bluuebunny/crossref_metadata_2025 huggingface dataset:
Focal Cryotherapy in the Treatment of Localized Prostate Cancer
Authors: Nguyen Huy D. , Allen Bryan J. , Pow-Sang Julio M.
Published: August 2017

Background

The management choice for newly diagnosed localized prostate cancer presents a challenge to both the physician and the patient. Traditionally, surgery and radiation therapy have been the most commonly recommended options. More recently, active surveillance is recommended as the preferred management choice for a subset of men with localized, low-risk cancer. Recent reports also suggest that focal cryotherapy may be considered as a management option for selected cases of clinically localized prostate cancer.

Methods

A review of the literature on focal cryotherapy from 2002 to 2012 was performed. Outcomes on cancer control, complications, and quality of life were extracted and assessed.

Results

The biochemical disease-free survival at 5 years is comparable to whole gland treatment modalities. Complications are minimal and comparable with other local treatment modalities.

Conclusions

Focal cryotherapy is safe and effective, and it may improve failure rates in men who initially pursue active surveillance protocols. Early outcomes with cancer control are encouraging.
Role of Systemic Chemotherapy in Urothelial Urinary Bladder Cancer
Authors: Gupta Shilpa , Mahipal Amit
Published: August 2017

Background

Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer; however, 50% of patients still relapse in distant sites following surgery. A systemic approach is needed to improve outcomes in bladder cancer in the metastatic and perioperative settings.

Methods

We reviewed the literature for use of systemic chemotherapy in bladder cancer and its role in metastatic, neoadjuvant, and adjuvant settings, including patients with comorbidities and renal dysfunction. Current controversies on the role of chemotherapy in neoadjuvant and adjuvant settings as well as the role of novel agents are discussed.

Results

First-line cisplatin-based polychemotherapy improves survival in the metastatic setting and is the standard of care. Approved regimens for subsequent-line therapy do not exist. Chemotherapy has a modest benefit in the neoadjuvant setting, but evidence is insufficient to justify its role in the adjuvant setting despite a possible benefit. Carboplatin cannot be substituted for cisplatin in fit patients, and the addition of taxane to a standard regimen cannot be recommended.

Conclusions

Systemic chemotherapy plays a central role in the management of invasive bladder cancer in the metastatic and neoadjuvant settings, but its role in the adjuvant setting remains undefined. Neoadjuvant chemotherapy is underutilized and should be routinely used. Pathological downstaging strongly correlates with improved outcomes and may serve as a surrogate end point for survival. An urgent need exists for the development of novel therapeutic agents to improve outcomes.
Primary Spine Tumors: Diagnosis and Treatment
Authors: Clarke Michelle J. , Mendel Ehud , Vrionis Frank D.
Published: August 2017

Background

Primary tumors are rare and those localized to a single location offer the potential for cure. To achieve this, early recognition of the primary tumor and proper workup and treatment are essential.

Methods

The authors reviewed the literature and best practices to provide recommendations on primary spine tumor treatment. Appropriate workup of primary spine tumors and treatment algorithms are also discussed.

Results

Patients suspected of a primary spine tumor should undergo fine-needle aspirate biopsy following consultation with the surgical team to ensure the biopsy tract is surgically resectable should the need arise. Once pathology is confirmed, metastatic workup should be performed to guide the level of treatment. If a localized lesion with poor radiation and chemotherapeutic response is diagnosed, then en bloc resection may be required for cure. If en bloc resection is not feasible or metastatic lesions are present, then radiation and medical oncology specialists must work in conjunction with the surgical team to determine the best treatment options.

