bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis and Treatment of mela-noma Brain Metastasis: A Literature Review
Authors: Sloan Andrew E. , Nock Charles J. , Einstein Douglas B.
Published: August 2017

Background

Brain metastasis is common in patients with malignant mela-noma and represents a significant cause of morbidity and mortality. Nearly 37% of patients with malignant mela-noma eventually develop brain metastasis, and autopsy reports show that 75% of those who died of this disease developed brain metastasis.

Methods

We review the level I and level II evidence that guides indications for treatment with surgery, stereotactic radiosurgery, chemotherapy, and immunotherapy for patients with mela-noma brain metastasis.

Results

Level I evidence supports the role of whole brain radiotherapy, microsurgery, and radiosurgery alone or in combination for the treatment of patients with mela-noma brain metastasis. Chemotherapy has been ineffective. Ongoing studies continue to assess the effects of immunotherapy and agents in development.

Conclusions

Brain metastasis is a common and formidable challenge in patients with malignant melanoma. Although there have been no randomized controlled trials exclusively in patients with mela-noma brain metastasis, care can be guided by the application of level I evidence for the treatment of brain metastasis in general and phase II studies focusing specifically on mela-noma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future.
The Use of Sociocultural Constructs in Cancer Screening Research Among African Americans
Authors: Deshpande Anjali D. , Thompson Vetta L. Sanders , Vaughn Kimberlee P. , Kreuter Matthew W.
Published: August 2017

Background

Studies are increasingly examining the role of sociocultural values, beliefs, and attitudes in cancer prevention. However, these studies vary widely in how sociocultural constructs are defined and measured, how they are conceived as affecting cancer beliefs, behaviors, and screening, and how they are applied in interventions.

Methods

To characterize the current state of this research literature, we conducted a critical review of studies published between 1990 and 2006 to describe the current use of sociocultural constructs in cancer screening research among African Americans. We included quantitative and qualitative studies with cancer as a primary focus that included African American participants, assessed screening behaviors, reported race-specific analyses, and considered one or more sociocultural factors. Studies were evaluated for type of cancer and screening analyzed, study population, methodology, sociocultural constructs considered, definitions of constructs, provision of psychometric data for measures, and journal characteristics.

Results

Of 94 studies identified for review, 35 met the inclusion criteria and were evaluated. Most focused on breast cancer screening, and thus African American women. Sociocultural constructs were seldom clearly defined, and the sources and psychometric properties of sociocultural measures were rarely reported.

Conclusions

A multidisciplinary approach to developing a common language and a standardized set of measures for sociocultural constructs will advance research in this area. Specific recommendations are made for future research.
Elastography for the Characterization of Breast Lesions: Initial Clinical Experience
Authors: Kumm Todd R. , Szabunio Margaret M.
Published: August 2017

Background

While breast biopsy remains the gold standard for diagnosis of suspicious lesions, a large proportion of biopsy specimens reveal a benign result. Therefore, a noninvasive and reliable method to identify low-risk lesions would be a valuable tool.

Methods

We assessed the application and diagnostic performance of elastography for the characterization of breast lesions in patients referred for biopsy. Subjects referred for ultrasound-guided biopsy of sonographically apparent breast lesions were included in this study. The Hitachi Hi-Vision 900 ultrasound was used to generate index test results for elastography scoring (ES) and for strain ratio (SR) measurement. Sensitivity, specificity, and positive and negative predictive values were determined using pathologic results from 14-gauge core needle biopsy as the reference standard.

Results

A total of 310 lesions in 288 patients were included in this series. Of these 310 lesions, 223 (72%) were benign and 87 (28%) were malignant. Sensitivity was 0.76 for ES and 0.79 for SR. Specificity was 0.81 for ES and 0.76 for SR. Positive predictive value was 0.60 for ES and 0.57 for SR. Negative predictive value was 0.90 for ES and 0.90 for SR. SR values for malignant lesions were significantly higher (median ratios 10.5 and 2.7, respectively, P < .001).

Conclusions

While the initial clinical performance of elastography imaging shows potential to reduce biopsy of low-risk lesions, a large-scale trial addressing appropriate patient selection, diagnostic parameters, and practical application of this technique is necessary prior to widespread clinical use.
Developing an Effective Breast Cancer Vaccine
Authors: Soliman Hatem
Published: August 2017

Background

Harnessing the immune response in treating breast cancer would potentially offer a less toxic, more targeted approach to eradicating residual disease. Breast cancer vaccines are being developed to effectively train cytotoxic T cells to recognize and kill transformed cells while sparing normal ones. However, achieving this goal has been problematic due to the ability of established cancers to suppress and evade the immune response.

Methods

A review of the literature on vaccines and breast cancer treatment was conducted, specifically addressing strategies currently available, as well as appropriate settings, paradigms for vaccine development and response monitoring, and challenges with immunosuppression.

Results

Multiple issues need to be addressed in order to optimize the benefits offered by breast cancer vaccines. Primary issues include the following: (1) cancer vaccines will likely work better in a minimal residual disease state, (2) clinical trial design for immunotherapy should incorporate recommendations from expert groups such as the Cancer Vaccine Working Group and use standardized immune response measurements, (3) the presently available cancer vaccine approaches, including dendritic cell-based, tumor-associated antigen peptide-based, and whole cell-based, have various pros and cons, (4) to date, no one approach has been shown to be superior to another, and (5) vaccines will need to be combined with immunoregulatory agents to overcome tumor-related immunosuppression.

