bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing Cancer Control and Functional Outcomes following Robotic Prostatectomy
Authors: Correa Joséa J. , Pow-Sang Julio M.
Published: August 2017

Background

Since robotic-assisted laparoscopic radical prostatectomy was introduced, different modifications in the technique have been described to improve cancer control and minimize the possibility of erectile dysfunction and incontinence.

Methods

We reviewed the recent English literature on specific topics including when to preserve the neurovascular bundle (NVB), and we describe techniques to diminish the rate of positive margins and to preserve continence and potency.

Results

Identifying predictor factors of local advanced disease helps in deciding when to preserve the NVB without compromising cancer control. Techniques to decrease the positive margins based on experience and modifications of the apical dissection are reviewed. Minimal disruption or reconstruction of the anatomic structures of the periprostatic tissues helps to maintain continence. Different degrees of NVB preservation can be performed based on the characteristics of the cancer. Cautery-free techniques and other modifications in the dissection to minimize the NVB injury are also discussed.

Conclusions

The understanding of the predictor factors of local advanced disease, together with modifications in the technique, helps to not only achieve cancer control but also improve quality of life after robotic-assisted laparoscopic radical prostatectomy.
Immunomodulatory Drugs and Active Immunotherapy for Chronic Lymphocytic Leukemia
Authors: Carballido Estrella , Veliz Marays , Komrokji Rami , Pinilla-Ibarz Javier
Published: August 2017

Background

The last decade witnessed the emergence of several therapeutic options for patients with chronic lymphocytic leukemia (CLL) for first-line and relapsed settings. The vast majority of patients with relapsed or refractory CLL carry poor prognostic features, which are strong predictors of shorter overall survival and resistance to first-line treatment, particularly fludarabine-based regimens.

Methods

This article highlights the current role of immunomodulatory drugs (IMiDs) and active immunotherapy as treatment options for this select group. The rationale of using IMiDs is discussed from the perspective of lenalidomide as a novel active agent. Relevant clinical trials using IMiDs alone or in combinations are discussed. New immunotherapeutic experimental approaches are also described.

Results

As a single agent, lenalidomide offers an overall response rate of 32% to 47% in patients with relapsed/refractory disease. Recent studies have shown promising activity as a single agent in treatment-naive patients. The combination of lenalidomide with immunotherapy (rituximab and ofatumumab) has also shown clinical responses. Encouraging preclinical and early clinical data have been observed with different immunotherapeutic approaches.

Conclusions

The use of IMiDs alone or in combination with immunotherapy represents a treatment option for relapsed/refractory or treatment-naive patients. Mature data and further studies are needed to validate overall and progression-free survival. The toxicity profile of lenalidomide might limit its use and delay further studies. Immunotherapy offers another potential alternative, but further understanding of the immunogenicity of CLL cells and the mechanisms of tumor flare reaction is needed to improve the outcomes in this field.
Overview of Diagnosis and Management of Metastatic Disease to Bone
Authors: Michael Hsiang-Hsuan , Tsai Ya-Yu , Hoffe Sarah E.
Published: August 2017

Background

Bone metastases occur frequently in patients with advanced cancer and are a serious complication of cancer. The decision to treat is often individualized, based on each patient's clinical presentation, life expectancy, and quality of life.

Methods

We reviewed the current literature pertaining to management of metastatic disease to bone, and the medical, radiotherapeutic, and surgical treatment options for management of bone metastasis are discussed.

Results

Current management of skeletal metastasis includes analgesia, systemic therapy, radiation therapy, and surgery. We propose treatment algorithms for management of vertebral and nonvertebral bone metastases and suggest individualized interventions based on clinical presentation.

Conclusions

Management of bone metastases is complex and requires a multidisciplinary approach. The goal of treatment is often palliative, and intervention and treatment regimens should be individualized based on the specific clinical presentation of each patient.
Current Management Considerations for the Incidentally Detected Small Renal Mass
Authors: Buethe David D. , Spiess Philippe E.
Published: August 2017

Background

Nephron-sparing treatments remain underutilized for the management of small renal masses despite a rise in incidentally detected renal cell carcinoma and a downward stage migration.

Methods

Historical publications representative of currently accepted paradigms were reviewed, and the results of a contemporary scientific literature search conducted in PubMed focusing on studies involving humans, published in English, and inclusive of clinical trials, meta-analyses, randomized controlled trials, and practice guidelines are included. Results from contemporary retrospective trials augment the data when level I or II evidence is absent.

Results

Phase III clinical trial results substantiate the long-held tenet that partial nephrectomy is equivalent to radical nephrectomy with respect to safety and oncologic efficacy. Further, minimally invasive techniques using laparoscopy and robotic assistance to achieve partial nephrectomy appear equally effective to traditional open techniques. Although no prospective randomized studies are available, large retrospective studies support the notion that active surveillance and thermal ablative techniques are viable options for carefully selected patients.