Conclusions

Patients with suspected primary tumors of the spine should be treated in a multidisciplinary fashion from the outset. With thoughtful management, these lesions offer the opportunity for surgical cure.
Spinal Tumor Surgery: Management and the Avoidance of Complications
Authors: Clarke Michelle J. , Vrionis Frank D.
Published: August 2017

Background

Complication avoidance is paramount to the success of any surgical procedure. In the case of spine tumor surgery, the risk of complications is increased because of the primary disease process and the radiotherapy and chemotherapeutics used to treat the disease. If complications do occur, then life-saving adjuvant treatment must be delayed or withheld until the issue is resolved, potentially impacting overall disease control.

Methods

We reviewed the literature and our own best practices to provide recommendations on complication avoidance as well as the management of complications that may occur. Appropriate workup of suspected complications and treatment algorithms are also discussed.

Results

Appropriate patient selection and a multidisciplinary workup are imperative in the setting of spinal tumors. Intraoperative complications may be avoided by employing proper surgical technique and an understanding of the pathological changes in anatomy. Major postoperative issues include wound complications and spinal reconstruction failure. Preoperative surgical planning must include postoperative reconstruction. Patients undergoing spinal tumor resection should be closely monitored for local tumor recurrence, recurrence along the biopsy tract, and for distant metastatic disease. Any suspected recurrence should be closely watched, biopsied if necessary, and promptly treated.

Conclusions

Because patients with spinal tumors are normally treated with a multidisciplinary approach, emphasis should be placed on the recognition of surgical complications beyond the surgical setting.
Spinal Neoplastic Instability: Biomechanics and Current Management Options
Authors: Filis Andreas K. , Aghayev Kamran V. , Doulgeris James J. , Gonzalez-Blohm Sabrina A. , Vrionis Frank D.
Published: August 2017

Background

Often the spine is afflicted from primary or metastatic neoplastic disease, which can lead to instability. Instability can cause deformity, pain, and spinal cord compression and is an indication for surgery. Although overt instability is uniformly agreed upon, it is sometimes difficult for specialists to agree on subtle degrees of instability due to lack of objective criteria.

Methods

In this article, treatment options and the spine instability neoplastic system are discussed and the neoplastic instability literature is reviewed.

Results

The Spinal Instability Neoplastic Score helps specialists determine whether instability is present and when surgery may be indicated. However, other parameters such as spinal cord compression and extent of disease dictate whether surgery is the most appropriate option. A wide range of fusion techniques exists, each one tailored to the location of the lesion and goals for surgery.

Conclusions

To optimize results, expert knowledge on the techniques and patient selection is of importance. Furthermore, a multidisciplinary approach is required because treatment of neoplastic disease is multimodal.
Molecular Assays in Cytopathology for Thyroid Cancer
Authors: Valderrabano Pablo , Zota Victor E. , Mciver Bryan , Coppola Domenico , Leon Marino E.
Published: August 2017

Background

Despite lack of adequate, validated, independently performed clinical studies, several molecular tests are commercially available on the market and are being used on indeterminate thyroid nodules to guide patient-care decisions.

Methods

We summarize the current evidence on the role and limitations of molecular tests used in combination with thyroid cytopathology to refine the presurgical diagnosis of thyroid nodules.

Results

The clinical performance of molecular tests depends on the pretest risk of malignancy within the specific cytological group being assessed. This risk is variable and should be assessed at each institution to optimize the selection of the molecular test and the interpretation of its results. Next-generation sequencing has increased the sensitivity of oncogene panels while maintaining high specificity. Tests assessing the gene expression pattern have shown promising results, with high sensitivity but low specificity. The impacts of molecular markers on clinical practice remains in flux and their effect on health care costs remains poorly understood.

Conclusions

Further large, independent, confirmatory, clinical validation studies and real-world, cost-effectiveness studies are necessary before the widespread adoption of these tests can be endorsed as standard of care.
Circulating Tumor Cells: A Window into Tumor Development and Therapeutic Effectiveness
Authors: Cáceres Gisela , Puskas John A. , Magliocco Anthony M.
Published: August 2017

Background

Circulating tumor cells (CTCs) are an important diagnostic tool for understanding the metastatic process and the development of cancer.