Conclusions

Combining a properly optimized cancer vaccine with novel immunomodulating agents that overcome tumor-related immunosuppression in a well-designed clinical trial offers the best hope for developing an effective breast cancer vaccine strategy.
Accelerated Partial Breast Irradiation: Potential Roles following Breast-Conserving Surgery
Authors: Biagioli Matthew C. , Harris Eleanor E.R.
Published: August 2017

Background

Multiple randomized trials comparing mastectomy to lumpectomy and whole breast irradiation (WBI) have shown equivalent survival outcomes in early-stage breast cancer. WBI requires a treatment course of several weeks, which has resulted in limited access to breast-conserving therapy in certain populations. A shorter accelerated course of partial breast irradiation (APBI) has been investigated recently.

Methods

This article reviews the current medical literature, including randomized trials and prospective institutional studies of APBI and the current recommendations regarding the use of this emerging technique.

Results

Several APBI techniques have been developed, including brachytherapy and external beam methods. The longest follow-up data are available for multicatheter interstitial brachytherapy, a technique that is not commonly used. Other methods, including balloon brachytherapy and external beam three-dimensional conformal techniques, have limited follow-up that shows similar local control rates to whole breast irradiation in highly selected patients. Guidelines for the appropriate use of APBI have been published.

Conclusions

While APBI may increase access to breast conservation therapy for some women with early-stage breast cancer, follow-up data demonstrating the efficacy of this relatively new treatment approach are limited. Therefore, strict evidence-based selection criteria should be applied when evaluating patients who may be appropriate for APBI.
Premalignant and Malignant Prostate Lesions: Pathologic Review
Authors: Dickinson Shohreh Iravani
Published: August 2017

Background

High-grade prostatic intraepithelial neoplasia (HGPIN) is currently the only recognized premalignant lesion of prostatic carcinoma.

Methods

This review article discusses HGPIN, its link to prostatic adenocarcinoma, and the significance of its presence on needle biopsy. The criteria and clinical impact of the diagnosis of atypical small acinar proliferation on needle biopsy are reviewed. Certain subtypes of prostate cancer that are not associated with HGPIN are of clinical relevance, and the unique clinicopathologic features of these subtypes are discussed. Histologic variants of prostatic adenocarcinoma with distinct cell types are also described.

Results

HGPIN is the only known pathologic factor currently available to distinguish which patients may be at risk for detecting carcinoma on repeat biopsy. Histologic variants are recognized due to the inference of a particular Gleason grade pattern associated with the cell type, hence affecting prognosis. Typically, pure forms of these histologic variants are associated with worse prognosis due to the associated high Gleason grades.

Conclusions

HGPIN has a strong association with acinar-type prostatic adenocarcinoma. HGPIN and acinar-type prostatic adenocarcinoma both show similar molecular alterations, providing further evidence of their association.
A Review of Cost-Effectiveness Studies in Ovarian Cancer
Authors: Sfakianos Gregory P. , Havrilesky Laura J.
Published: August 2017

Background

Ovarian cancer is the fifth leading cause of all cancer-related deaths among women. While the costs of diagnosis and treatment impact the affected individual and the health system, the most important costs for the patient are often the pain and suffering associated with ovarian cancer. The quality of life associated with any management decision should be closely examined. Costeffectiveness models take into account costs, effects, and quality of life and provide clinicians with useful tools to aid in making these difficult decisions.

Methods

A comprehensive review of costeffectiveness analyses was undertaken concerning screening for and treatment of ovarian cancer.

Results

Screening methods to detect ovarian cancer are unproven, and the majority of women present with advanced-stage disease. Multimodal screening strategies with high specificities targeted at the highest-risk individuals are the most likely strategies to be cost-effective. Primary treatment with intravenous paclitaxel and platinum regimens has proven to be cost-effective in multiple studies. Studies evaluating intraperitoneal chemotherapy show that this strategy is potentially cost-effective over a long-term time horizon. A costeffectiveness analysis of the management of recurrent platinum-sensitive ovarian cancer showed that treatment with carboplatin and paclitaxel is cost-effective compared to single-agent therapy. However, the preferred option for patients with recurrent platinum-resistant ovarian cancer appears to be supportive care (no chemotherapy) or single-agent therapy.

Conclusions

Many therapeutic choices are cost-effective in the treatment of ovarian cancer. Costeffectiveness models offer one way to examine options in the management of a disease. The quality of life of the patient should be the most important factor in any management decision and is incorporated into well-designed studies on costeffectiveness.
Clinical Aspects of Monoclonal B-Cell Lymphocytosis
Authors: Mowery Yvonne M. , Lanasa Mark C.
Published: August 2017

Background

Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic precursor condition for chronic lymphocytic leukemia (CLL). It is defined by the presence of small clones of aberrant B cells in the peripheral blood, with a total B-cell count below the threshold for diagnosis of CLL (< 5.0 x 109 cells/L).

Methods

The authors review current literature on the prevalence of MBL, and the clinical course of this CLL precursor condition, and recommended management for individuals with MBL.