Conclusions

The management of small renal masses encompasses a host of therapeutic options, all of which must be considered and discussed with the individual patient.
Palliative Strategies for the Management of Primary and Metastatic Spinal Tumors
Authors: Kaloostian Paul E. , Yurter Alp , Etame Arnold B. , Vrionis Frank D. , Sciubba Daniel M. , Gokaslan Ziya L.
Published: August 2017

Background

Technological advances during the last few decades have improved the success rate of surgery for the treatment of malignant spinal tumors. Nonetheless, many patients present with widespread tumor burden and minimal life expectancy, which excludes them from being surgical candidates. For these patients, palliative management is recommended.

Methods

The authors reviewed prospective and retrospective clinical studies as well as case series regarding palliative treatments for primary and metastatic spinal tumors.

Results

Analgesics, ranging from nonopioids to strong opioids, may be used depending on the degree of pain. Steroids may also improve pain relief, although they are associated with a number of adverse events. Vertebroplasty and kyphoplasty are conservative treatments with high rates of pain relief and vertebral body stabilization. Radiotherapy is the gold standard for palliative management, with approximately 60% of patients experiencing a decrease in tumor-related spinal pain and up to 35% experiencing complete relief. Stereotactic radiosurgery delivers high doses of radiation to patients to provide pain relief while also sparing delicate anatomical structures.

Conclusion

Palliative management of spinal tumors is diverse. Analgesics may be used in conjunction with radiotherapy and/or kyphoplasty or vertebroplasty to offer pain relief.
Management of Locally Advanced Pancoast (Superior Sulcus) Tumors with Spine Involvement
Authors: Setzer Matthias , Robinson Lary A. , Vrionis Frank D.
Published: August 2017

Background

The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection.

Methods

A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence.

Results

A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%.

Conclusions

Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
Surgical and Molecular Pathology of Barrett Esophagus
Authors: Zibadi Sherma , Coppola Domenico
Published: August 2017

Background

Patients with Barrett esophagus (BE) are predisposed to developing dysplasia and cancer. Adenocarcinoma, which is associated with BE, is the most common type of esophageal tumor and, typically, it has an aggressive clinical course and a high rate of mortality.

Methods

The English-language literature relating to tumor epidemiology, etiology, and the pathogenesis of BE was reviewed and summarized.

Results

The role of pathologists in the diagnosis and pitfalls associated with grading Barrett dysplasia is addressed. Current molecular testing for Barrett neoplasia, as well as testing methods currently in development, is discussed, focusing on relevant tests for diagnosing tumor types, determining prognosis, and assessing therapeutic response.

Conclusions

Grading is essential for developing appropriate treatment plans, follow-up visits, and therapeutic interventions for each patient. Familiarity with current molecular testing methods will help physicians correctly diagnose the disease and select the most appropriate therapy for each of their patients.
Risk of Colorectal Cancer by Subsite in a Swedish Prostate Cancer Cohort
Authors: Lu Yunxia , Ljung Rickard , Martling Anna , Lindblad Mats
Published: August 2017

Background

The relationship between sex hormone–related treatment for prostate cancer and the risk of colorectal cancer is controversial.

Methods

A prostate cancer cohort was initiated from the Swedish Cancer Registry of patients diagnosed between 1961 and 2008. Patients diagnosed with prostate cancer between 1961 and 1980 were generally treated with estrogen. The cohort diagnosed between 1981 and 2008 was further divided into 3 subcohorts of orchiectomy, prostatectomy, and other treatment. Standardized incidence ratios (SIRs) for developing colorectal adenocarcinoma were estimated and 95% confidence intervals (CIs) were used to compare relative risk among these patients and the general male population.

Results

Of 601,542 person-years of follow-up, 1,698 cases of colorectal adenocarcinoma were identified. Compared with the general male population, no association was detected in the cohort diagnosed between 1961 and 1980, whereas an increased risk of colorectal adenocarcinoma was observed among patients diagnosed with prostate cancer who received treatments other than estrogen. Following bilateral orchiectomy, the SIR was 1.30 (95% CI: 1.14–1.47); after prostatectomy, the SIR was 1.22 (95% CI: 1.04–1.43); among those who received treatment other than estrogen, the SIR was 1.37 (95% CI: 1.29–1.45). The increased risks were more apparent in cases of adenocarcinoma of the distal colon and rectum than in the proximal colon.

Conclusions

Patients with prostate cancer undergoing bilateral orchiectomy, prostatectomy, or other treatments, including antiandrogen therapy and radiation, may be at increased risk for colorectal adenocarcinoma.
Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease
Authors: Ahmed Kamran A. , Torres-Roca Javier F.
Published: August 2017

Background

The treatment of oligometastatic disease has become common as imaging techniques have advanced and the management of systemic disease has improved. Use of highly targeted, hypofractionated regimens of stereotactic body radiotherapy (SBRT) is now a primary management option for patients with oligometastatic disease.

