bluuebunny/crossref_metadata_2025 huggingface dataset:
Storytelling for Promoting Colorectal Cancer Screening among Underserved Latina Women: A Randomized Pilot Study
Authors: Larkey Linda K. , Lopez Ana Maria , Minnal Archana , Gonzalez Julie
Published: August 2017

Background

In a low socioeconomic-status population of Latina women, we evaluated the potential of storytelling (ST) as a culturally aligned narrative method to promote colorectal cancer (CRC) prevention and screening, compared to a risk tool (RT)-based intervention.

Methods

Seventy-eight women were randomized in this pilot study to one of two brief interventions to communicate CRC risk reduction options: ST or an RT. Measures of behavioral intentions relative to CRC prevention and screening were obtained following the intervention.

Results

Mean scores for intent to obtain and recommend endoscopy to others were significantly better for participants receiving ST than RT (P = .038 and P = .011, respectively). All participants expressed intent to increase fruit and vegetable consumption and physical activity in response to interventions. Post-intervention perceptions of cancer risk and fear of CRC were not significantly different for participants receiving ST compared with RT. Pre- to post-intervention perceptions of risk increased in ST and decreased in RT, while decreases in fear were similar across both intervention groups.

Conclusions

Storytelling may be an effective approach for changing CRC risk-related behavioral intentions among Latinas. Mediating factors (such as perceived risk or fear) often used to predict behavior change may not adequately explain the potential persuasive mechanisms of storytelling.
Epigenetics in Human Melanoma
Authors: Howell Paul M. , Liu Suhu , Ren Suping , Behlen Campbell , Fodstad Oystein , Riker Adam I.
Published: August 2017

Background

Recent technological advances have allowed us to examine the human genome in greater detail than ever before. This has opened the door to an improved understanding of the gene expression patterns involved with cancer.

Methods

A review of the literature was performed to determine the role of epigenetic modifications in human melanoma. We focused the search on histone deacetylation, methylation of gene promoter regions, demethylation of CpG islands, and the role of microRNA. We examined the relationship between human melanoma epigenetics and their importance in tumorigenesis, tumor progression, and inhibition of metastasis. The development and clinical application of select pharmacologic agents are also discussed.

Results

We identified several articles that have extensively studied the role of epigenetics in melanoma, further elucidating the complex processes involved in gene regulation and expression. Several new agents directly affect epigenetic mechanisms in melanoma, with divergent affects on the metastatic potential of melanoma.

Conclusions

Epigenetic mechanisms have emerged as having a central role in gene regulation of human melanoma, including the identification of several putative tumor suppressor genes and oncogenes. Further research will focus on the development of novel therapeutics that will likely target and alter such epigenetic changes.
Gene Expression Profiling in Breast Cancer
Authors: Turaga Kiran , Acs Geza , Laronga Christine
Published: August 2017

Background

Breast cancer is a heterogeneous group of different tumor subtypes that vary in prognosis and response to therapy. This heterogeneity has spawned an era of molecular assays striving to classify and thus predict outcome, thereby guiding the future in targeted personalized treatment strategies.

Methods

This article provides an overview of the development and application of molecular assays as applied to breast cancer. Differences in the technology used for these tests as well as scientific evidence supporting the validity of the gene expression profile are discussed. Examples of the clinical applicability of these assays are provided, but these represent only a fraction of the potential uses yet to be discovered. A comparison of the three most commonly used assays is included.

Results

Molecular assays have provided new genetic approaches to unravel the complexities of clinical specimens relevant to breast cancer treatment planning and assessment of outcome. In particular, on a molecular level specific to the woman's tumor, these assays allow a prediction of outcome (prognosis) in terms of low and high risk for the future development of distant metastatic disease. Additionally, one assay, Oncotype DX (Genomic Health Inc, Redwood City, CA), allows for the prediction of benefit of the addition of chemotherapy to hormone therapy alone.

Conclusions

While incorporation of molecular assays into the treatment planning strategy of breast cancer continues to be a work in progress, this approach is evolving quickly due to strong scientific evidence to become standard of practice in the near future. The possibilities of these assays in terms of clinical investigation are limitless, but currently their general applicability is limited to less than half of the population of women presenting with breast cancer.
Bladder Cancer: A Review of Non-Muscle Invasive Disease
Authors: Sexton Wade J. , Wiegand Lucas R. , Correa José J. , Politis Christos , Dickinson Shohreh Iravani , Kang Loveleen C.
Published: August 2017

Background

Bladder cancer is one of the most common cancers affecting men and women and thus has a profound impact on health care. The majority of patients (75%) with newly diagnosed urothelial tumors have nonmuscle invasive disease confined to the bladder mucosa or the lamina propria.

Methods

The authors review the literature as well as recently published clinical guidelines regarding the bladder cancer risk and causative factors, diagnostic and pathologic evaluation, prognostic variables, and management strategies for patients with nonmuscle invasive bladder cancer.