Methods

This review covers the background, relevance, and potential limitations of CTCs as a measurement of cancer progression and how information derived from CTCs may affect treatment efficacy. It also highlights the difficulties of characterizing these rare cells due to the limited cell surface molecules unique to CTCs and each particular type of cancer.

Results

The analysis of cancer in real time, through the measure of the number of CTCs in a “liquid” biopsy specimen, gives us the ability to monitor the therapeutic efficacy of treatments and possibly the metastatic potential of a tumor.

Conclusions

Through novel and innovative techniques yielding encouraging results, including microfluidic techniques, isolating and molecularly analyzing CTCs are becoming a reality. CTCs hold promise for understanding how tumors work and potentially aiding in their demise.
Molecular Pathology of Soft-Tissue Neoplasms and Its Role in Clinical Practice
Authors: Henderson-Jackson Evita B. , Bui Marilyn M.
Published: August 2017

Background

Soft-tissue neoplasms embody a histologically diverse group of mesenchymal tumors. Oftentimes the histopathological diagnosis of soft-tissue tumors is challenging due to overlapping pathological features.

Methods

We reviewed the current and most importantly known recurrent or tumor-specific genetic abnormalities involving soft-tissue tumors, focusing on how they are useful in working up differential diagnoses and the relevance of potentially targeted therapies.

Results

Molecular diagnostic tools have shown great advantage as an aid in the differentiation between different soft-tissue tumor entities, providing a potential avenue in the identification of novel therapeutic targets. Gastrointestinal stromal tumor is a well-known example of a soft-tissue tumor with a successful, molecularly driven treatment with response rates of more than 80% in stable disease and partial remission. Classifying soft-tissue neoplasms by their molecular genetic pathology has been considered as molecular testing becomes more integrated into various diagnostic and prognostic algorithms.

Conclusions

Molecular pathology provides a unique opportunity for pathologists to play a crucial role in the multidisciplinary care of patients with sarcoma. These opportunities include but are not limited to the appropriate triage of tissue for molecular testing and the integration of molecular testing results, with histological and immunohistochemical findings providing actionable information for the diagnosis, prognosis, and choice of therapeutic modality.
Impending Impact of Molecular Pathology on Classifying Adult Diffuse Gliomas
Authors: Macaulay Robert J.
Published: August 2017

Background

Progress in molecular oncology during the last decade has enabled investigators to more precisely define and group gliomas. The impacts of isocitrate dehydrogenase (IDH) mutation (mut) status and other molecular markers on the classification, prognostication, and management of diffuse gliomas are likely to be far-reaching.

Methods

Clinical experience and the medical literature were used to assess the current status of glioma categorization and the likely impact of the pending revision of the classification scheme of the World Health Organization (WHO).

Results

IDH-mut is a defining event in most adult fibrillary astrocytomas (FAs) and nearly all oligodendrogliomas (ODs). The IDH-mut status of most gliomas can be established by immunohistochemistry for the most common mutant of IDH1 (R132H). IDH wild-type (wt) diffuse gliomas include several familiar entities — in particular, glioblastoma (GBM) and most pediatric gliomas — as well as an assortment of less well-defined entities. The codeletion of 1p/19q distinguishes OD from FA, which, by contrast, shows frequent loss of the α thalassemia/mental retardation syndrome X-linked protein. Mixed oligoastrocytomas are typically classifiable as either OD or FA using molecular testing.

