bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemoprevention in African American Men with Prostate Cancer
Authors: Kumar Nagi B. , Pow-Sang Julio M. , Spiess Philippe E. , Park Jong Y. , Chornokur Ganna , Leone Andrew R. , Phelan Catherine M.
Published: August 2017

Background

Recommendations for cancer screening are uncertain for the early detection or prevention of prostate cancer in African American men. Thus, chemoprevention strategies are needed to specifically target African American men.

Methods

The evidence was examined on the biological etiology of disparities in African Americans related to prostate cancer. Possible chemopreventive agents and biomarkers critical to prostate cancer in African American men were also studied.

Results

High-grade prostatic intraepithelial neoplasia may be more prevalent in African American men, even after controlling for age, prostate-specific antigen (PSA) level, abnormal results on digital rectal examination, and prostate volume. Prostate cancer in African American men can lead to the overexpression of signaling receptors that may mediate increased proliferation, angiogenesis, and decreased apoptosis. Use of chemopreventive agents may be useful for select populations of men.

Conclusions

Green tea catechins are able to target multiple pathways to address the underlying biology of prostate carcinogenesis in African American men, so they may be ideal as a chemoprevention agent in these men diagnosed with high-grade prostatic intraepithelial neoplasia.
Human Metapneumovirus Infection in Immunocompromised Patients
Authors: Samuel Sharmeen , Nanjappa Sowmya , Cooper Christopher D. , Greene John N.
Published: August 2017

Human metapneumovirus (HMPV) is a pathogen associated with respiratory tract infection and is related to avian pneumovirus. Typically, children, the elderly, and those who are immunocompromised are the most susceptible to HMPV infection; however, the virus can infect persons of all ages. In otherwise healthy individuals, HMPV infection is generally self-limiting, but immunocompromised individuals can develop fatal complications. We present a case series of 3 severely immunocompromised patients who were infected with HMPV and describe their clinical course. All 3 patients had acute myeloid leukemia, histories of neutropenic fever, and prolonged hospitalization stays. This case series highlights the severe sequelae observed in individuals infected with HMPV, particularly among those who are immunocompromised.
Systematic Review and Case Series Report of Acinar Cell Carcinoma of the Pancreas
Authors: Glazer Evan S. , Neill Kevin G. , Frakes Jessica M. , Coppola Domenico , Hodul Pamela J. , Hoffe Sara E. , Pimiento Jose M. , Springett Gregory M. , Malafa Mokenge P.
Published: August 2017

Background

Acinar cell carcinoma of the pancreas is a rare malignancy representing less than 1% of all pancreatic malignancies.

Methods

We report on a case series of 21 patients with acinar cell carcinoma of the pancreas treated at a high-volume quaternary center. A systematic review of the medical literature was performed that described typical therapeutic management approaches for acinar cell carcinoma of the pancreas and reported on disease control and survival rates. Data for the case series were obtained from a prospective database.

Results

In our systematic review of 6 articles, study patients had a median age of 61 years, 66% were male, 52% had stage I/II disease, and 55% of lesions were located in the pancreatic head. The rates of median survival were approximately 47 months after resection with adjuvant therapy, 38 months for nonmetastatic, locally unresectable disease, and 17 months for metastatic disease treated with chemotherapy. Combination fluoropyrimidine-based chemotherapy regimens had better rates of disease control than other therapies. Our case series included 21 study patients, 14 of whom required resection and 7 who had metastatic disease. The rates of median survival were 40.2 + 31.9 months in those who underwent surgery and were treated with adjuvant therapy and 13.8 + 11.3 months for patients with metastatic disease.

Conclusions

Multidisciplinary treatment for acinar cell carcinoma of the pancreas should be considered due to the rarity of the disease and its lack of high-level therapeutic data. Progress in the molecular analysis of this tumor may improve outcomes through the use of personalized therapy based on underlying tumor mutations.
Imaging Management of Breast Density, a Controversial Risk Factor for Breast Cancer
Authors: Falcon Shannon , Williams Angela , Weinfurtner R. Jared , Drukteinis Jennifer S.
Published: August 2017

Background

Breast density is well recognized as an independent risk factor for the development of breast cancer. However, the magnitude of risk is controversial. As the public becomes increasingly aware of breast density as a risk factor, legislation and notification laws in relation to breast density have become common throughout the United States. Awareness of breast density as a risk factor for breast cancer presents new challenges for the clinician in the approach to the management and screening of women with dense breasts.

Methods

The evidence and controversy surrounding breast density as a risk factor for the development of breast cancer are discussed. Common supplemental screening modalities for breast cancer are also discussed, including tomosynthesis, ultrasonography, and magnetic resonance imaging. A management strategy for screening women with dense breasts is also presented.

Results

The American College of Radiology recognizes breast density as a controversial risk factor for breast cancer, whereas the American Congress of Obstetricians and Gynecologists recognizes breast density as a modest risk factor. Neither organization recommends the routine use of supplemental screening in women with dense breasts without considering additional patient-related risk factors.