Results

Recurrence and progression remain problematic for many patients and are dependent on multiple clinical and pathological features, the most important of which are tumor stage, grade, multifocality, size, recurrence patterns, and the association with carcinoma in situ. Accurate assessment of clinical stage and tumor grade is critical in determining management and surveillance strategies. Intravesical therapies positively influence tumor recurrence rates. Disease progression rates may be impacted in high-risk patients who receive both induction bacille Calmette-Guérin (BCG) and a maintenance BCG regimen. Cystectomy still plays a pivotal role in patients with high-risk tumors and in patients who fail more conservative attempts to eradicate nonmuscle invasive disease.

Conclusions

Nonmuscle invasive bladder cancers represent a broad group of tumors with varying biologic potential. Successful treatment depends on the careful integration of diagnostic and surveillance tests, macroablation through transurethral resection, accurate assessment of clinical stage, and the timely and appropriate delivery of intravesical chemotherapeutic and immunomodulatory agents.
An Examination of Educational Gaps in the Diagnosis and Treatment of Myelodysplastic Syndromes
Authors: Shammo Jamile M. , Foran James M. , Houk Alice , Epstein James , Narang Mohit , Rubinstein Pesha , Dennison Betsy , Latsko Joan M. , Naganna Gourishankar , York John M.
Published: August 2017

Background

Myelodysplastic syndromes (MDS) comprise a heterogeneous group of hematologic malignancies, with an incidence rate of 3.4 cases per 100,000 in the United States. MDS affects patients predominantly over 60 years of age. As these syndromes are not well understood by many medical practitioner, patients with MDS may be underrecognized or underdiagnosed. The availability of new MDS treatment options further establishes the need to more closely assess gaps in clinical practice and underscores the necessity to develop educational activities to address those gaps.

Methods

A multidisciplinary panel was convened to examine current educational needs and gaps. A group consensus approach incorporating a modified nominal group technique was utilized to prioritize and review needs identified in the pre-meeting survey and to evaluate data provided by panelists prior to the meeting.

Results

The panel identified and prioritized seven educational areas of need: (1) MDS disease awareness, (2) diagnosis, (3) classification and risk stratification, (4) treatment issues, (5) referral to stem cell transplantation or new treatment protocols, (6) clinical monitoring and toxicity management, and (7) translation of new data into patient care.

Conclusions

In-depth knowledge is critical to the timely diagnosis and optimal care of MDS patients. A number of key educational needs exist. Educational programs should be practical in orientation to integrate data into practice, and they should be tailored for the intended audience. In addition, an effective educational program must be easily applied by participants.
Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation in Adults with Acute Myeloid Leukemia
Authors: Hamadani Mehdi , Mohty Mohamad , Kharfan-Dabaja Mohamed A.
Published: August 2017

Background

Acute myeloid leukemia (AML), whether de novo or arising from antecedent hematologic disorders in elderly patients, is less likely to be curable with standard chemotherapy regimens used for younger patients. Allogeneic hematopoietic cell transplantation (alloHCT) is currently the most efficient anti-leukemia treatment for AML and has shown a survival advantage in younger patients with intermediate- or poor-risk cytogenetics.

Methods

The authors review their experience as well as the published data regarding the role of reduced-intensity conditioning (RIC) alloHCT in adults with AML. MEDLINE/PubMed and EMBASE/Ovid were searched, as well as reference lists of relevant articles, conference proceedings, and ongoing trial databases.

Results

Elderly patients with AML have a poor survival for all cytogenetics subgroups (except for acute promyelocytic leukemia) and higher rates of transplant-related mortality with myeloablative alloHCT. RIC regimens have been shown to decrease procedure-related toxicity and have emerged as an attractive treatment modality in AML patients not suitable for myeloablative conditioning regimens. While prospective data comparing outcomes of AML patients undergoing RIC alloHCT vs conventional chemotherapy alone are not yet available, RIC alloHCT is a reasonable option for high-risk older patients and for younger AML patients with medical comorbidities who achieve a first or subsequent remission. The application of RIC for patients with refractory disease or untreated relapse as well as the use of alternative donors should be considered within the context of clinical trials.

Conclusions

RIC alloHCT is a safe and effective treatment modality in high-risk elderly AML patients and in younger AML patients with medical comorbidities.
Hematopoietic Cell Transplantation for Lymphomas
Authors: Ayala Ernesto , Tomblyn Marcie
Published: August 2017

Background

The heterogeneity of lymphomas results in numerous treatment options, including both autologous and allogeneic hematopoietic cell transplantation. However, the type of transplantation, the timing the procedure, and the selection of suitable patients for transplant continue to evolve.

Methods

We reviewed the current medical literature to provide a succinct synthesis for the most common types of lymphoma and the indications for transplantation.

Results

This review discusses the outcomes of autologous and allogeneic transplantation for patients with diffuse large B-cell lymphoma, follicular lymphoma, HIV-associated lymphomas, mantle cell lymphoma, T-cell lymphoma, and Hodgkin lymphoma.