Results

MBL occurs in approximately 4% to 5% of healthy adults. While most cases of CLL are preceded by MBL, progression to leukemia requiring CLL treatment occurs in only 1% to 2% of individuals with MBL per year. The absolute B-cell count is most strongly associated with progression, and patients with low-count MBL identified in population screening studies rarely develop CLL. Studies are ongoing to better define the relationship between MBL and CLL and to identify prognostic indicators that predict which patients will progress to CLL. Given their elevated risk of developing malignancy, individuals with clinical MBL should be monitored at least annually for progressive lymphocytosis and signs or symptoms of CLL.

Conclusions

Many of the epidemiologic and genetic factors associated with MBL development and its progression to CLL have not yet been identified. However, ongoing studies by many research groups are aimed at answering these questions to facilitate management of individuals with this premalignant condition. In addition, active investigation of MBL will likely yield new insights into the biology of CLL, potentially identifying new therapeutic targets for this incurable disease.
Treatment of Relapsed or Refractory Chronic Lymphocytic Leukemia
Authors: Veliz Marays , Pinilla-Ibarz Javier
Published: August 2017

Background

Recent advances in the treatment of chronic lymphocytic leukemia (CLL) have moved beyond the traditional use of alkylating agents and purine analogs into regimens combining these two chemotherapy classes with monoclonal antibodies.

Methods

This article reviews treatments options for patients with relapsed or refractory CLL.

Results

Several studies have investigated novel agents in treating patients with 17p deletion, TP53 mutation, and fludarabine-refractory CLL, as well as patients with suboptimal response to intense treatment. These investigational agents include rituximab, alemtuzumab, ofatumumab, bendamustine, high-dose methylprednisolone, lenalidomide, lumiliximab, cyclin-dependent kinase inhibitors, small modular immunopharmaceuticals, Bcl-2 inhibitors, and histone deacetylase inhibitors. While these newer drugs and combination therapies have shown promise as treatment options for CLL, additional studies are needed to determine the immunosuppression, toxicities, and infections associated with their use.

Conclusions

Despite improvement in initial overall response rates, most patients relapse and require further treatment. CLL remains incurable with standard therapies due to development of disease refractoriness. As such, novel approaches such as those noted above warrant continued research to improve outcomes for patients with CLL.
Diagnostic Imaging and Image-Guided Therapy of Skeletal Metastases
Authors: Choi Junsung , Raghavan Meera
Published: August 2017

Background

The high incidence of skeletal metastases in cancer patients warrants careful detection with imaging and follow-up. Efforts are needed to manage pain associated with skeletal metastases as part of overall patient management.

Methods

This article reviews the current methods of diagnostic imaging in the evaluation of skeletal metastases and image-guided treatment of bone metastases for the palliation of pain based primarily on the assessment of imaging and interventional radiologic literature.

Results

Approaches to diagnostic imaging of skeletal metastases are summarized. Skeletal scintigraphy provides high sensitivity for detecting skeletal metastases, but targeted computed tomography (CT) or magnetic resonance imaging (MRI) may be needed to increase specificity. Newer imaging modalities, such as positron emission tomography (PET)/CT, improve detection of both lytic and blastic metastases. Minimally invasive percutaneous ablative treatment techniques, including radiofrequency ablation, microwave ablation, and cryoablation, are examined. They provide alternative approaches to radiation therapy to effectively palliate pain of bone metastases. Preliminary results of MR-guided focused ultrasound surgery (MRgFUS) demonstrate its effectiveness in palliating pain from skeletal metastases.

Conclusions

Skeletal scintigraphy is the most common imaging modality for detecting skeletal metastases. Additional imaging may be required based on the type of tumor, the disease state, or treatment options. External-beam radiation therapy remains the mainstay for palliation of pain from bone metastases. Alternative minimally invasive and noninvasive image-guided treatment options can provide effective pain palliation.
Beyond the Conventional Role of External-Beam Radiation Therapy for Skeletal Metastases: New Technologies and Stereotactic Directions
Authors: Michael Hsiang-Hsuan , Hoffe Sarah E.
Published: August 2017

Background

Radiation therapy is a common and effective treatment modality in the management of skeletal metastases. Recent advances in technology permitting delivery of an ablative radiation dose with an image-guided stereotactic approach improve the therapeutic threshold.

Methods

The authors reviewed the literature on conventional external-beam radiation therapy and summarized the emerging data about image-guided stereotactic body radiation therapy (SBRT) for vertebral oligometastasis.

Results

Pain control can be achieved effectively with conventional external-beam radiation therapy and may be further improved with image-guided spinal SBRT. Image-guided SBRT allows delivery of an ablative radiation dose with minimal toxicity, may potentially improve local tumor control, and may enhance clinical outcomes for histologies that are considered radioresistant. However, further understanding of long-term normal tissue toxicity is lacking.