Conclusions

Breast density is a poorly understood and controversial risk factor for the development of breast cancer. Mammography is a screening modality proven to reduce breast cancer–related mortality rates and is the single most appropriate tool for population-based screening. Use of supplemental screening modalities should be tailored to individual risk assessment.
Cardiac Magnetic Resonance Imaging in Oncology
Authors: Jeong Daniel , Patel Aarti , François Christopher J. , Gage Kenneth L. , Fradley Michael G.
Published: August 2017

Background

Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies.

Methods

An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment.

Results

Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques.

Conclusions

Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.
Melanoma and Skin Cancer Control: An International Perspective
Authors: Koh Howard K. , Geller Alan C.
Published: August 2017

Approximately one million Americans are diagnosed with skin cancer each year. Since melanoma and skin cancer are amenable to prevention, education, and early detection, efforts to reduce the incidence of and death from melanoma have developed in many countries. Programs promoting behavioral changes and the incorporation of skin cancer control into national health care agendas have begun in a number of countries. Additional programs for the at-risk and general populations require further development and evaluation.
Principles of Cancer Screening
Authors: Clark Robert
Published: August 2017

Early detection of cancer, prior to its clinical manifestations, appears to be a worthwhile and desirable goal. Yet, the concept and acceptance of cancer screening remain controversial and often confusing. While the benefits of screening are obvious to those whose screening tests have resulted in successful interventions, attention also needs to be given to the risks, economic costs, and psychological effects of screening procedures. Specific governing principles that define the cancers to be screened, the appropriate screening test, and the measurement of outcomes should be established in order for a screening program to be deemed worthwhile. A beneficial screening strategy detects cancer prior to its systemic spread, alters the natural history of the disease, and defers the time of death.
Adherence to Cancer Screening
Authors: Rimer Barbara K.
Published: August 2017

Routine breast cancer screening for women 50 years of age and older can reduce mortality from breast cancer by 30% to 35%. Regular Papanicolaou tests can decrease mortality from cervical cancer dramatically, and skin cancer screening could decrease deaths from melanoma. Adherence to recommended screening procedures for breast, cervical, and skin cancer screening increases the potential to lower the risk of death and disability from these diseases. The National Cancer Institute's goals include increasing the proportion of women who get regular mammograms to 80%, and similar goals have been issued for Pap tests. Yet, most women still are not being screened for breast or cervical cancer on a regular basis, and most people do not have regular skin checks for cancer.
Management of the Jehovah's Witness Oncology Patient: Perspective of the Transfusion Service
Authors: Benson Kaaron
Published: August 2017

Due to refusal of blood component transfusions, Jehovah's Witness patients with cancer present a challenge to oncologists who must find appropriate and acceptable treatments. In order to assess the morbidity and mortality that these patients suffer, a retrospective review was conducted of all 58 Jehovah's Witness patients treated at our center from October 1986 through February 1994. This study showed that (1) younger Jehovah's Witness patients or their parents were more likely to accept blood transfusion than older Jehovah's Witness patients, (2) considerable risk of acute morbidity and mortality occurred in patients who refused blood when blood transfusions were indicated, and (3) long-term prognosis may be worsened for some Jehovah's Witness patients due to limited treatment provided in those with anemia or with anticipated anemia.
Screening for Colorectal Cancer
Authors: Levin Bernard
Published: August 2017

Colorectal cancer is a major cause of morbidity and mortality in the United States. Early detection of the disease at an asymptomatic stage by screening holds promise for lowering the incidence of colorectal cancer deaths, yet compliance with screening guidelines is poor. Evidence in support of the use of screening techniques for colorectal cancer is accumulating, however, and screening for this disease with fecal occult blood tests and flexible sigmoidoscopy can increase the likelihood of early detection, can decrease mortality and morbidity, and can be cost effective.
Cytoreductive Surgery in Ovarian Cancer: Why, When, and How?
Authors: Roberts William S.
Published: August 2017

Retrospective evidence supports the value of optimal cytoreductive surgery in the initial therapy of patients with advanced ovarian cancer. Specialized procedures, including radical pelvic surgery, bowel resection, and diaphragm resections, are frequently necessary to accomplish optimal cytoreduction. Cytoreduction and total gross tumor removal are possible more frequently with new surgical instruments such as the Cavitron ultrasonic surgical aspirator and argon beam laser. Pelvic and periaortic lymph node resection is an important aspect of cytoreductive surgery, and systematic removal of grossly uninvolved lymph nodes may improve survival. Secondary cytoreductive surgery appears to benefit a select group of patients.
Frontiers of Ovarian Cancer Therapy
Authors: Balat Ozcan , Mohammed Ehab , Kudelka Andrzej P. , Verschraegen Claire F. , Kavanagh John J.
Published: August 2017

Since the majority of patients with ovarian cancer present with advanced stages of disease, more effective systemic approaches are needed to add to the benefits of surgical staging and debulking. New combinations of taxoids with cisplatin have prolonged survival, and other chemotherapeutic agents are being evaluated. Immunotherapy, including intraperitoneal approaches with monoclonal antibodies, cellular therapies and vaccines, hormone therapy with well-known drugs such as tamoxifen, and gene therapy give promise for the future.
Psychosocial Aspects of Palliative Care
Authors: Jacobsen Paul B. , Breitbart William
Published: August 2017

Background

Relief of suffering is a central goal for palliative care. Achievement of this goal can be difficult, however, due to the complex nature of suffering.