Methods

The properties of SBRT are summarized and the results of retrospective and prospective studies of SBRT use in the management of oligometastases are reviewed. Future directions of SBRT, including optimizing dose and fractionation schedules, are also discussed.

Results

SBRT can deliver highly conformal, dosed radiation treatments for ablative tumors in a few treatment sessions. Phase 1/2 trials and retrospective institutional results support use of SBRT as a treatment option for oligometastatic disease metastasized to the lung, liver, and spine, and SBRT offers adequate toxicity profiles with good rates of local control. Future directions will involve optimizing dose and fractionation schedules for select histologies to improve rates of local control while limiting toxicity to normal structures.

Conclusions

SBRT offers an excellent management option for patients with oligometastases. However, additional research is still needed to optimize dose and fractionation schedules.
Feasibility, Preliminary Efficacy, and Lessons Learned from a Garden-Based Lifestyle Intervention for Cancer Survivors
Authors: Spees Colleen K. , Hill Emily B. , Grainger Elizabeth M. , Buell Jackie L. , White Susan E. , Kleinhenz Matthew D. , Clinton Steven K.
Published: August 2017

Background

Cancer survivors remain at increased risk for secondary malignancies, comorbidities, and all-cause mortality. Lifestyle behaviors, such as diet and physical activity, are strongly linked to a decreased risk of chronic disease and improved health outcomes, yet a paucity of research has been conducted in this vulnerable population.

Methods

Adult cancer survivors were recruited to participate in Growing Hope, an experimental single-group study designed to assess the feasibility and efficacy of a theory-driven and evidence-based intervention. For 4 months, 22 participants received group and individual education and had access to harvesting fresh produce at an urban garden. Data on program satisfaction, compliance, diet, and physical activity were collected via surveys; anthropometrics, blood values, and skin carotenoids were objectively measured.

Results

The intervention resulted in significant improvements in consumption of fruits and vegetables (P = .003), decreased consumption of red and processed meats (P = .030) and sugar-sweetened beverages (P = .020). Levels of skin carotenoids, fasting blood glucose, and non–high density lipoprotein cholesterol were also significantly improved (P = .011, P = .043, and P = .05, respectively).

Conclusions

The results of this study support the feasibility and efficacy of a multifaceted, garden-based intervention for cancer survivors. In addition, these preliminary results demonstrate a positive impact aligning with the current lifestyle recommendations for cancer survivorship. Larger randomized controlled trials are warranted to define impact on sustained health outcomes.
Tobacco-Related Health Disparities across the Cancer Care Continuum
Authors: Simmons Vani Nath , Piñeiro Bárbara , Hooper Monica Webb , Gray Jhanelle E. , Brandon Thomas H.
Published: August 2017

Background

Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups.

Methods

We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities.

Results

Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established.

Conclusions

To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.
A Single-Institution Study of Demographics and Outcomes of Adult Patients with Multiple Cancers
Authors: Ho Thanh P. , Foster Nathan R. , Jatoi Aminah
Published: August 2017

Background

Few studies have described the demographics and outcomes in patients with multiple cancers.

Methods

We reviewed the health records of patients with at least 3 invasive solid-tumor malignancies (lung, colorectal, pancreatic, prostate, breast, or ovarian) diagnosed between 1995 and 2014 at our institution.

Results

A total of 163 patients were identified. The median age at first cancer diagnosis was 61 years. Sixteen (10%) had a family history of cancer, and 7 (4%) had a cancer-predisposing syndrome. Most had early-stage malignancies and underwent a series of surgical resections. The median survival from the first cancer diagnosis was 14 years (95% confidence interval: 12–16). Forty-three percent developed 4 or more cancers. In univariate analyses, older age, male sex, smoking history, concurrent cancer, and stage IV disease were associated with worse survival; by contrast, breast cancer as the first cancer diagnosis yielded better survival. In multivariate analyses, older age, smoking history, and stage IV disease were associated with worse survival.

Conclusions

A small group of patients with no ostensible risk factors develop multiple early-stage cancers, receive curative therapy (often surgery), and live for years. These patients merit further study to ascertain the broader prevalence rates of individuals with multiple invasive cancers and to better understand factors that contribute to cancer risk.
Chemosaturation with Percutaneous Hepatic Perfusion in Unresectable Hepatic Metastases
Authors: Glazer Evan S. , Zager Jonathan S.
Published: August 2017

Background

In patients with hepatic metastases from solid-organ malignancies, surgical resection may be a potentially curative option, but it is not possible in most cases. Chemosaturation with percutaneous hepatic perfusion was developed for the management of unresectable metastases to the liver.

