines into adjuvant therapy regimens.

NEW ORLEANS-Palonosetron (Aloxi) prevented chemotherapy-induced nausea and vomiting in older patients better than two other 5-HT3 receptor antagonists-ondansetron

In their article, Drs. Matthew Cooperberg,Sangtae Park, and PeterCarroll summarize four nationalregistries that have studied risk migration,practice patterns, outcomepredictions, and quality-of-life outcomesin prostate cancer. Each of thesefour large registries-the Prostate CancerOutcomes Study (PCOS), the Departmentof Defense Center for ProstateDisease Research (CPDR), the Cancerof the Prostate Strategic Urologic ResearchEndeavor (CaPSURE), and theShared Equal Access Regional CancerHospital (SEARCH)-has a particularstrength that complements theothers. As more patients enroll in theseregistries, researchers will gain greaterinsight into the patterns of care andclinical and health-related quality oflife for diverse cohorts of prostate cancerpatients.

Only a minority of elderly patientswith advanced non–small-cell lung cancer(NSCLC) have been offered palliativechemotherapy, as indicated by clinicalsurveys beginning in the 1980s.Lilenbaum’s thorough review of thetreatment of locally advanced and metastaticNSCLC studies in two specialpopulations (elderly and Eastern CooperativeOncology Group [ECOG]performance status [PS] 2 patients)highlights a new trend seen with theadvent of better-tolerated chemotherapyregimens.