Methods

A psychosocial perspective is used to understand suffering and to identify interventions to relieve suffering in patients with advanced disease.

Results

Clinical experience and research suggest that attending to the psychosocial aspects as well as the medical aspects of palliative care has the potential of further reducing the suffering experienced by patients with advanced disease.

Conclusions

Suffering is best viewed as a subjective phenomenon t hat can be influenced by biological, psychological and social processes. Interventions in each of these areas can help to relieve patient suffering.
Barriers to Palliative Care
Authors: Rhymes Jill A.
Published: August 2017

Background

Palliative care is received by a small number of patients with terminal illness, most of them with cancer.

Methods

Data are reviewed and evaluated that relate to the barriers and problems that limit access of patients to appropriate palliative and/or hospice care.

Results

Palliative care generally is not well integrated into the health care system. Access is limited, and many health care professionals and laypeople are unaware of its possible benefits. Cultural and religious barriers often apply, and problems exist in obtaining narcotics. Palliative care for patients other than those with cancer may be especially difficult to achieve.

Conclusions

Recognizing and overcoming the barriers to the provision of palliative care can bring about changes in education, health care practices, and administration to achieve the desired goals.
Management of Toxicities of Combined Modality Therapy for Intrathoracic Malignancies
Authors: Weakland Tina , Wagner Henry
Published: August 2017

Background

Combined radiation and chemotherapy for intrathoracic tumors can produce appreciable morbidity. Apprehension about the severity of these toxicities may inhibit optimal patient care.

Methods

The literature on recognition, diagnosis, prophylaxis, and management of these toxicities is reviewed and combined with the experiences of the authors to produce management recommendations.

Results

Toxicities include acute and chronic esophagitis, early and late pneumonitis with fibrosis, myelosuppression, and neurologic deficits. Measures are available to minimize their severity and to reduce their impact on the patient.

Conclusions

The morbidity of combined radiation and chemotherapy patients with intrathoracic tumors can be minimized by recognizing potential toxicities and by applying appropriate prophylactic and management measures.
Regional Transcatheter Therapy of Hepatic Neoplasms
Authors: Choi Junsung
Published: August 2017

Background

Surgical resection of hepatocellular carcinomas and metastases to the liver cannot always be performed, and systemic therapies for these entities are of limited value. The techniques of chemoembolization and hepatic artery infusion have been used for patients who are not candidates for surgery.

Methods

Chemoembolization uses percutaneous intra-arterial infusion of chemotherapeutic agents and embolic material. This provides longer contact of the agents with the tumor cells and induces ischemia. Hepatic arterial chemoinfusion uses the knowledge that hepatic cancers are supplied predominantly by the hepatic artery.

Results

Chemoembolization using Lipiodol, doxorubicin, and Gelfoam has promoted necrosis of unresectable hepatocellular tumors and may have prolonged patient survival. Hepatic arterial infusion with fluorinated pyrimidines produces more objective responses than systemic chemotherapy but probably does not alter survival.

Conclusions

The nonsurgical treatments of chemoembolization and hepatic arterial infusion of chemotherapy have expanded our armamentarium to manage many primary and metastatic tumors in the liver. Additional approaches are needed.
Non-Hodgkin's Lymphoma in the Elderly
Authors: Balducci Lodovico , Ballester Oscar F.
Published: August 2017

Background

The incidence of non-Hodgkin's lymphoma in the elderly continues to increase. There has been a tendency among some treating physicians to minimize appropriate workup and treatment, which may produce a negative effect on outcomes.

Methods

Several characteristics of non-Hodgkin's lymphoma in the elderly are reviewed, including classification and staging, pathophysiology, clinical presentation, and treatment strategies.

Results

The Working Formulation remains the principal classification used. In older and younger individuals, the prevalence of histologic subtypes and the stage at presentation are similar. Regardless of the regimen chosen, doxorubicin or mitoxantrone should be included if optimal responses are to be obtained. New purine analogs extend the therapeutic armamentarium.

Conclusions

Advanced age and comorbidities can impair the capability for treatments to control non-Hodgkin's lymphoma. To enhance results, more studies that focus on the elderly are needed on drug combinations and the newer purine analogs.
Systemic Therapy for Invasive Bladder Cancer
Authors: Javle Milind , Raghavan Derek
Published: August 2017

Background

Bladder cancer is one of the most common malignancies in Western society. In the United States, approximately 10,000 of these patients present with invasive disease, and more progress from superficial bladder cancer.