Methods

Relevant medical literature was summarized with regard to the outcomes and limitations of chemosaturation with percutaneous hepatic perfusion.

Results

Six articles were identified that contained data on 91 individuals who received chemosaturation with percutaneous hepatic perfusion. More than 60% of these study patients were diagnosed with ocular melanoma. The overall response rate was 48% and the rate of disease control was 90%. Chemosaturation with percutaneous hepatic perfusion improved the rates of overall and hepatic progression-free survival (PFS). The data are limited but suggest that the rate of PFS was improved in study patients with isolated melanoma hepatic metastases who received chemosaturation with percutaneous hepatic perfusion compared with those assigned to standard care.

Conclusions

Our results suggest that chemosaturation with percutaneous hepatic perfusion produces favorable tumor response rates in select individuals with unresectable hepatic metastases from multiple primary cancers, particularly ocular and cutaneous melanomas. Data from a single randomized clinical trial have also shown that chemosaturation with percutaneous hepatic perfusion can affect hepatic PFS in certain patients.
Immunotherapy of Human Melanoma with Gene-Modified Tumor Cell Vaccines
Authors: Darrow Timothy L. , Abdel-Wahab Zeinab , Seigler Hilliard F.
Published: August 2017

The incidence of melanoma in the United States is increasing at a faster rate than that of any other cancer. The prognosis for metastatic disease is poor, and more effective treatments for disseminated disease are needed. Since melanoma is one of the more immunogenic tumors, strategies have focussed on immune recognition. In vitro studies suggest that potent tumor-specific cytotoxic T cells can be induced against human melanoma. Melanoma specific T-cell activation depends on appropriate presentation to the immune system of recently defined melanoma-associated antigens presented in the context of self-HLA gene products. Full T-cell activation requires the co- stimulation by B7-CD28 interactions at the T-cell surface and the elaboration of immune cytokines to promote T-cell growth. Data from animal models of tumor-specific immunization with tumor cells engineered to express immune cytokines or the B7 co-stimulatory molecule suggest that gene therapy for human melanoma may be an effective means to treat disseminated disease.
Management of Extremity Lymphedema
Authors: Puleo Christopher A. , Luh Marianne
Published: August 2017

Chronic lymphedema is almost always a permanent and often progressive condition. In most cases, neither medical nor surgical means can completely relieve the effects of lymphedema. Surgical management of chronic lymphedema has high morbidity and a success rate of only 30%, and many patients return to their presurgical limb girth within three to four years. Nonsurgical treatment of chronic lymphedema can decrease overall lymphatic edema. Sequential gradient compression systems, which compensate for impaired lymphatic flow, return protein-rich lymphatic fluid from the extracellular regions of the tissues back into the circulatory system where the fluid can be excreted.
Cervical Cancer: Screening and Prevention of Invasive Disease
Authors: Hoffman Mitchel S. , Cavanagh Denis
Published: August 2017

Cancer of the cervix is one of the leading causes of cancer-related deaths in women in the United States and accounts for more cancer deaths than any other cancer in third-world countries. Various screening procedures have been developed, but many issues need to be resolved for cervical cancer screening to be effective. Large segments of the population who do not undergo regular screening account for most of the patients with invasive cancers in the United States and worldwide. Allocation of resources and widespread educational programs for these target populations are needed to promote adequate cytologic screening programs and to reduce the death rate from squamous carcinoma of the cervix.
Role of Radiation Therapy and Fluoropyrimidines in the Treatment of Gastrointestinal Malignancies
Authors: Wong William W. , Schild Steven E. , Martenson James A.
Published: August 2017

Background

The use of combined chemotherapy and radiation for gastrointestinal malignancies has several theoretical advantages, and clinical trials to determine the type and extent of clinical benefits have been performed.

Methods

The basic science and clinical trial data evaluating such combinations are reviewed, with an emphasis on the interactions between fluoropyrimidines and radiation.

Results

Improved outcomes from chemoradiotherapy have been demonstrated in patients with selected stages of anal, esophageal, rectal, and pancreatic cancer.

Conclusion

Despite these positive results, further work is needed to demonstrate even more effective and less toxic treatment regimens.
Metastatic Adenoid Cystic Carcinoma of Salivary Glands: Case Reports and Review of the Literature
Authors: Spiers Alexander S.D. , Esseltine Dixie Lee W. , Ruckdeschel John C. , Davies Jack N.P. , Horton John
Published: August 2017

Background

Adenoid cystic carcinoma is an uncommon tumor of the salivary gland. Little has been published on the chemotherapy of this neoplasm.

Methods

The literature on this disease is reviewed, and data from seven unpublished cases are presented.

Results

Four patients received cyclophosphamide. One responded, and another had pain relief. The literature review did not identify any single drug or combination that might be regarded as the treatment of choice.