Conclusions

Each of these histologies differs in the indications and timing for transplantation. However, ongoing clinical trials support the continuing role of both autologous and allogeneic transplantation for lymphoma management.
Advances in the Autologous and Allogeneic Transplantation Strategies for Multiple Myeloma
Authors: Nishihori Taiga , Alsina Melissa
Published: August 2017

Background

Multiple myeloma is largely an incurable malignant plasma cell neoplasm; however, the landscape of its treatment is rapidly changing.

Methods

The recent literature on both autologous and allogeneic transplant approaches for multiple myeloma was reviewed.

Results

High-dose chemotherapy followed by autologous hematopoietic cell transplantation (HCT) remains an integral component of upfront treatment strategy, and the incorporation of novel immunomodulators and proteasome inhibitor to induction regimens improves response rates and increases overall survivals. Bortezomib-and lenalidomide-based combination chemotherapy regimens have become the standard induction myeloma therapy. When myeloma patients proceed to transplant after novel combination regimens, their response rates are further improved. Despite these recent major improvements, myeloma remains incurable and long-term survival appears elusive. Due in part to a potential graft-vs-myeloma effect, allogeneic HCT is a potentially curative transplant option. However, initial attempts have been hampered by the high transplant-related mortality. With a reduction of toxicity, allogeneic transplant approaches with reduced-intensity conditioning have been utilized, although they are subject to continued disease progression and relapse following transplantation. Recent research efforts have shifted to the use of a tandem autologous-allogeneic HCT approach. The long-term follow-up of this new strategy is awaited.

Conclusions

Recent advances in HCT have improved outcomes of patients with multiple myeloma. Ongoing research activity focuses on the strategies to improve outcomes of HCT by incorporation of tandem autologous-allogeneic transplantation schema, novel conditioning regimens, and the use of consolidation and maintenance therapy.
Biology of Bone Metastases
Authors: Theriault Rachel L. , Theriault Richard L.
Published: August 2017

Background

Bone metastases cause morbidity and mortality in multiple malignancies. In addition to portending a dire prognosis, bone metastases cause bone pain, fractures, hypercalcemia, spinal cord compression, and other nerve compression syndromes. Improved understanding of the mechanisms that predispose tumor metastases to bone is needed to improve patients’ therapeutic options, maintain their quality of life, and improve their survival.

Methods

This review discusses selected preclinical and clinical data regarding bone metastasis development and cytokine/molecular interactions predisposing to bone metastases formation. Potential interventions for reducing bone metastases are also described.

Results

Biologic mechanisms resulting in metastases of tumor cells to bone are being studied. Among these are the RANKL pathway, osteoclast activation via cytokines (produced by tumor cell and cells in the bone microenvironment), interactions with transient and stromal cells in the bone microenvironment, and molecules such as PTHrP and endothelin-1. These molecules offer important opportunities for targeted interventions to decrease bone metastases-associated morbidity.

Conclusions

Knowledge of the pathophysiology of bone and cancer is developing rapidly. Relationships among cancer cells, bone-derived cells, and cytokines provide opportunities for the development of new interventions. Therapy targeting osteoclast/osteoblast interactions has proven benefit for patients with bone metastases.
The Management of Pain in Metastatic Bone Disease
Authors: Buga Sorin , Sarria Jose E.
Published: August 2017

Background

Metastatic bone disease is a common cause of pain in cancer patients. A multidisciplinary approach to treatment is often necessary because simplified analgesic regimens may fail in the face of complex pain generators, especially those involved in the genesis of neuropathic pain. From the origins of formalized guidelines by the World Health Organization (WHO) to recent developments in implantable therapies, great strides have been made to meet the needs of these patients.

Methods

The authors review the existing literature on the pathophysiology and treatment options for pain generated by metastatic bone disease and summarize classic and new approaches.

Results

Relatively recent animal models of malignant bone disease have allowed a better understanding of the intimate mechanisms involved in the genesis of pain, resulting in a mechanistic approach to its treatment. Analgesic strategies can be developed with specific targets in mind to complement the classic, opioid-centered WHO analgesic ladder obtaining improved outcomes and quality of life. Unfortunately, high-quality evidence is difficult to produce in pain medicine, and these concepts are evolving slowly.

Conclusions

Treatment options are expanding for the challenging clinical problem of painful metastatic bone disease. Efforts are concentrated on developing alternative nonopioid approaches that appear to increase the success rate and improve patients’ quality of life.
Lessons Learned from the Bevacizumab Experience
Authors: Mortimer Joanne , Zonder Helene B. , Pal Sumanta K.
Published: August 2017

Background

Bevacizumab is an important agent in the oncologic armamentarium, with activity in a broad spectrum of solid tumors. It has been approved in the management of metastatic colorectal cancer, non-small cell lung cancer, renal cancers, and recurrent glioblastoma multiforme.

Methods

We reviewed the published literature and briefing documents of the US Food and Drug Administration that provided the data leading to approval or change in approval status.