Conclusions

The current practice of designating IDH-mut WHO grade 4 astrocytoma as secondary GBM will likely be discouraged, and primary or de novo GBM, which is always IDH-wt, may lose this qualification. Histologically, low- or intermediate-grade IDH-wt gliomas with molecular changes characteristic of GBM might justify the designation of GBM WHO grade 3. Mixed oligoastrocytoma is losing popularity as a diagnostic term because most cases will fall into either the FA or OD category. Distinguishing IDH-mut from IDH-wt tumors in clinical trials is likely to clarify sensitivity rates or tumor resistance among subgroups, thus suggesting opportunities for targeted therapy.
Use of Immunohistochemical Stains in Epithelial Lesions of the Breast
Authors: Khazai Laila , Rosa Marilin
Published: August 2017

Background

During the last few decades, immunohistochemistry (IHC) has become an integral part of pathology. Although hematoxylin and eosin (H & E) stain remains the fundamental basis for diagnostic pathology of the breast, IHC stains provide useful and sometimes vital information. Moreover, considering the role of hormonal therapy in hormone receptor–positive breast tumors, as well as the availability of targeted chemotherapeutic agents for HER2-positive cases, IHC studies represent a major part of workups.

Methods

A literature search was performed to explore the uses of IHC stains related to the diagnoses of breast lesions and prognostic/predictive information.

Results

Selective use of IHC stains in conjunction with H & E examination helps resolve most diagnostic issues encountered by surgical pathologists during their day-to-day practice. Pathologists should be familiar with the use of each immunostain and its limitations to avoid interpretative errors.

Conclusions

IHC stains help guide the differential diagnosis of challenging epithelial lesions of the breast. They should be selectively and judiciously used and their findings must be interpreted with the differential diagnoses in mind and with an understanding of possible pitfalls.
Special Technologies for Ex Vivo Analysis of Cancer
Authors: Kreahling Jenny M. , Altiok Soner
Published: August 2017

Background

Predictive assays for cancer treatment are not new technology, but they have failed to meet the criteria necessary for standardized use in clinical decision-making.

Methods

The authors summarize the use of predictive assays and the challenges and values associated with these assays in the clinical setting.

Results

Predictive assays commercially available in the clinical setting are not standardized, have significant obstacles to overcome, and cannot be relied upon by health care professionals due to the limited value these assays provide to the decision-making process for the treatment of patients.

Conclusions

A method that more closely recapitulates the human tumor microenvironment and accurately predicts response with high reproducibility would be beneficial to patient outcomes and quality of life.
Cost Effectiveness of Colorectal Cancer Screening Strategies
Authors: Patel Shaan S. , Kilgore Meredith L.
Published: August 2017

Background

Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how current CRC screening strategies for CRC compare with no screening and whether agreement exists with regard to the cost effectiveness of different strategies.

Methods

Databases were searched for cost-effectiveness analyses focused on CRC screening strategies in the United States and published between May 2007 and February 2014. We analyzed the uses of fecal occult blood, fecal immunochemistry, and stool DNA tests, as well as sigmoidoscopy, colonoscopy, and virtual colonoscopy. A paired comparison of each screening strategy with no screening across each of the studies reviewed was conducted. A series of paired comparisons of the results reported in each of the studies is also included.

Results

When compared with no screening, all CRC screening strategies evaluated in this review were cost effective. There was disagreement as to which screening strategy was the most cost effective. However, sigmoidoscopy combined with fecal blood testing always dominated either strategy alone. Studies comparing colonoscopy with fecal blood testing, sigmoidoscopy, or both had mixed results.

Conclusions

Compared with no screening, all CRC screening strategies are more cost effective. Study results disagree as to which screening strategy should be the preferred method.
Stereotactic Body Radiotherapy for Recurrent Unresectable Head and Neck Cancers
Authors: Strom Tobin , Wishka Christian , Caudell Jimmy J.
Published: August 2017

Background

Treatment of locoregional, recurrent head and neck cancers following definitive radiotherapy has evolved during the past 30 years. Brachytherapy as well as protracted courses of systemic therapy and chemoradiotherapy result in 12-month survival rates of 40% to 50% but have high rates of severe toxicity. Given the advancements in radiotherapy targeting and delivery, stereotactic body radiotherapy (SBRT) has been investigated as an alternative treatment option with the potential advantages of reduced treatment time and rates of toxicity.