Conclusions

Systematic, multi-institutional studies are required to determine appropriate systemic treatment for metastatic adenoid cystic carcinoma of salivary gland origin.
Role of Retroperitoneal Lymph Node Dissection in the Management of Testicular Cancer
Authors: Rowland Randall G.
Published: August 2017

Background

Retroperitoneal lymph node dissection is an important component of staging and management of nonseminomatous germ-cell carcinoma of the testis. Ejaculatory impotence has been a dominant aspect of operative morbidity.

Methods

The author has led the investigation of a series of modifications of operative techniques with the aim of reducing morbidity while retaining the prognostic and therapeutic benefits for retroperitoneal lymph node dissection.

Results

The advances in surgical techniques have reduced the incidence of ejaculatory impotence to less then 5%. Guidelines for the type of retroperitoneal lymph node dissection for different clinical stages of disease are presented.

Conclusions

The advances in surgical techniques for retroperitoneal node dissection have minimized morbidity. The procedure plays a role in many clinical stages of testicular cancer.
Carcinoid Tumors of the Gut
Authors: Sweeney John F. , Rosemurgy Alexander S.
Published: August 2017

Background

Carcinoid tumors are the most frequently encountered endocrine tumors of the gastrointestinal tract. They are most often found in the appendix, although they can arise in any location of the gut. Carcinoid tumors may secrete a variety of bioactive substances, which can cause the complex of symptoms associated with the carcinoid syndrome.

Methods

The authors reviewed the pathology, clinical presentation, and management of carcinoid tumors with an emphasis on the surgical management.

Results

The primary treatment for a carcinoid tumor located anywhere in the gut is surgical. Those who have widely metastatic disease or who are anatomically unresectable may undergo cytoreductive surgical debulking and/or hepatic arterial embolization followed by palliation of symptoms with octreotide, the long-acting somatostatin analog.

Conclusions

The prognosis for patients with carcinoid tumors that are fully resected is excellent. Those with hepatic metastases and the carcinoid syndrome.
Chemoprevention of Bladder and Prostate Carcinoma
Authors: Joseph Jean V. , Messing Edward M.
Published: August 2017

Background

The incidence of bladder and prostate cancer continues to rise, with little accompanying improvement in management strategies. Opportunities exist for testing various types of chemopreventive interventions.

Methods

The authors review the biology of progression to invasive disease for cancers of the bladder and the prostate and identify intermediate disease and surrogate endpoint markers. Candidate interventions and initial clinical trial results are described.

Results

Markers of cellular proliferation and differentiation, as well as antigens such as Lex, M344, DD23, and bladder tumor antigen, are promising for bladder cancer. Testing with prostate-specific antigen and prostate-specific membrane antigen is promising for prostate cancer. Several prevention intervention trials are in progress for both cancers.

Conclusions

Vitamins, polyamine synthesis inhibitors, and oltipras are undergoing clinical tests for chemopreventive effects in bladder cancer, and a large trial of finasteride to prevent prostate cancer is completing accrual. Results from these studies will direct future research.
Controversies in Breast Cancer
Authors: Cummings Frank J. , Saba Nabil
Published: August 2017

Background

A large number of controversies about the management of breast cancer produce uncertainties for patients and physicians alike. In addition, questions are constantly raised about the true value of new approaches or treatments.

Methods

The authors have conducted a critical review of the literature on several of these issues, and they present a balanced view that can be useful for clinical decision making.

Results

Although new staging systems for ductal carcinoma in situ have been proposed, a consensus has not yet been reached regarding the criteria to allow tumor excision alone. The extent of benefit of the main adjuvant therapies is becoming better established, and improvement in outcomes may accrue from dose-intensive treatments and autologous stem cell or hematopoietic growth factor support.

Conclusions

Progress in breast cancer management continues to evolve. Several new approaches either reduce morbidity or improve outcomes.
A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer
Authors: Anderson Benjamin O. , Austin-Seymour Mary M. , Gralow Julie R. , Moe Roger E. , Byrd David R.
Published: August 2017

Background

Lymph node metastasis is the single most important factor in assessing breast cancer prognosis and planning systemic therapy. However, lymph node dissection portends significant morbidity, with little or no therapeutic benefit if the nodes prove to be negative for cancer.

Methods

The authors review indications for avoiding axillary dissection, and they analyze the results from lower-level axillary lymphadenectomy together with the morbidity from full axillary dissection.

Results

Limited level I dissection depends on surgical technique and limits prognostic information. Three approaches have evolved to identify the sentinel node in breast cancer: perilesional breast injection of radiocolloid alone, blue dye alone, or a combination of radiocolloid and blue dye. These techniques provide high diagnostic accuracy, few false-negative results, and less morbidity.