Conclusions

Radiotherapy options are expanding for patients with skeletal metastases. Image-guided spinal SBRT can deliver a safe ablative radiation dose to improve pain control and potentially local tumor control. Randomized clinical trials are ongoing to assess clinical benefits and outcome with spinal SBRT.
Systemic Therapy for Bone Metastases
Authors: Loftus Loretta S. , Edwards-Bennett Sophia , Sokol Gerald H.
Published: August 2017

Background

Accelerated bone loss in patients with cancer is a frequent problem that may result from invasion of the cancer to bone, paraneoplastic tumor proteins, and/or hormonal therapies utilized for cancer treatment. Patients with osteolytic bone disease from multiple myeloma and bone metastases from solid tumors may develop a vicious cycle of bone destruction involving both osteolytic and osteoblastic effects. Consequently, a variety of skeletal-related events (SREs) may occur, including pathological fractures, hypercalcemia, spinal cord compression, and the need for surgical intervention and radiation therapy.

Methods

This article reviews the results of trials that investigated the safety and efficacy of pharmacologic agents, including bisphosphonates and denosumab, for treatment of bone metastases. This analysis is derived from an assessment of the medical literature.

Results

Beneficial systemic therapies for bone metastases have been developed to decrease SREs. Possible antitumor effects of the bisphosphonates are explored. In addition, the utility of markers of bone turnover in relation to response to therapy and survival, the safety and toxicity of bone-targeted therapies, treatment guidelines, and economic considerations are also discussed.

Conclusions

Effective systemic therapies for metastatic bone disease are available. Ongoing and future research projects in this field are also presented.
Evolving Treatment Paradigms for Chemotherapy-Induced Nausea and Vomiting
Authors: Wickham Rita
Published: August 2017

Background

Chemotherapy-induced nausea and vomiting (CINV) is one of the most debilitating toxicities associated with cancer treatment. Although effective antiemetic agents are available, their use in practice often is suboptimal.

Methods

The author reviews the pathophysiology of CINV as well as the drug classes and cost considerations that should be incorporated into treatment planning.

Results

Several drug classes, including 5-hydroxytryptamine-3 receptor antagonists, neurokinin-1 receptor antagonists, and corticosteroids, are effective, especially when used in combination. Older antiemetic agents, such as prochlorperazine and metoclopramide, as well as olanzapine may provide reasonable alternatives in certain settings.

Conclusions

Interventions for CINV should include standard-of-care antiemetics combined with corticosteroids. The cost of using older, less expensive antiemetics may be outweighed by the expenditures to rescue patients after suboptimal prophylaxis, as well as the indirect costs of missed work and lost productivity.
Patient-Centered Management of Chemotherapy-Induced Nausea and Vomiting
Authors: Grunberg Steven
Published: August 2017

Background

Oncology providers frequently underestimate the incidence of chemotherapy-induced nausea and vomiting (CINV), and patients often are reluctant to report symptoms. Inadequate patient-provider communication is a significant barrier to optimal management of this debilitating toxicity.

Methods

The author reviews relevant published data and methods to optimize the clinical care of patients receiving chemotherapy with moderate-to-high emetogenic potential.

Results

Patient reticence plus physician expectations that patients will report symptoms accurately lead to lapses in communication and suboptimal clinical care.

Conclusions

Communication strategies should serve to encourage patients to share the responsibility for establishing goals of therapy and understanding the risks and benefits of their selected antiemetic regimen, thereby becoming active participants in their own cancer care.
Primary Bladder Preservation Treatment for Urothelial Bladder Cancer
Authors: Biagioli Matthew C. , Fernandez Daniel C. , Spiess Philippe E. , Wilder Richard B.
Published: August 2017

Background

Significant advancements have occurred in surgical procedures and chemoradiation therapy for bladder preservation.

Methods

This review addresses primary treatment options for bladder cancer, including an overview of bladder-sparing strategies.

Results

Surgical series demonstrate that highly selected patients with cT2N0M0 urothelial bladder cancers can be managed with partial cystectomy and bilateral pelvic lymphadenectomy. For patients with cT2N0M0 to cT4aN0M0 urothelial bladder cancers, neoadjuvant chemotherapy followed by radical cystectomy or maximal transurethral resection of the bladder tumor (TURBT) followed by chemoradiation therapy results in equivalent survival rates. However, each treatment option has a different impact on quality of life. Current chemoradiation therapy trials are evaluating novel approaches to improve outcomes.

Conclusions

Maximal TURBT followed by chemoradiation therapy demonstrated equivalent survival with radical cystectomy while preserving bladder function in the majority of patients. Future efforts will be directed toward improving survival and quality of life.
Targeted Therapy of Kidney Cancer: Keeping the Art around the Algorithms
Authors: Fishman Mayer N.
Published: August 2017

Background

Therapy for metastatic kidney cancer is actively evolving, particularly in the results of registration drug trials that have led to the approval of vascular endothelial growth factor pathway drugs such as sorafenib, sunitinib, pazopanib, bevacizumab, and axitinib, with focus on patients with good- or intermediate-risk criteria and clear cell histology. Mammalian target of rapamycin (mTOR) drugs such as everolimus and temsirolimus pivotal trials emphasize experiences in the setting of prior treatment or high-risk features. Interferon and interleukin 2 also are part of the treatment algorithms.

Methods

The results of pivotal trials and the underlying context for the development of a cogent, cohesive treatment plan for an individual are reviewed, touching on decision points such as nephrectomy, metastasectomy, and medical initiation and discontinuation time points.