Methods

The authors review the literature on systemic treatment for both localized and metastatic bladder cancer, and they include their experience in defining approaches to various stages of disease.

Results

Cisplatin-based combination chemotherapy is the most effective systemic approach for advanced bladder cancers, although few patients are cured. Neoadjuvant, perspective, and adjuvant trials, as well as concurrent chemoradiation studies, are in progress to attempt to demonstrate better outcomes.

Conclusions

The combination of systemic chemotherapy and definitive local therapy may have a useful role in the management of locally advanced bladder cancers, but optimal schedules and true survival benefit have not been established.
Bladder Replacement and Urinary Diversion after Radical Cystectomy
Authors: Pow-Sang Julio M. , Spyropoulos Evangelos , Helal Mohammed , Lockhart Jorge
Published: August 2017

Background

The optimal mode of urinary tract reconstruction following cystectomy continues to challenge the urologic surgeon. Disadvantages with bowel conduits have prompted the search for better techniques to improve patient outcomes.

Methods

The development of urinary tract reconstruction is reviewed, and results from several forms of continent urinary diversion and bladder replacement construction are presented. The authors report on their experience in creating continent reservoirs or neobladders in over 400 patients.

Results

Several surgical approaches are now available for continent urinary diversion. Metabolic and nutritional abnormalities, stone formation, infection, and cancer formation are potential complications.

Conclusions

Advances in surgical techniques, an understanding of the physiology of isolated bowel segments, and improvements in pre- and post-operative care have altered the field of urinary reconstruction after cystectomy for bladder cancer. Most patients can expect minimal morbidity and mortality.
Use of G-CSF to Sustain Dose Intensity in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Pilot Study
Authors: Webster Jack , Kuderer Nicole , Lyman Gary H.
Published: August 2017

Background

Adjuvant chemotherapy for breast cancer is frequently accompanied by neutropenia requiring dose reduction or treatment delay that can potentially compromise therapeutic effectiveness. Recombinant granulocyte-colony stimulating factor (G-CSF) reduces the duration and severity of neutropenia.

Methods

Nineteen patients with newly diagnosed breast cancer receiving adjuvant systemic chemotherapy met criteria for dose reduction or treatment delay due to neutropenia. All were treated with G-CSF. The mean duration of G-CSF therapy was five days.

Results

An increase in mean absolute neutrophil count was seen in cycles with G-CSF. Chemotherapy treatment was delayed less often following the use of G-CSF.

Conclusions

Breast cancer patients receiving adjuvant chemotherapy who face treatment delays or dose reductions can continue on full-dose intensity therapy using supportive G-CSF. Prospective trials are needed to accurately measure the impact of G-CSF on dose intensity and long-term disease control.
Local Management of Primary Breast Cancer
Authors: Small William , Morrow Monica
Published: August 2017

Background

Various options are available for the local control of cancer in the breast - mastectomy, conservation therapy, and mastectomy with reconstruction.

Methods

To evaluate the benefits and drawbacks of the available management options, the authors combine their extensive experience with a review of the literature on outcomes from these approaches.

Results

Conservation therapy provides survival outcomes similar to those from mastectomy. Differences in local recurrence rates can be minimized by close adherence to guidelines for patient selection, operative approach, and radiation technique.

Conclusions

The role of the physician in selecting a local therapy for breast cancer has changed from one of informing the patient of the treatment to assessing the presence of medical contraindications to any of the treatments, educating the patients on each treatment approach, providing access to multidisciplinary consultation, and allowing the patient to choose an appropriate treatment approach.
The Role of Selective Lymphadenectomy in Breast Cancer
Authors: Reintgen Douglas , Joseph Emmanuella , Lyman Gary H. , Yeatman Tim , Balducci Lodovico , Ku Ni Ni , Berman Claudia , Shons Alan , Wells Karen , Horton John , Greenberg Harvey , Nicosia Santo , Clark Robert , Shivers Steven , Li Weiguo , Wang Xiangning , Cantor Alan , Cox Charles
Published: August 2017

Background

Axillary node dissection is considered a standard staging procedure in patients with breast cancer. The procedure is associated with significant morbidity and provides pathologists with many lymph nodes to evaluate.

Methods

A total of 174 women participated in a trial that included preoperative lymphoscintigraphy and intraoperative lymphatic mapping using a combination of a vital blue dye and radiocolloid mapping.

Results

The intraoperative lymphatic mapping correctly identified a sentinel lymph node (SLN) in 160 (92%) of 174 patients. One skip metastasis (0.7%) occurred in 136 women who had a subsequent complete node dissection.

Conclusions

Lymphatic mapping and SLN biopsy using a combination of mapping techniques provide accurate nodal staging for women with breast cancer. With this technique, approximately 70% to 80% of women with no axillary metastases could be spared the morbidity of a complete node dissection.
Conservation Therapy of the Breast: Optimizing Long-term Results
Authors: Greenberg Harvey M.
Published: August 2017

Background

Radiation therapy is a key component of breast conservation therapy for breast cancer. There is great interest in safety and long-term outcome issues for this still underutilized approach.