Conclusions

Knowledge of axillary status is critical to current breast cancer management and cannot be foregone in the preponderance of patients with advanced breast cancer. Results from lymphatic mapping and sentinel node biopsy are highly encouraging.
The Technique of Intraoperative Nuclear Mapping to Facilitate Minimally Invasive Parathyroidectomy
Authors: Norman James
Published: August 2017

Background

Despite the fact that primary hyperparathyroidism (HPTH) is the result of a single adenoma in 85% to 92% of cases and is cured following the removal of this one gland, many surgeons continue to perform a complete bilateral neck exploration for patients with primary HPTH. The advent of the sestamibi scan now enables the identification of patients with a single adenoma.

Methods

The use of preoperative sestamibi scanning followed immediately by minimally invasive parathyroidectomy using intraoperative nuclear mapping allows cure for primary HPTH in properly selected patients.

Results

Reports have shown that preoperative sestamibi scanning has a sensitivity of approximately 90% and a specificity of almost 100% in identifying patients with a single adenoma. Intraoperative mapping allows a limited dissection to be performed under local anesthesia in an outpatient setting in approximately 80% of all patients with primary hyperparathyroidism. The details of this new technique — patient selection, timing, use of the intraoperative nuclear probe, and surgical exploration — are described.

Conclusions

When selected appropriately, most patients with primary HPTH can be successfully treated through a minimally invasive technique.
Large Granular Lymphocyte Leukemia
Authors: Lamy Thierry , Loughran Thomas P.
Published: August 2017

Background:

Clonal diseases of large granular lymphocyte (LGL) disorders can arise from a CD3+ T-cell lineage or from a CD3– NK-cell lineage. CD3+ LGL leukemia is the most frequent form of LGL leukemia and is a distinct entity by FAB and REAL classifications.

Methods:

The clinical course, biological features, and recent data on pathogenesis of CD3+ LGL leukemia are reviewed. The spectrum of differential diagnosis is described.

Results:

T-LGL leukemia affects elderly people. Approximately 60% of patients are symptomatic; recurrent infections secondary to chronic neutropenia, anemia, and rheumatoid arthritis are the main clinical features. The most common phenotype is CD3+, CD8+, CD57+. Clonality is detected by clonal rearrangement of the T-cell receptor gene. Clinical and molecular remission can be obtained with oral low-dose methotrexate. Serologic findings show frequent reactivity to the BA21 epitope of HTLV-I env p21e, suggesting that a cellular or retroviral protein with homology to BA21 may be important in pathogenesis. Clonal expansion may be facilitated by IL-12 and IL-15 lymphokines. Constitutive expression of Fas ligand by leukemic LGLs support the hypothesis that leukemic cells arise from antigen-activated cytotoxic T cells. Leukemic LGLs express a multidrug-resistance phenotype that could partly explain the chemoresistance observed in aggressive cases.

Conclusions:

CD3+ LGL leukemia is a distinct lymphoproliferative T-cell disorder with specific clinicobiological aspects. The clinical spectrum of LGL proliferations is wide and immunophenotypic, and genotypic studies are needed to establish the diagnosis.
Implantable Slow-Release Chemotherapeutic Polymers for the Treatment of Malignant Brain Tumors
Authors: Sampath Prakash , Brem Henry
Published: August 2017

Background:

Despite significant advances in neurosurgery, radiation therapy, and chemotherapy, the prognosis for patients with malignant brain tumors remains dismal. In an effort to improve control of local disease, we have developed a biodegradable, controlled-release polymer that is implanted directly at the tumor site.

Methods:

The preclinical and clinical development of the polymeric delivery of chemotherapeutic agents for treatment of patients with malignant gliomas is reviewed.

Results:

Carmustine (BCNU)-impregnated biodegradable polymer is the first new therapy approved by the FDA for patients with gliomas in 23 years. This delivery system provides high local concentration of drug with minimal systemic toxicity and obviates the need for drug to cross the blood-brain barrier. Randomized, multi-institutional, double-blinded, placebo-controlled studies have shown improved survival in patients treated for gliomas both at initial presentation and at recurrence. Several clinical principles have emerged from the use of this polymer system, and further applications are currently being investigated.

Conclusions:

Local delivery of therapeutic agents via biodegradable polymers may play an increasing role in patients with brain tumors.
Current Concepts in the Management of Tumors of the Skull Base
Authors: Morita Akio , Sekhar Laligam N. , Wright Donald C.
Published: August 2017

Background:

Due to their involvement with critical neurovascular structures, tumors located in the cranial base present challenges to neurosurgeons and are associated with high morbidity and mortality.

Methods:

Rates of tumor control, complications, patient outcomes, and recurrences were extracted and summarized from two decades of our surgical and radiological treatment follow-up and review of the medical literature.