Results

To the extent that these drug therapies are essential for achieving best outcomes for patients, these pivotal trial results and associated guidelines exist within a multidimensional, multidisciplinary context of many other disease features, comorbid features, and non-drug treatment decisions. Other dimensions include investigational targeted therapies, patient selection strategies, surgical strategies, and immunotherapies, some of which are in active development.

Conclusions

Clinicians should work toward the best use of drug sequencing and selection strategies based on core data derived from prospective randomized trials. To address individual patient needs, they should also recognize and emphasize individualized goals, to the extent that these are different from issues that were directly addressed in the trials.
Biomarkers in Hematological Malignancies: A Review of Molecular Testing in Hematopathology
Authors: Hussaini Mohammad
Published: August 2017

Background

Molecular interrogation of genetic information has transformed our understanding of disease and is now routinely integrated into the workup and monitoring of hematological malignancies. In this article, a brief but comprehensive review is presented of state-of-the-art testing in hematological disease.

Methods

The primary medical literature and standard textbooks in the field were queried and reviewed to assess current practices and trends for molecular testing in hematopathology by disease.

Results

Pertinent materials were summarized under appropriate disease categories.

Conclusion

Molecular testing is well entrenched in the diagnostic and therapeutic pathways for hematological malignancies, with rapid growth and insights emerging following the integration of next-generation sequencing into the clinical workflow.
Overexpression of Vascular Endothelial Growth Factor A in Invasive Micropapillary Colorectal Carcinoma
Authors: Rosa Marilin , Abdelbaqi Maisoun , Bui Katherine M. , Nasir Aejaz , Bui Marilyn M. , Shibata David , Coppola Domenico
Published: August 2017

Background

Invasive micropapillary carcinoma (IMPC) is a rare variant of colorectal cancer with an adverse prognosis. “Retraction artifact” around tumor cells is a feature of IMPC. The aim of this study was to assess the nature of the retractions around the tumor cells and to describe the histopathological features of a group of 18 cases of IMPC.

Methods

A pathology review of 128 consecutive colorectal cancers identified 18 cases of histologically proven IMPC using 5% of the total tumor volume comprised of a micropapillary component as the diagnostic criterion. Immunostains for D2–40, CD31, CD34, vascular endothelial growth factor A (VEGF-A), and mucin 1 (MUC-1) were performed using the avidin-biotin complex method.

Results

Cases of IMPC were characterized by pseudomicropapillae surrounded by lacunar-like clear spaces. These structures exhibited the inside-out growth pattern as highlighted by MUC-1 staining. The lining of the lacunar spaces was immunoreactive to CD31 but not CD34 or D2–40, indicating that they are neovascular structures. Furthermore, the tumor cells strongly and diffusely expressed VEGF-A.

Conclusions

The strong coexpression of VEGF-A and CD31 suggests a prominent role of neoangiogenesis in these tumors.
Effect of Age on Clinical Outcomes in Phase 1 Trial Participants
Authors: Mahipal Amit , Denson Aaron C. , Djulbegovic Benjamin , Lush Richard , Kumar Ambuj , Juan Tzu-Hua , Schell Michael J. , Sullivan Daniel M.
Published: August 2017

Background

Most persons with cancer living in the United States are older than 65 years of age; however, in general, elderly persons are under-represented in clinical trials and outcomes data are lacking.

Methods

Outcomes data were analyzed of elderly participants (≥ 65 years of age) enrolled in phase 1 clinical trials and the results compared with those of younger patients. All consecutive, single-center, phase 1 oncology trials initiated and completed at the H. Lee Moffitt Cancer Center & Research Institute between 1997 and 2007 were included. Patient data (including survival, response, and toxicity rates) were extracted from a cancer registry database and electronic medical records at Moffitt Cancer Center.

Results

After excluding multi-institution trials, we analyzed 39 trials for a total of 1,162 enrolled study participants, 32.7% of whom were elderly. Among patients who underwent transplantation, median survival rates were worse in those who were elderly compared with those who were younger (44.9 vs 32.9 months; P = .0037). However, in the no-transplantation setting, participants who were elderly had a median survival rate of 10.9 months (95% confidence interval [CI]: 8.9–13.1) compared with 8.8 months (95% CI: 7.9–10.3) in those who were younger (P = .15). Both groups had similar overall response rates (15.2% vs 13.1%) and similar treatment-related mortality rates (1% vs 0.9%, respectively). Adverse events occurring among the elderly and younger participants were not statistically significant.

Conclusions

Survival, response, toxicity, and treatment-related mortality rates were not significantly different between the elderly and younger phase 1 trial participants in the no-transplantation setting. Regardless of the complex pharmacological profiles and logistical issues involved in treating the elderly population, our data imply that elderly study participants do at least as well as their younger counterparts, contributing to the justification of increasing the phase 1 trial enrollment of elderly patients.
Local Ablation for Solid Tumor Liver Metastases: Techniques and Treatment Efficacy
Authors: Wong Joyce , Cooper Amanda
Published: August 2017

Background

Treatment options for liver metastases from solid tumors, such as colon cancer, breast cancer, neuroendocrine tumors, and sarcomas, have expanded in recent years and now include nonresection methods.

Methods

The literature focused on the treatment of liver metastases was reviewed for technique, perioperative, and long-term outcomes specifically related to local ablation techniques for liver metastases.