Methods

The author reviews a series of factors that may affect the end results of conservation therapy and highlights those that are likely to be of clinical significance.

Results

Daily dose fractions are usually less than 2 Gy and a homogeneous whole-breast dose is used. Care is needed with patients with collagen vascular diseases, large breasts, breast trauma, and prior infections, but these factors are not absolute contraindications to breast conservation therapy. Acute skin reactions are not predictive of long-term complications.

Conclusions

With adherence to proper surgical and radiation techniques, most patients presenting with localized breast cancer can be managed safely and effectively with breast conservation.
Management Issues for Stage IV Non-Small-Cell Lung Cancer
Authors: Earle Craig C. , Evans William K.
Published: August 2017

Background

The management of stage IV non-small-cell lung cancer (NSCLC) has been a controversial subject over the past several decades. Data from randomized trials and from phase II trials on new cancer agents are changing physician attitudes and treatment practices.

Methods

The literature on the management of metastatic lung cancer was reviewed and interpreted.

Results

There is good evidence from randomized controlled trials and meta-analyses that chemotherapy provides a modest survival benefit in stage IV NSCLC. There is indirect evidence of improvement in quality of life, as systemic chemotherapy palliates cancer-related symptoms in the majority of patients. New drug combinations are likely to improve recent treatment results with less morbidity than older chemotherapy regimens. Despite the relatively high cost of these treatments, chemotherapy is cost effective in the Canadian health care environment relative to other accepted medical interventions.

Conclusions

Chemotherapy will play an increasing role in the management of patients with advanced NSCLC.
A Primer for Evaluating Clinical Trials
Authors: Lyman Gary H. , Kuderer Nicole M.
Published: August 2017

Background

Evidence-based medicine demands the use of information from clinical trials to direct medical care. Knowledge of the principles of trial design and conduct is important to assess the validity of results.

Methods

The authors review the key principles behind clinical study design and conduct, and they summarize important biases and confounding issues.

Results

Clear hypotheses, a well-described study population, precise measurements, freedom from bias, and consideration of any interactions are attributes of good clinical trials.

Conclusions

The greatest level of evidence in support of a difference in outcome is associated with randomized, controlled clinical trials, particularly when combined with other randomized trials in a systematic fashion (meta-analysis).
T-cell Prolymphocytic Leukemia
Authors: Matutes Estella
Published: August 2017

Background:

T-cell prolymphocytic leukemia (T-PLL) is a post-thymic T-cell malignancy with aggressive clinical course. Although T-PLL has been referred to under different designations, it is a distinct clinico-biological entity and should be distinguished from other T-cell disorders.

Methods:

The literature on T-PLL is reviewed. Experience on the clinical and laboratory features, differential diagnosis, and therapy on a large series of T-PLL patients is presented.

Results:

T-PLL affects adults and occurs more frequently in men. The principal disease characteristics are organomegaly, skin lesions, and a raised lymphocyte count. Immunological markers show a post-thymic T-cell phenotype (TdT– CD2+ CD5+ CD3±) with strong expression of CD7. A CD4+ CD8– phenotype is seen in two thirds of cases. CD4 and CD8 are coexpressed in 25%, and a CD4– CD8+ phenotype is rare. Cytogenetics show a recurrent abnormality inv(14)(q11;q32) that is always associated to other aberrations (particularly iso8q or trisomy 8). Differential diagnosis between T-PLL and other T-cell malignancies is based on a constellation of clinical and laboratory features. Generally, T-PLL patients are refractory to the therapy used in lymphoid disorders. Median survival is short but is improving with the use of 2'-deoxycoformycin and the humanized monoclonal antibody, anti-CDw52 (Campath-1H).

Conclusions:

T-PLL is a distinct T-cell disorder with characteristic clinical and laboratory features and a poor prognosis. A precise diagnosis of this disease is important in determining patient management and treatment.
Progress in the Systemic Treatment of Advanced Soft-Tissue Sarcomas
Authors: Okuno Scott H. , Edmonson John H.
Published: August 2017

Background:

Despite the plethora of chemotherapeutic remedies for advanced soft-tissue sarcomas, little evidence has developed to indicate that these efforts have been curative. No controlled comparison has yet proven that patients receiving multidrug regimens survive longer than those receiving doxorubicin alone.

Methods:

The authors review current systemic treatments and then discuss some investigational efforts now in progress. Also, they seek to demonstrate how the therapies currently available can be integrated with surgery and radiation therapy to accomplish more than might be anticipated from chemotherapy alone.

Results:

While working to develop better systemic therapies for advanced soft-tissue sarcomas, the integrated use of our best chemotherapy regimens in combination with selected surgical and radiotherapy efforts may provide patients with the best available therapy. Some recent observations involving the use of molgramostim plus chemotherapy have been intriguing.