Results

Bevacizumab initially received accelerated approval for the treatment of advanced breast cancer. However, lack of confirmatory data from additional clinical trials resulted in the loss of that indication. Both the expected and unexpected toxicities reported from clinical trials using bevacizumab have helped us to understand the drug's mechanism of action and to identify who are most likely to benefit from this important agent.

Conclusions

The side effects of treatment may provide important information about drug mechanism and efficacy. Bevacizumab is clearly an important agent in oncology and is likely to become more significant once a clinical or pathological marker to predict its efficacy has been identified.
Sequencing Systemic Therapies in Metastatic Castration-Resistant Prostate Cancer
Authors: Liu Jane Jijun , Zhang Jingsong
Published: August 2017

Background

Men with prostate cancer will not die of the disease until it progresses to the metastatic castration-resistant stage. At that stage, the median survival is 9 to 30 months.

Methods

Recently approved and emerging treatments for metastatic castration-resistant prostate cancer (mCRPC) were reviewed based on their mechanisms of action, as well as sequencing and combining these treatments with existing options.

Results

Advances in androgen deprivation therapy, immunotherapy, bone-targeted therapy, and chemotherapy have led to approvals of abiraterone acetate, sipuleucel-T, denosumab, and cabazitaxel for the treatment of mCRPC. Despite improvements in patient survival and quality of life, mCRPC remains incurable.

Conclusions

With the emerging new therapies, this is an unprecedented time in treating mCRPC. A better understanding of their mechanisms of action, the genetic makeup of each mCRPC, and the development of new prognostic and predictive biomarkers will help determine sequencing or different combination treatments for each individual patient.
Controversial Issues in Kyphoplasty and Vertebroplasty in Malignant Vertebral Fractures
Authors: Papanastassiou Ioannis D. , Filis Andreas K. , Gerochristou Maria A. , Vrionis Frank D.
Published: August 2017

Background

Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures.

Methods

A critical review of the medical literature was performed and controversial issues were analyzed. Results: Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized.

Conclusions

In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure.
Practical Applications of Digital Pathology
Authors: Saeed-Vafa Daryoush , Magliocco Anthony M.
Published: August 2017

Background

Virtual microscopy and advances in machine learning have paved the way for the ever-expanding field of digital pathology. Multiple image-based computing environments capable of performing automated quantitative and morphological analyses are the foundation on which digital pathology is built.

Methods

The applications for digital pathology in the clinical setting are numerous and are explored along with the digital software environments themselves, as well as the different analytical modalities specific to digital pathology. Prospective studies, case-control analyses, meta-analyses, and detailed descriptions of software environments were explored that pertained to digital pathology and its use in the clinical setting.

Results

Many different software environments have advanced platforms capable of improving digital pathology and potentially influencing clinical decisions.

Conclusions

The potential of digital pathology is vast, particularly with the introduction of numerous software environments available for use. With all the digital pathology tools available as well as those in development, the field will continue to advance, particularly in the era of personalized medicine, providing health care professionals with more precise prognostic information as well as helping them guide treatment decisions.
Advances in EGFR as a Predictive Marker in Lung Adenocarcinoma
Authors: Khalil Farah K. , Altiok Soner
Published: August 2017

Background

Worldwide, lung cancer is the most common cause of mortality. Toxins from tobacco smoke are known to increase the risk of lung cancer; however, up to 15% of lung cancer–related deaths in men and up to 50% of lung cancer–related deaths in women occur in people who do not smoke. Despite the fact that chemotherapy generally provides a survival benefit for non–small-cell lung cancer, not every patient will respond to therapy and many experience therapy-related adverse events. Thus, predictive markers are used to determine which patients are more likely to respond to a given regimen.

Methods

We reviewed the current medical literature in English relating to predictive markers that may be positive, such as the presence of an activating EGFR mutation.

Results

The advances in using EGFR as a molecular predictive marker were summarized. This biomarker influences therapeutic response in patients with lung adenocarcinoma. Clinical evidence supporting its value is also reviewed.

Conclusions

The use of EGFR as a predictive factor in lung adenocarcinoma may help target therapy to individual tumors to achieve the best likelihood for long-term survival and to avoid adverse events from medications unlikely to be effective.
Primary Enteropathy-Associated T-Cell Lymphoma Type 2: An Emerging Entity?
Authors: Grigg-Gutierrez Nicole M. , Estremera-Marcial Rodolfo , Cáceres William W. , Toro Doris H.
Published: August 2017

Intestinal T-cell lymphoma is a rare hematological malignancy that can present as primary intestinal lymphoma or as a manifestation of systemic disease. Primary involvement accounts for approximately 0.1% to 0.5% of all colorectal neoplasms. It is an aggressive disease with a poor prognosis and low survival rate. Inflammatory bowel disease, celiac disease, immunosuppression, and infectious etiologies, such as Epstein–Barr and human T-lymphotropic viruses, have been reported as risk factors, but no direct causal link has been established. Herein, we examine the case of a Hispanic man 69 years of age diagnosed with positive CD3, CD7, CD8, CD43, and Bcl-2 diffuse primary colorectal T-cell lymphoma. The patient did not exhibit a concomitant autoimmune or genetic disease. Because of the patient's history of polyps, surveillance colonoscopy was performed and the diagnosis was confirmed.
Developments in Intralesional Therapy for Metastatic Melanoma
Authors: Sloot Sarah , Rashid Omar M. , Sarnaik Amod A. , Zager Jonathan S.
Published: August 2017

Background

Locoregional advanced melanoma poses a complex clinical challenge that requires a multidisciplinary, patient-centered approach. Numerous agents have been studied for their suitability as intralesional therapy in the past decades, but few have successfully completed phase 3 clinical trial testing.