Results:

Recent advances in surgical techniques involving cranial base approaches have made surgical intervention safer and curative resection more likely. In managing benign tumors, surgical resection is the gold standard for treatment. While immediate complications are still significant, long-term outcomes in most cases are excellent. Focused radiosurgery using a gamma knife or linear accelerator has produced favorable outcomes, and it improves the management of small or minimally symptomatic cranial base tumors. For slow-growing malignant tumors, extensive surgery followed by radiotherapy achieves the best outcome. In managing highly malignant tumors, outcome is determined by the effects of chemotherapy and radiotherapy. On some occasions, surgery is needed to obtain greater control of highly malignant tumors.

Conclusions:

Skull base tumors are relatively common, and management of these tumors is rapidly evolving. The combination of surgical excision using cranial base techniques, radiosurgery, fractionated radiotherapy, and chemotherapy should be individually tailored based on the location and pathological aggressiveness of the tumor and the symptomatology of the patient. Appreciation is expressed to Jennifer Pryll for her illustrative and photographic assistance and to Joseph Reister for editing and preparing the manuscript.
Cytostatic Agents in the Management of Malignant Gliomas
Authors: Mikkelsen Tom
Published: August 2017

Background:

Cytotoxic therapy for malignant gliomas is limited by poor delivery and drug resistance, and local therapy is ineffective in managing migratory cells. However, recent developments in malignant glioma therapy involve trials of cytostatic rather than conventional cytotoxic agents.

Methods:

The biology of the brain extracellular matrix, tumor invasion, and angiogenesis are reviewed, and the cytostatic agents that inhibit matrix metalloproteinases, angiogenesis, cell proliferation, and signal transduction are discussed, as well as studies of the angiogenic and migratory capacity of malignant brain tumors.

Results:

Two specific and interrelated areas, anti-invasion (migration) and anti-angiogenesis, are potential areas to develop new treatment strategies. Tumor invasion and angiogenesis are important components of the spread and biologic effects of malignant gliomas. Several proteinase inhibitors are in clinical trial, as well as anti-angiogenic agents and signal transduction cascade inhibitors.

Conclusions:

Biologic control of brain tumor cell populations may offer a new management approach to add to currently available management options for malignant brain tumors.
Uveal Melanoma
Authors: Kincaid Marilyn C.
Published: August 2017

Background

Malignant melanoma of the uveal tract is a rare malignancy but a significant cause of mortality and visual loss. Approximately 50% of patients diagnosed with a melanoma of the choroid or ciliary body will die of the disease within 15 years of enucleation.

Methods

The author reviewed the current literature on the clinical findings, epidemiology, and treatment of uveal melanoma.

Results

Methods of diagnosis have improved substantially in the past several years, although clinical diagnosis by an experienced examiner remains the standard in eyes with clear media. Ultrasound is the most useful adjunctive technique. While enucleation has been the mainstay of therapeutic intervention, alternative therapies – especially different types of irradiation – offer hope for tumor control and vision preservation. The Collaborative Ocular Melanoma Study, a multicenter national trial, is designed to provide long-term data on the natural history as well as therapeutic intervention.

Conclusions

Malignant melanoma of the uveal tract can be diagnosed clinically with more confidence than ever before. It is also possible in many cases to retain the eye and functional vision while controlling the tumor. However, unanswered questions remain about the natural history and optimal therapy of uveal melanoma.
Anemia in Lymphoproliferative Disorders
Authors: Loughran Thomas P.
Published: August 2017

The onset of anemia in patients with lymphoproliferative disorders can be attributed to various causes, including autoimmune hemolytic anemia, pure red cell aplasia, and anemia of chronic disease. A variety of interventions can provide benefit.
HER-2 as a Prognostic, Predictive, and Therapeutic Target in Breast Cancer
Authors: Perez Edith A.
Published: August 2017

Background:

An expanded understanding of the biology of breast cancer has led to the identification of the HER-2 receptor as an important growth factor. This receptor possesses intrinsic tyrosine kinase activity and has been associated with aggressive biological behavior and poor clinical outcome.

Methods:

Data have been reviewed regarding the role of HER-2 expression as a prognostic variable, as a predictive factor for response to chemotherapy and hormonal therapies, and as a directed therapeutic target for breast cancer.

Results:

Therapy with a humanized monoclonal antibody to HER-2 (trastuzumab) can be effective treatment in some patients with metastatic breast cancer, either given alone or in combination with some chemotherapeutic agents. Cardiac toxicity limits concurrent use with anthracyclines. Clinical trials will further define optimal combination regimens with this agent, and its value in patients with localized or locally advanced stages.

Conclusions:

Trastuzumab is a significant addition to the armamentarium against breast cancer. Standardization of the optimal method to evaluate for HER-2 overexpression is necessary to better define its role as a prognostic, predictor, and therapeutic target in this disease.
Pregnancy after Breast Cancer
Authors: Gemignani Mary L. , Petrek Jeanne A.
Published: August 2017

Background:

The issue of pregnancy following the diagnosis and treatment of breast cancer is important because the incidence of breast cancer is increasing in women of childbearing age. The fact that many women are delaying childbearing, whether for educational, professional, or personal reasons, increases the number of women who will undergo breast cancer treatment before completing childbearing.