Conclusions:

Progress in the systemic treatment of advanced soft-tissue sarcomas may be gradual, but it is real. Our daily challenge is to be certain that we offer each patient the best available multimodality treatment applicable to his or her clinical situation. Molgramostim should be made available for further study with chemotherapy in controlled clinical trials.
The Pleural Tent
Authors: Venugopal Priya R. , Berman Claudia G. , Robinson Lary A.
Published: August 2017

This regular feature will enhance your knowledge of imaging technology in oncologic diagnosis, treatment, and evaluation.
Ten Best Readings on T-Cell Lymphoid Malignancies
Authors: Loughran Thomas P.
Published: August 2017

The ten best articles in the medical literature relating to T-cell lymphoid malignancies are reviewed here.
The New Approaches to Brain Tumor Therapy (NABTT) CNS Consortium: Organization, Objectives, and Activities
Authors: Grossman Stuart A. , Fisher Joy D. , Piantadosi Steven , Brem Henry
Published: August 2017

Background:

Despite advances in neuro-imaging, neurosurgery, radiation therapy, and chemotherapy, limited progress has been made in the treatment of patients with high-grade astrocytomas. The National Cancer Institute has attempted to speed advances in this field by funding CNS consortia to conduct innovative clinical trials in this patient population since 1994.

Methods:

The NABTT CNS Consortium is composed of a consortium headquarters and nine member institutions with outstanding multidisciplinary expertise, clinical and laboratory research capabilities, and access to large numbers of patients with brain tumors.

Results:

The objectives of the NABTT Consortium are to improve the therapeutic outcome for adults with primary brain tumors, to conduct basic science and clinical research, and to improve the care and quality of life of adults with primary brain tumors. NABTT's clinical studies have discovered important drug interactions between anticonvulsant and antineoplastic agents, defined the activity of paclitaxel and 9-aminocamptothecin in glioblastoma multiforme, tested a novel dose escalation strategy for brain tumor trials, and established new protocol “classes” to expedite and standardize clinical research in this field.

Conclusions:

Significant progress in the care of patients with primary brain tumors is likely to result from the highly focused and multidisciplinary efforts of the NIH-funded CNS consortia.
Papillary Squamous Cell Carcinoma of the Vagina
Authors: Cowper Shawn E. , Fiorica James V. , Haller Edward M. , Nicosia Santo V. , Jones Mirka , Coppola Domenico
Published: August 2017

This regular feature presents special issues in oncologic pathology.
Interferon in the Treatment of Multiple Myeloma
Authors: Shustik Chaim
Published: August 2017

Background

The role of interferon (IFN) in the treatment of multiple myeloma has been investigated for nearly two decades. The mechanisms underlying antitumor activity of IFN may be mediated by antiproliferative and immunomodulatory effects. The benefits of treatment remain controversial, and guidelines for the use of IFN in myeloma are needed. This review evaluates available data on the impact of IFN therapy on multiple myeloma.

Methods

A MEDLINE search of published prospective, randomized trials of IFN in multiple myeloma provided the data included in this review, as well as selected abstracts presented at international meetings.

Results

IFN has complex and pleiotropic effects on human myeloma lines and ex vivo myeloma cells. An antiproliferative effect with disruption of the IL-6-mediated growth loop may be crucial, but biologic heterogeneity in myeloma may have important clinical implications for response to IFN. IFN has demonstrable antitumor activity in multiple myeloma but appears to have a modest effect on overall survival when combined with chemotherapy during induction or when used as maintenance therapy. Most studies have shown a prolongation of the plateau phase of disease with IFN of variable duration of between four and 12 months.

Conclusions

A reliable estimate of the benefit of IFN in the overall population of patients with myeloma is difficult to determine with discordant results from different trials. Possible sources of heterogeneity in randomized trials need to be identified, and recognition of subsets of patients who may benefit is important. Cost-benefit analyses with integration of quality-of-life data are essential for developing guidelines for the use of IFN in myeloma.
Retinoblastoma
Authors: Margo Curtis E. , Harman Lynn E. , Mulla Zuber D.
Published: August 2017

Background

Retinoblastoma is the most common intraocular malignancy of infants and children. With early diagnosis and treatment, survival is greater than 90%; however, patients with a germline retinoblastoma mutation have a substantial risk of having a second high-grade malignancy.

Methods

The recent developments in the diagnosis and treatment of retinoblastoma are reviewed.

Results

Identification of the retinoblastoma germline mutation is now possible with the discovery of the retinoblastoma gene. Patients with the germline mutation have a 51% cumulative risk over 50 years of developing a second malignancy. Several pilot studies using primary chemotherapy for retinoblastoma have shown promising results.