Methods

The relevant medical literature was searched for articles regarding use of intralesional therapies in metastatic melanoma. Therapies with data from phase 2 or higher studies were selected for review. This review also summarizes the mechanisms of action, adverse-event profiles, and clinical data for these agents.

Results

Intralesional therapies demonstrate promising effects in select patients with advanced melanoma. The optimal approach should be individually tailored and consist of a combination of intralesional therapies, regional perfusions, systemic immunotherapies, targeted therapies, and surgery, if necessary.

Conclusions

Due to its relatively good local response rates and tolerable adverse-event profile, intralesional therapy may be a treatment option for select patients with unresectable, locally advanced or metastatic melanoma.
Association of microRNA 21 with Biological Features and Prognosis of Neuroblastoma
Authors: Zhou Yaodong , Sheng Bo
Published: August 2017

Background

The aim of this study was to assess the differences in microRNA 21 expression among neuroblastoma (NB), embryonic tissue, and normal adrenal tissue and to identify correlations between microRNA 21 expression, the biological features of the tumor, and prognosis.

Methods

A total of 70 patients with NB were selected from December 2005 and December 2007. Real-time polymerase chain reaction was used to assess microRNA 21 expression. All patients were followed-up for 5 years.

Results

Significant differences in microRNA 21 expression were found between the 3 groups, with the highest expression in the NB samples (P < .001). The expression of microRNA 21 was highest in the high-risk group compared with the moderate- and low-risk groups (P < .001). The microRNA 21 expression in the MYCN amplification group was higher than in the group without amplification (P = .001). The 5-year overall survival rate of patients with NB was 71.4%.

Conclusions

The higher expression of microRNA 21 in NB samples compared with embryonic and normal tissue samples predicted a close correlation between microRNA 21 expression and the biological features of NB. In patients with NB, higher microRNA 21 expression correlated with lower rates of overall survival. Therefore, microRNA 21 expression may represent a novel risk factor for determining the prognosis of patients with NB.
Clinical Benefits of Proton Beam Therapy for Tumors of the Skull Base
Authors: Ahmed Kamran A. , Demetriou Stephanie K. , Mcdonald Mark , Johnstone Peter A.S.
Published: August 2017

Background

The unique radiobiological properties of protons have been understood for many years. In addition, many of the clinical benefits of radiotherapy were first noted in tumors involving the skull base. More public attention has been given to proton beam therapy due to the increasing number of centers now in operation or in the planning stages for offering this treatment option.

Methods

We reviewed the physical properties of protons and the clinical studies performed to justify their use in the management of skull-base tumors and determine the benefits of proton beam therapy.

Results

Published reports suggest a benefit to proton beam therapy for use in tumors of the skull base, including craniopharyngiomas, chordomas, skull-base sarcomas, and unresectable meningiomas.

Conclusions

Use of proton beam therapy may be beneficial in select patients. Surgical and medical oncologists should have a general understanding of such cases to facilitate their appropriate referral.
Primary Gangrenous Cutaneous Mold Infections in a Patient with Cancer and Neutropenia
Authors: Yacoub Abraham , Soni Kiran K. , Mojica Lysenia , Mai Jane , Morano Jamie , Cruse C. Wayne , Sandin Ramon L. , Nanjappa Sowmya , Bohra Chandrashekar , Gajanan Ganesh , Greene John N.
Published: August 2017

Background

Opportunistic fungal infections caused by Aspergillus and Candida followed by infections with Fusarium, Rhizopus, Mucor, and Alternaria species are an important cause of morbidity and mortality in patients with hematological malignancies. Cutaneous mucormycosis infections are rare, and the incidence, outcomes, and factors associated with survival in the setting of hematological malignancies are not clear.

Methods

A literature search was conducted for all cases of primary cutaneous mold infections in patients with hematological malignancy, of which 50 cases were found. Our case of a patient with a hematological malignancy who sustained a cat bite that in turn caused a primary cutaneous mold infection is also included.

Results

In the 51 cases identified, 66.7% were neutropenic upon presentation, and 54.9% were male with an average age of 32 years. Aspergillus species (33.3%) was the most cited followed by Rhizopus species (19.6%). Overall mortality rate was 29.4% and was observed more frequently in patients with neutropenia (60.0%) and without surgical intervention (73.3%). Survival rate was higher (35.3%) for cases utilizing both antifungal and surgical intervention. The antifungal agent with the highest survival rate was amphotericin B and its formulations (58.8%).