Results

Ablation modalities have become popular as therapies for patients who are not appropriate candidates for surgical resection. Use of these techniques, alone or in combination with other liver-directed therapies (and often systemic therapy), has extended the rate of survival for patients with liver metastases and, at times, offers nearly equivalent disease-free survival rates to surgical resection.

Conclusions

Although surgical resection remains the optimal treatment for liver metastasis, local options, including microwave ablation and radiofrequency ablation, can offer similar long-term local control in appropriately selected patients.
Exploring the Perceptions of Anal Cancer Screening and Behaviors among Gay and Bisexual Men Infected with HIV
Authors: Koskan Alexis M. , Leblanc Natalie , Rosa-Cunha Isabella
Published: August 2017

Background

The incidence of anal cancer is on the rise among HIV-infected men who have sex with men (MSM). Given the increasing availability of screening, this study explored anal cancer screening awareness and behaviors among MSM infected with HIV.

Methods

In-depth interviews were conducted with 58 MSM infected with HIV.

Results

Other than 2 participants treated for anal cancer and 3 treated for precancerous anal lesions, the majority of participants had never heard of anal cancer. Men reported lack of awareness and recommendations from their health care professionals as the greatest barriers to screening. Upon learning about their risk for anal cancer and the availability of screening, the men were eager to discuss screening with their physicians. Participants provided numerous recommendations for future interventions, including training health care professionals to promote screening, disseminating information pertaining to anal cancer through social networks, and creating media campaigns to raise awareness about the need to screen for this type of cancer.

Conclusions

Future intervention work should focus on ensuring that health care professionals, particularly among HIV/primary care specialists, promote screening for anal dysplasia. It is critical that intervention methods use a community-based approach to raise awareness about the need to screen for anal cancer, especially among MSM infected with HIV.
Genetic Investigation of Uterine Carcinosarcoma: Case Report and Cohort Analysis
Authors: Hembree Timothy N. , Teer Jamie K. , Hakam Ardeshir , Chiappori Alberto A.
Published: August 2017

Background

Uterine carcinosarcoma, a rare gynecological malignancy, often presents at the advanced stage with a poor prognosis because current therapies have not improved rates of survival. Genetic characterization of this tumor may lead to novel, specifically targeted drug targets to provide better treatment options for patients with this malignancy.

Methods

We present a case of a woman aged 61 years with uterine carcinosarcoma and retrospectively analyzed 100 study patients with uterine carcinosarcoma. From this group, 9 study patients underwent targeted sequencing of 1,321 genes.

Results

All 9 study patients had at least 1 mutation in JAK2, KRAS, PIK3CA, CTNNB1, PTEN, FBXW7, TP53, and ERBB2; of these, TP53 was the most frequently mutated gene (6/9). In addition, ARID1A and KMT2C, which have been described and identified as part of a set of chromatin-remodeling genes, were also found in our analyses. From our 100-person cohort clinical analyses, study patients with stage 1 cancer had a median survival rate of 33 months (95% confidence interval, 19–109) compared with a median survival rate of 6 months (95% confidence interval, 3–12) in those with stage 4 disease.

Conclusions

Disease stage alone predicted the rate of clinical survival. Up to 50% in the study group were identified at having early stage disease (stage 1/2), indicating improved rates of overall detection compared with previously reported data. Our mutational analysis findings add to the number of tumors in which these mutations have been found and suggest that chromatin-remodeling dysregulation may play a role in the tumorigenesis of carcinosarcoma.
Definitive Radiotherapy for Squamous Cell Carcinoma of the Glottic Larynx
Authors: Mendenhall William M. , Dagan Roi , Bryant Curtis M. , Amdur Robert J. , Mancuso Anthony A.
Published: August 2017

Background

Depending on the extent of disease, squamous cell carcinoma (SCC) of the glottis is managed with surgery, radiotherapy (RT), or a combination of these modalities. Patients with advanced disease may receive concomitant chemotherapy in conjunction with definitive or postoperative RT.

Methods

The treatment policies of the University of Florida and patient outcomes are reviewed.

Results

The likelihood of cure after RT for carcinoma in situ (Tis) to T2 glottic SCC varies from 70% to 94% depending on tumor stage. Consideration should be given to adding weekly cisplatin for patients with T2b SCC because of the high local recurrence rate after RT alone. The probability of cure is about 65% to 80% for select low-volume (≤ 3.5 cc) T3 to T4 glottic SCC after RT. These patients should be considered for concomitant weekly cisplatin. Higher-volume tumors, particularly those with airway compromise, should be treated with laryngectomy and postoperative RT.

Conclusion

Definitive RT is an excellent treatment for select patients with laryngeal cancer.
Multidisciplinary Management of Salivary Gland Cancers
Authors: Mifsud Matthew J. , Burton Jon N. , Trotti Andy M. , Padhya Tapan A.
Published: August 2017

Background

Salivary carcinomas are a rare group of biologically diverse neoplasms affecting the head and neck. The wide array of different histological entities and clinical presentations has historically limited attempts to establish well-defined treatment algorithms. In general, low-risk lesions can be managed with a single treatment modality, whereas advanced lesions require a more complex, multidisciplinary approach.

Methods

The relevant literature was reviewed, focusing on diagnostic and treatment algorithms for salivary malignancies.