Methods

The authors reviewed prospective trials and retrospective reports from the past decade addressing the management of locoregional, recurrent, previously radiated head and neck cancers, focusing on SBRT.

Results

The body of evidence is growing in support of reirradiation using SBRT for the treatment of recurrent head and neck cancers. The 1-year survival rates associated with SBRT are promising and similar to those seen with chemotherapy alone and concurrent, conventionally fractionated radiotherapy and chemotherapy. Treatment-related adverse events of reirradiation using SBRT are also similar to other palliative therapies. Late carotid rupture is a relatively rare but concerning late toxicity associated with reirradiation using SBRT.

Conclusions

SBRT is a promising treatment for locoregional recurrent head and neck cancers. It also offers a logistical advantage over other palliative treatments, as it only requires 1 to 2 weeks of treatment.
Racial Disparity in Time between First Diagnosis and Initial Treatment of Prostate Cancer
Authors: Kinlock Ballington L. , Thorpe Roland J. , Howard Daniel L. , Bowie Janice V. , Ross Louie E. , Fakunle David O. , Laveist Thomas A.
Published: August 2017

Background

Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored.

Methods

Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when they entered the North Carolina Central Cancer Registry during the years 2007 and 2008. Our dependent variable was the amount of months that had passed between first diagnosis and treatment. Our main independent variable was self-reported race. Covariates included age, income, level of education, insurance status, treatment received, Gleason score, and level of medical mistrust. We used negative binomial regression analysis to determine the association between the amount of time that lapsed between a diagnosis of prostate cancer and treatment by race.

Results

Compared with white men, black men were more likely to experience a longer wait time between diagnosis and treatment of prostate cancer (incidence rate ratio [IRR] 1.19; 95% confidence interval [CI], 1.04–1.36). Controls for demographical, clinical, and psychosocial variables (IRR 1.24; 95% CI, 1.04–1.43) did not explain this difference between the races.

Conclusions

These results suggest that the amount of time that lapses between first diagnosis and treatment of prostate cancer is longer for black men compared with white men. Our findings have identified an under-reported racial disparity in the disease continuum of prostate cancer.
Hyperuricemia in 2 Patients Receiving Palbociclib for Breast Cancer
Authors: Bromberg David J. , Valenzuela Mauricio , Nanjappa Sowmya , Pabbathi Smitha
Published: August 2017

The authors reviewed retrospective cases of 2 women — one aged 78 years and the other aged 86 years — with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer treated with combination palbociclib/letrozole who presented with hyperuricemia. In both cases, the patients experienced hyperuricemia and neutropenia that required palbociclib to be temporarily discontinued and its dose to be subsequently reduced. Although study data have demonstrated that combination palbociclib/letrozole is safe and effective as a first-line treatment option for patients with advanced ER-positive, HER2-negative breast cancer, the efficacy and safety of cyclin-dependent kinase inhibitors, including their adverse events, still remains an active area of research. The authors postulate that hyperuricemia may be a potential adverse event of palbociclib not yet reported in randomized control studies or in clinical practice.
Advances in the Endoscopic Diagnosis of Barrett Esophagus
Authors: Davis-Yadley Ashley H. , Neill Kevin G. , Malafa Mokenge P. , Peña Luis R.
Published: August 2017

Background

Barrett esophagus (BE) continues to be a major risk factor for developing esophageal adenocarcinoma.

Methods

We review the risk factors, diagnosis, and management of BE, with an emphasis on the most current endoscopic diagnostic modalities for BE.

Results

Novel diagnostic modalities have emerged to address the inadequacies of standard, untargeted biopsies, such as dye-based and virtual chromoendoscopy, endoscopic mucosal resection, molecular biomarkers, optical coherence tomography, confocal laser endomicroscopy, volumetric laser endomicroscopy, and endocytoscopy. Treatment of BE depends on the presence of intramucosal cancer or dysplasia, particularly high-grade dysplasia with or without visible mucosal lesions.