Conclusions

Neutropenia within hematological malignancies demonstrate a risk for developing severe cutaneous fungal infections, of which primary cutaneous mucormycosis can carry significant mortality. Combination antifungal therapy and surgical debridement appears to be associated with higher survival outcomes and warrants further investigation.
Platelet-to-Lymphocyte Ratio and Use of NSAIDs during the Perioperative Period as Prognostic Indicators in Patients with NSCLC Undergoing Surgery
Authors: Lee Brenda M. , Rodríguez Andrea , Mena Gabriel , Gottumukkala Vijaya , Mehran Reza J. , Rice David C. , Feng Lei , Yu Jun , Cata Juan P.
Published: August 2017

Background

Hematological biomarkers of inflammation such as the neutrophil-to-lymphocytic rate have been reported as predictors of survival in a variety of cancers. The aim of the present study was to investigate the prognostic value of the perioperative platelet-to-lymphocyte ratio in patients with non–small-cell lung cancer (NSCLC) and to elucidate the effects of the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) on tumor recurrence and survival in patients undergoing surgical resection for NSCLC.

Methods

This retrospective study included data from 1,637 patients who underwent surgical resection for stage I, II, or III NSCLC. Perioperative data and tumor-related variables were included. Univariate and multivariable Cox proportional hazard ratio (HR) models were used to evaluate the association between perioperative platelet-to-lymphocyte ratio and NSAID use on recurrence-free survival (RFS) and overall survival (OS).

Results

Multivariate analysis showed that a preoperative platelet-to-lymphocyte ratio of at least 180 was associated with reduced rates of RFS (HR = 1.22; 95% confidence interval [CI], 1.03–1.45; P = .019) and OS (HR = 1.33; 95% CI, 1.10–1.62; P = .004). Perioperative use of NSAIDs showed no statistically significant changes in RFS and OS rates (P = .72 and P = .44, respectively).

Conclusions

A higher preoperative inflammatory status is associated with decreased rates of RFS and OS in patients with NSCLC undergoing curative surgery. Perioperative use of NSAIDs was not found to be an independent predictor of survival.
Skeletal Scintigraphy
Authors: Montilla-Soler Jaime L. , Makanji Rikesh
Published: August 2017

Background

Skeletal scintigraphy remains a valuable tool in the initial and subsequent evaluation of the skeletal system in patients with a diagnosis of primary or metastatic neoplasms.

Methods

We discuss radiopharmaceuticals, nuclear medicine imaging techniques, and current as well as future oncological applications in the adult population. Pertinent literature was reviewed to describe the advantages and limitations of available technologies for the evaluation of skeletal metastatic disease. Evaluation of primary and metastatic skeletal disease using nuclear medicine and positron emission tomography techniques is discussed.

Results

Skeletal scintigraphy provides valuable information in the initial evaluation for the presence of osteoblastic skeletal metastases. Incremental advances on available radiopharmaceuticals (fludeoxyglucose F 18, sodium fluoride F 18), coupled with advances in imaging techniques and imaging devices (single photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging), have had a significant impact on sensitivity, specificity, and accuracy rates for the detection of skeletal metastases.

Conclusions

Skeletal scintigraphy has a significant role in the initial diagnosis, staging, restaging, and treatment monitoring of patients with cancer and primary skeletal or metastatic disease. The coupling of diagnostic and therapeutic nuclear medicine agents in the setting of osteoblastic skeletal metastases is a valuable tool for the treatment for certain cancer types, including prostate cancer, and may become more widely used to treat other histologies as more data on other tumor types (eg, breast cancer, osteosarcoma) become available.
Hormone Replacement Therapy in the Gynecologic and Breast Cancer Patient
Authors: Disaia Philip J.
Published: August 2017

Hormone replacement therapy has increased in use as a result of its well-established benefits as an effective tool against such consequences as osteoporosis and ischemic heart disease and in the management of menopausal symptoms. However, its possible negative impact on the survival of patients with a previous diagnosis of breast, uterine, or ovarian cancer remains controversial. The risk:benefit analysis of hormone replacement therapy in this setting warrants further investigation. In the meantime, patients should be counseled on the risks, benefits, and contraindications of hormone replacement therapy before embarking on its use.
Predicting and Treating the Sexual Difficulties of Gynecologic Cancer Survivors
Authors: Andersen Barbara L.
Published: August 2017

Women treated for gynecologic cancer represent approximately 45% of cancer survivors. Many report significant sexual difficulties during follow-up, and data suggest these difficulties are direct consequences of their cancer treatments. Health care providers can identify at the time of initial therapy those women who will be at greater risk for problem development. Clinical observations are provided on the development of sexual problems for these women as they attempt to resume sexual intercourse, and the psychologic and behavioral therapies that can be used for treatment are discussed.
Pain and Symptom Management in Palliative Care
Authors: Ripamonti Carla , Bruera Eduardo
Published: August 2017

Background

Pain, dyspnea, and anorexia are common symptoms experienced by patients with cancer and often are poorly managed.