Results

Salivary carcinomas with high-risk features require an aggressive treatment approach with complete surgical resection, neck dissection to appropriate cervical lymph-node basins, and postoperative radiotherapy.

Conclusions

The heterogeneity of salivary neoplasms represents a unique clinical challenge. Despite the multidisciplinary management paradigm detailed in this review, outcomes for advanced disease are unsatisfactory. Future progress will likely require the addition of novel systemic therapeutic strategies.
Diffuse Alveolar Hemorrhage in Acute Myeloid Leukemia
Authors: Nanjappa Sowmya , Jeong Daniel K. , Muddaraju Manjunath , Jeong Katherine , Hill Eboné D. , Greene John N.
Published: August 2017

Diffuse alveolar hemorrhage is a potentially fatal pulmonary disease syndrome that affects individuals with hematological and nonhematological malignancies. The range of inciting factors is wide for this syndrome and includes thrombocytopenia, underlying infection, coagulopathy, and the frequent use of anticoagulants, given the high incidence of venous thrombosis in this population. Dyspnea, fever, and cough are commonly presenting symptoms. However, clinical manifestations can be variable. Obvious bleeding (hemoptysis) is not always present and can pose a potential diagnostic challenge. Without prompt treatment, hypoxia that rapidly progresses to respiratory failure can occur. Diagnosis is primarily based on radiological and bronchoscopic findings. This syndrome is especially common in patients with hematological malignancies, given an even greater propensity for thrombocytopenia as a result of bone marrow suppression as well as the often prolonged immunosuppression in this patient population. The syndrome also has an increased incidence in individuals with hematological malignancies who have received a bone marrow transplant. We present a case series of 5 patients with acute myeloid leukemia presenting with diffuse alveolar hemorrhage at our institution. A comparison of clinical manifestations, radio-graphic findings, treatment course, and outcomes are described. A review of the literature and general overview of the diagnostic evaluation, differential diagnoses, pathophysiology, and treatment of this syndrome are discussed.
Resection of the First Rib with Preservation of the T1 Nerve Root in Pancoast Tumors of the Lung
Authors: Filis Andreas K. , Robinson Lary A. , Vrionis Frank D.
Published: August 2017

Background

Surgical outcomes for Pancoast (superior sulcus) tumors of the lung have significantly changed during the last few decades and have improved with use of curative-intent surgery by utilizing en bloc complete resections.

Methods

A retrospective analysis was conducted of 11 selected patients treated at Moffitt Cancer Center from 2007 to 2016. Data from patient records were collected and analyzed.

Results

All 11 patients with a Pancoast tumor involving the first rib had their T1 root preserved at surgery. In 10 patients (90.9%), the tumor was removed en bloc. Clear margins of resection were documented in 4 cases (36.0%). No patient developed postoperative hand weakness, but 3 patients (27.3%) had minor postoperative complications, including air leak, chylothorax, and pericardial effusion. One iatrogenic injury to the subclavian artery was reported during surgery; the injury was subsequently repaired. No operative mortality was reported.

Conclusions

Radical resection of Pancoast tumors is considered to be safe, and preserving the T1 nerve root provides more favorable, functional outcomes.
Hypofractionated Stereotactic Radiotherapy for Auditory Canal or Middle Ear Cancer
Authors: Murai Taro , Kamata Shin-Etsu , Sato Kengo , Miura Kouki , Inoue Mitsuhiro , Yokota Naoki , Ohta Seiji , Iwabuchi Michio , Iwata Hiromitsu , Shibamoto Yuta
Published: August 2017

Background

Stereotactic radiotherapy (SRT) may represent a new treatment option for individuals with auditory canal or middle ear cancer.

Methods

Study participants with pathologically proven ear cancer were treated with SRT (35 Gy for 3 fractions or 40 Gy for 5 fractions) as first-line therapy. When local tumor recurrence developed following SRT, subtotal temporal bone resection and postoperative chemoradiotherapy were performed as salvage treatment. Boluses were used for the initial 14 study patients.

Results

Twenty-nine study participants were enrolled and staged with T1 (n = 3), T2 (n = 7), T3 (n = 14), or T4 disease (n = 5). Three-year overall survival rates were 69% for T1/2 disease, 79% for T3 disease, and 0% for T4 disease. Three-year local control rates were 70% for T1/2 disease, 50% for T3 disease, and 20% for T4 disease. Grade 2 or higher dermatitis or soft-tissue necrosis occurred more frequently in study patients treated with boluses (8/14 vs 2/15; P = .02). Salvage treatment was safely performed for 12 recurrent cases.

Conclusions

These results suggest that SRT outcomes are promising for patients with ear cancer (≤ T3 disease). The rate of toxicity was acceptable in the study patients treated without boluses. Outcomes of salvage surgery and postoperative radiotherapy following SRT were also encouraging.
Racial and Ethnic Differences in the Epidemiology and Genomics of Lung Cancer
Authors: Schabath Matthew B. , Cress W. Douglas , Muñoz-Antonia Teresita
Published: August 2017

Background

Lung cancer is the most common cancer in the world. In addition to the geographical and sex-specific differences in the incidence, mortality, and survival rates of lung cancer, growing evidence suggests that racial and ethnic differences exist.