Methods:

Data on pregnancy in breast cancer survivors are limited and consist only of retrospective data. This paper reviews the published literature on the influence of subsequent pregnancy on breast cancer, including three recent large-scale population-based studies.

Results:

The survival of women with breast carcinoma who subsequently become pregnant is not reported to be decreased in any of the published series. However, several biases may be present that justify the concern regarding the conclusions.

Conclusions:

Further research on the safety of subsequent pregnancy after breast carcinoma treatment is needed. To address these issues, patients are currently being accrued for a large, prospective, multicenter study of young breast carcinoma patients.
Pharmacology of Chemotherapy in the Older Cancer Patient
Authors: Balducci Lodovico , Beghé Claudia
Published: August 2017

Background

The incidence of cancer among the elderly population is increasing. The aging process can deplete functional reserve of many organ systems and thus affects the treatment goals for this age-group.

Methods

The pharmacologic consequences of the aging process on elderly cancer patients are reviewed, and guidelines are suggested for assessing and treating this patient population with antitumor drugs.

Results

Individualized management of the older cancer patient reflects the results of a comprehensive geriatric assessment. Factors that affect treatment decisions include estimates of the extent of treatment toxicity, the impact of treatment on quality of life, estimates of life expectancy, and the influence of age on pharmacokinetic parameters.

Conclusions

Management of older patients with cancer includes individual assessments that consider the effects of aging on the pharmacodynamics, therapies, and complications of treatment for this population. Treatment can be made safer and more effective by adjusting chemotherapy dosage, maintaining hemoglobin levels, and using hemopoietic growth factors when appropriate.
Evaluation of Palliative Endpoints in Oncology Clinical Trials
Authors: Jacobsen Paul B. , Weitzner Michael A.
Published: August 2017

Background

In recent years, there has been a growing recognition that improvements in quality of life may be as important as improvements in quantity of life in patients with advanced cancer. With this goal in mind, many oncology trials now seek to evaluate palliative endpoints as well as disease progression and survival.

Methods

Methodologic advances and challenges in evaluating palliative endpoints in oncology clinical trials are reviewed.

Results

Valid and reliable self-report measures have been developed that permit evaluation of palliative endpoints. Issues to consider in conducting research on palliative endpoints include the selection of appropriate outcome measures, the number and timing of outcome assessments, and the handling of missing data.

Conclusions

The inclusion of palliative endpoints into clinical trials in oncology has the potential to advance clinical care by identifying chemotherapeutic agents that are effective in improving the quality of life of patients with advanced cancer.
Is Retirement a Crisis for Men? Class and Adjustment to Retirement
Authors: Pietilä Ilkka , Calasanti Toni , Ojala Hanna , King Neal
Published: August 2017

Because paid work is taken to be central to manhood, scholarly and popular discourse have characterized retirement as presenting a “crisis of masculinity.” However, such a crisis is not borne out by research, perhaps because scholars have not considered how class might shape masculinities and thus expectations and experiences of retirement. Using data obtained from interviews with Finnish metal workers and engineers who are either approaching retirement or recently retired, we ask whether (1) this crisis discourse is reflected in their retirement expectations, (2) it matches their actual experiences of retirement, and (3) retirement disrupts the masculinities of some class groups more than others. We find evidence of this retirement crisis discourse in our respondents’ views of retirement, but not in their actual experiences, belying the homogeneity of masculinity implied by it. Class shapes both the perceived content of crises and the actual retirement experiences.
Investigation on performance characteristics and metallographic transformation on drilling aluminium/titanium sandwich
Authors: Zhu Zhaoju , Liu Kai , Sun Jie , Li Jianfeng
Published: August 2017

Materials sandwiches of aluminium/titanium are widely used in structural aerospace, especially in the surface coating and skeletons of aircrafts. Due to their inhomogeneous behavior and poor machinability, drilling aluminium/titanium sandwich in one-shot operation has brought great challenges to the modern manufacturing community. In this paper, a series of experiments were conducted to understand and characterize the process of drilling aluminium/titanium sandwich. Experimental results have shown that the serrated chip is not common in drilling. Only the outer edge of the spiral chip has saw teeth because of the variable cutting speed along the cutting edge. In addition, a better understanding of the phase transformation on surface and subsurface of drilled hole has been provided. Two kinds of phase transformations on the surface of drilled hole have been observed: one is the allotropic transformation from α to β phase and the other is that from β to minor phases α′ (hexagonal martensites). All these are mainly due to the interaction of mechanical force and high temperature.