Methods

The incidence and causes of these symptoms are described, as well as factors that exacerbate or ameliorate their impact.

Results

Pharmacologic management of cancer pain is based on the use of a sequential “ladder” that incorporates nonopioid, opioid, and adjuvant drugs, depending on the severity of the pain. This approach usually is effective. Other symptoms of advanced disease may be more difficult to control.

Conclusions

Adherence to an adequate pain-control strategy will significantly enhance palliation of pain in patients with cancer.
Localization of Neuroendrocrine Tumors Using Somatostatin Receptor Imaging with Indium-111-Pentetreotide (OctreoScan)
Authors: Ellison E. Christopher , Schirmer William J. , Olsen John O. , Pozderac Rodney V. , Hinkle George , Hill Tom , O'Dorisio Thomas M. , O'Dorisio M. Sue
Published: August 2017

Background

Many imaging methods have been used to detect neuroendocrine tumors of the gastrointestinal system. There is no gold standard for identifying the location of primary tumors and their potential metastases, and most conventional imaging techniques cannot detect tumors less than 1.0 cm in size.

Methods

The authors have investigated the use of 111In-pentetreotide as an imaging agent for abdominal neuroendocrine tumors.

Results

The agent is cleared rapidly by the kidneys and is primarily excreted intact with a biologic half-life of six hours. The largest radiation burden is to the spleen and kidneys. A nine-center study conducted in Europe involved 365 patients with gastroenteropancreatic neuroendocrine tumors that were also imaged by other methods. The results of 111In-pentetreotide were in agreement with those obtained by other methods for 79% of tumor locations. An additional 110 tumor localizations were detected that were not seen with conventional methods. The smallest gastrinoma imaged by 111In-pentetreotide was a 4-mm duodenal tumor.

Conclusions

Scintigraphy with 111In-pentetreotide is effective in visualizing various somatostatin receptors characteristic of neuroendocrine tumors of the gastrointestinal tract. Insulinomas, however, are not well imaged. Concurrent computed tomography scanning is advised to minimize the risk of missing liver metastases.
Cancer Prevention: The Roles of Diet and Chemoprevention
Authors: Greenwald Peter , Mcdonald Sharon S.
Published: August 2017

Background

Reduction of cancer risk by either preventing carcinogenesis or stopping carcinogenesis in its early stages is a logical approach for reducing the cancer burden, both for high-risk individuals and for the general population. The areas of dietary modification and chemoprevention show considerable promise as effective approaches for cancer prevention and are a focus of research efforts.

Results

Diet and cancer studies show that, generally, vegetables and fruits, dietary fiber, and certain nutrients seem to be protective against cancer, whereas fat, excessive calories, and alcohol seem to increase cancer risk. Chemoprevention research is closely linked to diet and cancer research and represents a logical research progression.

Conclusions

Dietary epidemiologic studies have helped to identify many naturally occurring chemopreventive agents. Currently, randomized clinical prevention trials sponsored by the NCI include dietary interventions (eg, low-fat and/or high-fiber vegetables and fruits) targeting breast and colorectal cancer, chemoprevention trials using micronutrients (eg, vitamin E, calcium, vitamin D) aimed at lung and colorectal cancer, and chemoprevention trials testing the effectiveness of pharmaceutical agents (eg, tamoxofen, finasteride, aspirin) for breast, prostate, and colorectal cancer.
Head and Neck Chemoprevention: Recent Advances
Authors: Lippman Scott M.
Published: August 2017

Background

Head and neck cancers are important to human life and health in both developed and underdeveloped countries. Management of established cancers is difficult, and there is great interest in evaluating methods to prevent these tumors from developing.

Methods

The biology of carcinogenesis, including field carcinogenesis, is reviewed, together with the biology and pharmacology of the retinoids. Intervention studies of premalignant lesions have led to prospective clinical trials of the capability of various retinoids to reduce the incidence of new second cancers.

Results

High-dose 13-cis-retinoic acid (13cRA) has significant activity in reversing oral leukoplakia but at a cost of substantial toxicity, and relapses occur early. An ongoing intergroup trial is underway to evaluate the capacity of low-dose (30 mg/d) 13cRA given for three years to reduce the incidence of second primary tumors in patients with “cured” squamous head and neck cancers.

Conclusions

Molecular studies of loss of heterozygosity and p53 gene mutations are advancing our understanding of field carcinogenesis and the biology, pharmacology, and effects of the retinoids used in cancer prevention. Translation of early clinical trials into large-scale intervention trials to prevent
Polypharmacy in the Older Patient with Cancer
Authors: Corcoran Mary E.
Published: August 2017

Background

Elderly patients – those aged 65 years and over – use more medications than their younger counterparts and experience higher risks for polypharmacy, drug interactions, adverse drug reactions, and noncompliance for this age-group.