Conclusions

Risk assessment and genetic counseling have become more precise with the development of laboratory methods to identify the retinoblastoma gene. The development of primary chemotherapy regimens to reduce the size of retinoblastoma tumors may decrease the need for radiation therapy and thereby reduce the risk of radiation-related malignancies in patients with the germline mutation.
Intraocular Lymphoma
Authors: Bardenstein David S.
Published: August 2017

Background

Primary ocular lymphoma is a distinct subtype of intraocular lymphoma. Its clinical presentation can mimic benign conditions. Diagnosis is often based on obtaining an intraocular biopsy. Optimal management is not yet realized.

Methods

This report combines the experience of the author with a review of the current literature pertaining to intraocular lymphoma.

Results

Primary ocular lymphoma, a subtype of primary central nervous system (CNS) lymphoma, has a variable clinical course and frequently mimics benign inflammatory disease. Even when suspected, diagnosis can be elusive. Chemoradiation is the most effective treatment, but significant ocular and cerebral morbidity is associated with its use. Novel treatment regimens may reduce or eliminate side effects while preserving life, vision, and CNS function.

Conclusions

Primary CNS lymphoma with ocular involvement should be considered in patients with refractory uveitis, yellow-white choroidal masses, and CNS lymphoma. Aggressiveness in making the diagnosis should be tempered by the potential complications of the diagnostic process and advanced by the life-threatening nature of the disease. Treatment should attempt to maximize efficacy while incorporating considerations such as extent of disease and the patient's age, health, and mental state.
Management of Ocular Metastasis
Authors: Small William
Published: August 2017

Background

Intraocular metastasis is a significant clinical problem in patients with metastatic cancer. The frequency of intraocular metastasis in all patients dying of cancer is approximately 12%, but in breast cancer patients, the frequency can be as high as 37%.

Methods

A review of pertinent literature and the author's experience are used to describe the epidemiology, diagnosis, and management of metastatic tumors of the eye.

Results

Intraocular metastases occur frequently and are diagnosed by ophthalmologic examination. Radiotherapy remains the cornerstone of therapy and allows the majority of patients to maintain useful vision for the remainder of their lives.

Conclusions

The recognition and treatment of intraocular metastasis are important clinical oncologic issues. With proper management, patients with ocular metastasis can maintain vision and thus maximize quality of life.
High-Dose Chemotherapy in the Adjuvant Treatment of Breast Cancer: Benefit/Risk Analysis
Authors: Djulbegovic Benjamin , Hozo Iztok , Fields Karen K. , Sullivan Daniel
Published: August 2017

Backgroundg

High-dose chemotherapy (HDRx) may improve the prognosis of patients with high-risk breast cancer but at the expense of increased toxicity. However, no randomized, controlled trials have been published that clearly demonstrate the superiority of HDRx over conventional adjuvant chemotherapy.

Methods

We developed a simple model to compare benefits and risks of HDRx with conventional adjuvant chemotherapy (SDRx). The model integrates data on efficacy and risks of two competing treatment strategies into a single decision rule.

Results and Conclusions

Using data from phase II studies, we show that if a disease-free survival is considered to be the most important outcome, HDRx should be administered when the probability of breast cancer relapse at five years exceeds 54% to 71% for patients with 4 to 9 positive nodes and exceeds 29% to 40% for patients with >9 positive nodes. If the endpoint of interest is five-year overall survival, then the treatment should be administered when the probability of relapse exceeds 77% to 83% for patients with 4 to 9 nodes involved and 22% to 31% for those with >9 lymph nodes involved. While awaiting results of randomized, controlled trials to definitively establish the efficacy rate of HDRx, we also found that HDRx could be considered in the management of high-risk breast cancer if its efficacy rate is at least 54% to 60% superior to SDRx in reducing relapse risk in breast cancer patients with 4 to 9 nodes and at least 31% to 38% for >9 positive nodes. If survival data are used instead of disease-free survival outcomes, HDRx efficacy should be at least 47% to 48% superior to SDRx in reducing death risk in breast cancer patients with 4 to 9 nodes and at least 27% to 30% superior for >9 positive nodes to consider its use in the adjuvant setting.
Minimal Residual Cancer Detection in Hematopoietic Stem Cell Products and its Prognostic Significance in Patients with Breast Cancer, Lymphoma, or Multiple Myeloma
Authors: Moss Thomas J.
Published: August 2017

Background

Despite the initial success of high-dose therapy and bone marrow transplant, the major reason for posttransplant failure is relapse of disease. Reinfusion of tumor cells may contribute to relapse in autologous stem cell transplants. We now have ultra-sensitive methods of tumor cell detection that can determine the presence of minimal residual cancer (MRC) in marrow and peripheral blood stem cells.

Methods

The author has conducted a critical review of the literature on this issue.

Results

The factors that are associated with an increase in contamination of the graft include (1) the number of cycles of induction therapy, (2) the type of mobilization regimen used, (3) the presence of tumor cells in the marrow, and (4) the number of phereses. A number of studies show that the presence of occult breast cancer in the marrow and/or stem cell product predicts for a poor posttransplant clinical outcome. The presence of clonogenic breast cancer or lymphoma cells in the graft is also associated with a very poor outcome. Published data regarding contamination in graft and outcome for patients with myeloma are limited.