Conclusions

Recent advances in endoscopic diagnostic tools demonstrate promising results and help to mitigate the shortcomings of the Seattle protocol. Future research as well as refining these tools may help aid them in replacing standard untargeted biopsies.
Management of Oropharyngeal Cancer in the HPV Era
Authors: Naghavi Arash O. , Strom Tobin J. , Ahmed Kamran A. , Echevarria Michelle I. , Abuodeh Yazan A. , Venkat Puja S. , Frakes Jessica M. , Harrison Louis B. , Trotti Andy M. , Caudell Jimmy J.
Published: August 2017

Background

Historically, oropharyngeal cancer (OPC) has been attributed to risk factors such as smoking and alcohol use. The increased incidence of OPC has been driven by human papillomavirus (HPV) infection.

Methods

A search of the literature involving HPV infection and OPC was performed, along with a search of ongoing clinical trials regarding HPV-positive OPC.

Results

This review summarizes the differences in epidemiology and prognosis of HPV-positive OPC compared with non–HPV-related OPC. It will also discuss use of de-escalating treatment to minimize toxicity while maintaining excellent outcomes. Disease management is also addressed, including prevention and follow-up recommendations for this cohort of patients.

Conclusions

HPV-positive OPC is a distinct disease, and efforts should be made to personalize its management. Preventive measures and vaccinations, along with de-escalation of treatment, may help optimize outcomes in this population.
Management of BCC and SCC of the Head and Neck
Authors: Strom Tobin J. , Caudell Jimmy J. , Harrison Louis B.
Published: August 2017

Background

For decades radiotherapy (RT) has been shown to treat skin cancers; however, the indications, delivery methods, and techniques for RT continue to evolve.

Methods

Relevant prospective and retrospective reports were reviewed that addressed outcomes with, indications for, and delivery techniques used with RT for the management of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the head and neck.

Results

Rates of local control higher than 90% are typically achievable for early-stage BCC and SCC of the head and neck. RT is often recommended for tumors located in cosmetically or functionally sensitive areas of the face, for patients who cannot tolerate anesthesia, for those taking anticoagulants, or for patients who prefer RT to other treatment options. A wide range of radiation doses, daily fractionation schedules, and radiation techniques have been shown to be effective for management. In general, postoperative local radiation is recommended following excision for patients with high-risk factors, including those whose tumors have close or positive margins, perineural invasion, invasion of the bone or nerves, or those with recurrent disease.

Conclusions

RT plays an integral role in the treatment of primary and postoperative cutaneous BCC and SCC of the head and neck. Prospective trials are in progress to address the roles of concurrent systemic therapy and RT for both cutaneous BCC and SCC.
Practical Issues for Retroperitoneal Sarcoma
Authors: Pham Vicky , Henderson-Jackson Evita , Doepker Matthew P. , Caracciolo Jamie T. , Gonzalez Ricardo J. , Druta Mihaela , Ding Yi , Bui Marilyn M.
Published: August 2017

Background

Retroperitoneal sarcoma is rare. Using initial specimens on biopsy, a definitive diagnosis of histological subtypes is ideal but not always achievable.

Methods

A retrospective institutional review was performed for all cases of adult retroperitoneal sarcoma from 1996 to 2015. A review of the literature was also performed related to the distribution of retroperitoneal sarcoma subtypes. A meta-analysis was performed.

Results

Liposarcoma is the most common subtype (45%), followed by leiomyosarcoma (21%), not otherwise specified (8%), and undifferentiated pleomorphic sarcoma (6%) by literature review. Data from Moffitt Cancer Center demonstrate the same general distribution for subtypes of retroperitoneal sarcoma. A pathology-based algorithm for the diagnosis of retroperitoneal sarcoma is illustrated, and common pitfalls in the pathology of retroperitoneal sarcoma are discussed.