Methods

We reviewed published data related to racial and ethnic differences in lung cancer.

Results

Current knowledge and substantive findings related to racial and ethnic differences in lung cancer were summarized, focusing on incidence, mortality, survival, cigarette smoking, prevention and early detection, and genomics. Systems-level and health care professional–related issues likely to contribute to specific racial and ethnic health disparities were also reviewed to provide possible suggestions for future strategies to reduce the disproportionate burden of lung cancer.

Conclusions

Although lung carcinogenesis is a multifactorial process driven by exogenous exposures, genetic variations, and an accumulation of somatic genetic events, it appears to have racial and ethnic differences that in turn impact the observed epidemiological differences in rates of incidence, mortality, and survival.
Genomic Disparities in Breast Cancer among Latinas
Authors: Lynce Filipa , Graves Kristi D. , Jandorf Lina , Ricker Charité , Castro Eida , Moreno Laura , Augusto Bianca , Fejerman Laura , Vadaparampil Susan T.
Published: August 2017

Background

Breast cancer is the most common cancer diagnosed among Latinas in the United States and the leading cause of cancer-related death among this population. Latinas tend to be diagnosed at a later stage and have worse prognostic features than their non-Hispanic white counterparts. Genetic and genomic factors may contribute to observed breast cancer health disparities in Latinas.

Methods

We provide a landscape of our current understanding and the existing gaps that need to be filled across the cancer prevention and control continuum.

Results

We summarize available data on mutations in high and moderate penetrance genes for inherited risk of breast cancer and the associated literature on disparities in awareness of and uptake of genetic counseling and testing in Latina populations. We also discuss common genetic polymorphisms and risk of breast cancer in Latinas. In the treatment setting, we examine tumor genomics and pharmacogenomics in Latina patients with breast cancer.

Conclusions

As the US population continues to diversify, extending genetic and genomic research into this underserved and understudied population is critical. By understanding the risk of breast cancer among ethnically diverse populations, we will be better positioned to make treatment advancements for earlier stages of cancer, identify more effective and ideally less toxic treatment regimens, and increase rates of survival.
Clinical Considerations of Risk, Incidence, and Outcomes of Breast Cancer in Sexual Minorities
Authors: Mattingly Anne E. , Kiluk John V. , Lee M. Catherine
Published: August 2017

Background

Breast cancer is a leading cause of cancer-related mortality in women. Limited research exists on the impact of sexual orientation on overall risk of and mortality from breast cancer. We sought to summarize the medical literature on breast cancer in sexual minority women and identify possible disparities in this population.

Methods

A comprehensive literature search was conducted for English-language studies in peer-reviewed medical journals that referenced breast cancer and sexual minority, lesbian, bisexual, or transgender individuals. Articles published between January 2000 and November 2015 were included. They were reviewed for relevance to breast cancer risk stratification, breast cancer mortality, breast reconstruction, and transgender issues.

Results

Behavioral risks, reproductive risks, and risks associated with decreased access to health care may all affect outcomes for sexual minorities with breast cancer. Limited studies have mixed results regarding mortality associated with breast cancer in sexual minorities due to an inconsistent reporting of sexual orientation.

Conclusions

Overall, the research examining breast cancer in sexual minority women remains limited. This finding is likely due to limitations in the reporting of sexual orientation within large databases, thus making broader-scale research difficult.
Construction and Validation of a Multi-Institutional Tissue Microarray of Invasive Ductal Carcinoma from Racially and Ethnically Diverse Populations
Authors: Seijo Edward , Lima Diana , Iriabho Egiebade , Almeida Jonas , Monico Jesus , Echeverri Margarita , Gutierrez Sylvia , Flores Idhaliz , Lee Ji-Hyun , Fisher Kate , Grizzle William E. , Sica Gabriel L. , Butler Charles , Hicks Chindo , Meade Cathy D. , Sodeke Stephen Olufemi , Moroz Krzysztof , Coppola Domenico , Muñoz-Antonia Teresita
Published: August 2017

Background

The scarcity of tissues from racial and ethnic minorities at biobanks poses a scientific constraint to research addressing health disparities in minority populations.

Methods

To address this gap, the Minority Biospecimen/Biobanking Geographic Management Program for region 3 (BMaP-3) established a working infrastructure for a “biobanking” hub in the southeastern United States and Puerto Rico. Herein we describe the steps taken to build this infrastructure, evaluate the feasibility of collecting formalin-fixed, paraffin-embedded tissue blocks and associated data from a single cancer type (breast), and create a web-based database and tissue microarrays (TMAs).

Results

Cancer registry data from 6 partner institutions were collected, representing 12,408 entries from 8,279 unique patients with breast cancer (years 2001–2011). Data were harmonized and merged, and deidentified information was made available online. A TMA was constructed from formalin-fixed, paraffin-embedded samples of invasive ductal carcinoma (IDC) representing 427 patients with breast cancer (147 African Americans, 168 Hispanics, and 112 non-Hispanic whites) and was annotated according to biomarker status and race/ethnicity. Biomarker analysis of the TMA was consistent with the literature.

Conclusions

Contributions from participating institutions have facilitated a robust research tool. TMAs of IDC have now been released for 5 projects at 5 different institutions.