Methods

The data on polypharmacy in the aged is reviewed, supplemented with preliminary information from studies performed on elderly patients with cancer at our institution.

Results

Polypharmacy occurs in ambulatory, extended care, and institutional settings. Over-the-counter medications are underreported. The number of potential drug-related problems is related to the total number of prescriptions. Methods for evaluating the extent of polypharmacy include the “brown-bag” technique and careful medication histories.

Conclusions

The risks of polypharmacy may be reduced with patient and physician education, intervention, and drug monitoring. Further pharmacokinetic investigations of anticancer medications are needed to recognize the potential for harmful drug interactions, to understand their toxicity profiles, and to avoid the clinical implications of drug interactions.
Radioisotope-Guided Surgical Biopsy of Suspected Osseous Metastases
Authors: Robinson Lary A.
Published: August 2017

Background

Radioisotope bone scanning is frequently used to stage patients with suspected or proven malignancies. Since false-positive results are common, especially in the ribs, open biopsy is often necessary. The conventional approach of visual inspection of the bone scan image to guide the surgeon usually requires excision of a large area of one or two ribs to assure that the biopsy was performed on the correct rib. A more precise method to guide the biopsy is desirable.

Methods

One technique to localize the suspicious area of bone intraoperatively for accurate biopsy involves percutaneous injection of the bone abnormality with a radioisotope followed by injection of methylene blue into the periosteum and subsequent open surgical biopsy. A more recent technique uses a hand-held gamma probe in a sterile sleeve in the operating room to locate the bone “hot spot” directly in the wound to guide the biopsy.

Results

Both techniques are effective in pinpointing the bone scan abnormality, but use of the gamma probe is less cumbersome and consumes less time and fewer resources. In one series of 10 patients undergoing gamma probe-guided biopsies of 13 rib and 1 sternal bone scan lesions, this technique showed a sensitivity of 100% in locating the area of abnormal radioisotope uptake. All biopsies yielded an abnormal diagnosis to account for the bone scan abnormality, but only 4 of 14 (29%) demonstrated metastatic tumor.

Conclusions

Techniques described for radioisotope-guided localization of areas of increased tracer uptake in asymptomatic suspected bone metastases are accurate, sensitive guides to the open biopsy of these bony abnormalities. Due to the high false-positive rates in these asymptomatic but suspicious bone scan abnormalities, a diagnosis should be histologically confirmed.
The Role of Immunohistochemistry in the Differential Diagnosis of Soft-Tissue Tumors
Authors: Muro-Cacho Carlos A.
Published: August 2017

This regular feature presents special issues in oncologic pathology.
Perfusion Magnetic Resonance Imaging to Assess Brain Tumor Responses to New Therapies
Authors: Lev Michael H. , Hochberg Fred
Published: August 2017

Background:

Although magnetic resonance imaging (MRI) is effective in detecting the location of intracranial tumors, new imaging techniques have been studied that may enhance the specificity for the prediction of histologic grade of tumor and for the distinction between recurrence and tumor necrosis associated with cancer therapy.

Methods:

The authors review their experience and that of others on the use of perfusion magnetic resonance imaging to evaluate responses of brain tumors to new therapies.

Results:

Functional imaging techniques that can distinguish tumor from normal brain tissue using physiological parameters. These new approaches provide maps of tumor perfusion to monitor the effects of novel compounds that restrict tumor angiogenesis.

Conclusions:

Perfusion MRI not only may be as effective as radionuclide-based techniques in sensitivity and specificity in assessing brain tumor responses to new therapies, but also may offer higher resolution and convenient co-registration with conventional MRI, as well as time- and cost-effectiveness. Further study is needed to determine the role of perfusion MRI in assessing brain tumor responses to new therapies.
Ten Best Readings on Brain Tumors
Authors: Brem Steven
Published: August 2017

The ten best articles in the medical literature relating to brain tumors are reviewed here.
Manipulating the Immunologic Characteristics of Both Graft and Host to Improve Transplant Outcome
Authors: Noga Stephen J. , O'donnell Paul V.
Published: August 2017

Background

Several critical outcomes of allogeneic stem cell transplantation for hematologic malignancies such as engraftment, incidence of graft-vs-host disease (GVHD) and disease-free survival depend on a balance between residual host and infused donor T cells and on chemosensitivity of the underlying disorder. Manipulating cell compartments of the allograft does affect long-term outcome.

Methods

The authors review investigations on the effect of blood and marrow graft components, treatment regimens, and immunologic interventions on eventual transplant outcome, an approach termed “graft engineering.”

Results

Major advances in graft engineering over the last decade are presented as a series of related developments or levels that derive from the goals of reducing GVHD and minimal residual disease.

Conclusions

Morbidity and mortality of GVHD have decreased markedly by methods of T-cell depletion but at the expense of recurrent disease. Cellular therapy and immunotherapy show promise in potentially eradicating residual disease posttransplant.