Conclusions

An informative diagnosis of retroperitoneal sarcoma via specimens on biopsy is achievable and meaningful to guide effective therapy. A practical and multidisciplinary algorithm focused on the histopathology is helpful for the management of retroperitoneal sarcoma.
Marijuana Smoking in Patients with Leukemia
Authors: Khwaja Sara , Yacoub Abraham , Cheema Asima , Rihana Nancy , Russo Robin , Paula Velez Ana , Nanjappa Sowmya , Sandin Ramon L. , Bohra Chandrashekar , Gajanan Ganesh , Greene John N.
Published: August 2017

Worldwide, marijuana (cannabis) is a widely used drug. The incidence of marijuana smoking is increasing and is second only to tobacco as the most widely smoked substance in the general population. It is also the second most commonly used recreational drug after alcohol. Some adverse effects of marijuana smoking have been documented; however, the number of studies on the pulmonary effects of marijuana in individuals with leukemia is limited. In our case series, we report on 2 men with acute myeloid leukemia with miliary nodular lung patterns on computed tomography of the chest due to heavy marijuana use. We also report on 2 patients with acute lymphocytic leukemia who had a history of smoking marijuana and then developed lung opacities consistent with mold infection.
Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer
Authors: Hamel Lauren M. , Penner Louis A. , Albrecht Terrance L. , Heath Elisabeth , Gwede Clement K. , Eggly Susan
Published: August 2017

Background

Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial — a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care.

Methods

Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor–patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels.

Results

Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success.

Conclusion

To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.
Determinants of Treatment Delays among Underserved Hispanics with Lung and Head and Neck Cancers
Authors: Borrayo Evelinn A. , Scott Katie L. , Drennen Ava R. , Macdonald Tiare , Nguyen Jennifer
Published: August 2017

Background

Evidence is lacking to explain the reasons why treatment is delayed among disadvantaged Hispanic patients diagnosed with lung and head and neck cancers. Data indicate that treatment delays beyond 46 days increase the risk of death for individuals with these cancers.

Methods

A mixed-methods design was used to explore determinants of treatment delays by analyzing data from the medical records of 40 Hispanic patients and data from interviews with 29 Hispanic patients, care-givers, health care professionals, and patient navigators from a safety-net hospital.

Results

Of the 40 Hispanic patients, 35% initiated treatment 46 days or more after being diagnosed, but women experienced longer delays than men (average of 48 days). Women with few comorbid diseases (≤ 4) were more likely to experience treatment delays. Institutional-related determinants at publicly funded hospitals appear to delay treatment for patients at the safety-net hospital, and patient-related determinants common to underserved patients (eg, no health insurance coverage) are likely to further contribute to these delays.

Conclusions

Delayed treatment is associated with poor outcomes and low rates of survival in patients with lung and head and neck cancers. Therefore, action should be taken to improve the time between diagnosis and the initiation of treatment for disadvantaged Hispanic patients.
Geographical Factors Associated with Health Disparities in Prostate Cancer
Authors: Gilbert Scott M. , Pow-Sang Julio M. , Xiao Hong
Published: August 2017

Background

Treatment variation in prostate cancer is common, and it is driven by clinical and clinician factors, patient preferences, availability of resources, and access to physicians and treating facilities. Most research on treatment disparities in men with prostate cancer has focused on race and socioeconomic factors. However, the geography of disparities — capturing racial and socioeconomic differences based on where patients live — can provide insight into barriers to care and help identify outlier areas in which access to care, health resources, or both are more pronounced.

Methods

Research regarding treatment patterns and disparities in prostate cancer using the Geographical Information System (GIS) was searched. Studies were limited to English-language articles and research focused on US populations. A total of 43 articles were found; of those, 30 provided information about or used spatial or geographical analyses to assess and describe differences or disparities in prostate cancer and its treatment. Two additional GIS resources were included.