Conclusions

Testing for minimal MRC in the oncology patient provides prognostic information that may be useful to the transplant physician.
Radiation-Induced Sarcoma following Treatment of Breast Cancer
Authors: Brenin Christiana M. , Small William , Talamonti Mark S. , Gradishar William J.
Published: August 2017

Background

Radiation therapy (XRT) is an important modality in the treatment of cancer, and XRT is now commonly utilized in the treatment of early-stage breast cancer. However, its use has occasionally resulted in the development of secondary malignancies. We present a critical review of radiation- induced sarcoma (RIS) that develops after irradiation for the treatment of breast cancer.

Methods

The case of a patient who developed sarcoma after radiation for breast cancer is presented, and current literature on RIS is reviewed. The role of XRT in the development of RIS is examined, and the evaluation and treatment of these malignancies are reviewed.

Results

RIS occurs in 0.2% of patients following treatment of breast cancer. The role of radiation in the development of RIS has been clearly demonstrated. Clinical presentation varies, and diagnosis is commonly delayed. Treatment consists of wide surgical excision. The role of chemotherapy is controversial.

Conclusions

The occurrence of RIS following treatment of breast cancer is rare. Its development has an average latency of over 10 years and likely correlates with the dose and technique of the radiation treatment. The prognosis of patients with RIS following treatment for breast cancer is poor predominantly due to a delay in diagnosis. However, the benefit derived by breast cancer patients from XRT far outweighs the risk of RIS and should not affect the decision to treat these patients with this modality.
Management of Hormone-Sensitive and Hormone-Refractory Metastatic Prostate Cancer
Authors: Rago Randall
Published: August 2017

Background

Prostate cancer is a significant health problem in the United States and is the focus of increasing attention in our society. With the aging of the US population, it is likely that prostate cancer will continue to grow in importance. The options for systemic therapy of metastatic prostate cancer should be familiar to physicians, including nonspecialists, whose patients seek their advice and counsel.

Methods

Past and recent literature was surveyed to provide an understanding of the systemic treatment of advanced prostate cancer. The author presents a review of the systemic treatment of metastatic prostate cancer in different clinical circumstances and addresses the current status of chemotherapy in the management of advanced prostate cancer.

Results

Early androgen deprivation used over prolonged periods appears to be modestly superior to delayed androgen deprivation with a small potential survival advantage and an advantage in delaying disease progression in advanced prostate cancer. Patients with hormone-refractory prostate cancer may benefit from secondary hormonal therapy (eg, adrenal enzyme inhibitors, antiandrogens, glucocorticoids) and chemotherapy.

Conclusions

The choices of therapy for metastatic prostate cancer depend on individual patient preference. Patients and physicians should be aware of the possible side effects associated with the therapeutics options for treatment of metastatic prostate cancer.
Anemia of Aging: A Model of Erythropoiesis in Cancer Patients
Authors: Balducci Lodovico , Hardy Cheryl L.
Published: August 2017

Anemia produces deleterious effects in the older patient with cancer and corresponds with an increasing prevalence of comorbid conditions. Erythropoietin can improve anemia of chronic disease, the most common form of anemia in the elderly.
Erythropoietin and the Management of Anemia in Patients with Lung Cancer
Authors: Crawford Jeffrey , Blackwell Susan
Published: August 2017

The onset of anemia is a confounding factor that will affect the majority of patients with lung cancer. In an attempt to manage or prevent anemia in this population, three trials have incorporated erythropoietin in the treatment schedules. The results of erythropoietin use for cancer patients with anemia have been encouraging.
The Use of Erythropoietin in Radiation Oncology
Authors: Lee Jin Soo
Published: August 2017

Erythropoietin can minimize problems with anemia in cancer patients who receive radiation either alone or in conjunction with chemotherapy. Its use is not associated with greater thrombocytopenia or other side effects.
Barrett's Esophagus and Barrett's-Associated Neoplasia: Etiology and Pathologic Features
Authors: Coppola Domenico , Karl Richard C.
Published: August 2017

Background:

The incidence of Barrett's esophagus (BE) has been increasing in recent years. Patients with BE have 30- to 125-fold increased risk of developing adenocarcinoma. New techniques allowing early diagnosis, in addition to the identification of markers capable of predicting tumor progression, are needed.

Methods:

The authors discuss the diagnostic features of BE and BE-associated neoplasia.

Results:

BE can exhibit different types of metaplastic mucosa, but only the specialized (intestinal) mucosa has the potential to progress to dysplasia and carcinoma. The problems associated with diagnosing BE and with predicting the behavior of this condition are outlined.

Conclusions:

Studies are underway to identify molecular markers capable of predicting which BE patient will progress to carcinoma. Brush cytology and flow cytometry may become useful tools in the early detection of this disease.