Results

The research on geographical and spatial determinants of prostate cancer disparities was reviewed. We also examined geographical analyses at the state level, focusing on Florida. Overall, we described a geographical framework to disparities that affect men with prostate cancer and reviewed existing published evidence supporting the interplay of geographical factors and disparities in prostate cancer.

Conclusions

Disparities in prostate cancer are common and persistent, and notable differences in treatment are observable across racial and socioeconomic strata. Geographical analysis provides additional information about where disparate groups live and also helps to map access to care. This information can be used by public health officials, health-systems administrators, clinicians, and policymakers to better understand and respond to geographical barriers that contribute to disparities in care.
Disparities in Penile Cancer
Authors: Sharma Pranav , Zargar-Shoshtari Kamran , Pettaway Curtis A. , Schabath Matthew B. , Giuliano Anna R. , Spiess Philippe E.
Published: August 2017

Background

Although penile cancer is a rare malignancy in developed nations, racial and socioeconomic differences exist in the incidence of the disease and its associated survival-related outcomes.

Methods

A search of the literature was performed for research published between the years 1990 and 2015. Case reports and non—English-language articles were excluded, instead focusing specifically on large, population-based studies.

Results

The incidence of penile cancer is higher in Hispanic and African American men compared with whites and Asians. Men with penile cancer also appear to have a distinct epidemiological profile, including lower educational and income levels, a history of multiple sexual partners and sexually transmitted infections, and lack of circumcision with the presence of phimosis. African American men presented at a younger age with a higher stage of disease and worse survival rates when compared with white men. Rates of cancer-specific mortality increased with age, single marital status, and among those living in regions of lower socioeconomic status.

Conclusions

An understanding of sociodemographical differences in the incidence and survival rates of patients with penile cancer can help advance health care policy changes designed to improve access and minimize disparities in cancer care for all men alike.
Disparities in Adolescents and Young Adults with Cancer
Authors: Isenalumhe Leidy L. , Fridgen Olivia , Beaupin Lynda K. , Quinn Gwendolyn P. , Reed Damon R.
Published: August 2017

Background

Cancer care for adolescents and young adults (AYAs) focuses on the care of patients aged 15 to 39 years. Historically, this group has favorable outcomes based on a preponderance of diagnoses such as thyroid cancers and Hodgkin lymphoma. Improvements in outcomes among the AYA population have lagged behind compared with younger and older populations.

Methods

We discuss and review recent progress in AYA patient care and highlight remaining disparities that exist, including financial disadvantages, need for fertility care, limited clinical trial availability, and other areas of evolving AYA-focused research.

Results

Survival rates have not improved for this age group as they have for children and older adults. Disparities are present in the AYA population and have contributed to this lack of progress.

Conclusions

Recognizing disparities in the care of AYAs with cancer has led many medical specialty disciplines to improve the lives of these patients through advocacy, education, and resource development. Research addressing barriers to clinical trial enrollment in this population, quality-of-life issues, and the improvement of survivorship care is also under way.
Best Practices in Treatment Selection for Patients with Advanced NSCLC
Authors: Socinski Mark A. , Pennell Nathan A.
Published: August 2017

Worldwide, lung cancer is the most prevalent form of cancer, and its non–small-cell subtype constitutes up to 85% of cases. Overall, lung cancer is the most common cause of cancer-related death in the United States for both sexes, and its 5-year survival rate is 17%. It is a heterogeneous disease characterized by a variety of biomarkers and differing histologies. Non–small-cell lung cancer may be squamous or nonsquamous in nature and fueled by a number of oncodrivers. Obtaining sufficient tissue during biopsy to perform thorough biomarker testing is a challenge but essential for the modern, targeted therapeutic environment. Although platinum-based doublets still play a major role in first-line treatment, novel therapeutic agent targeting BRAF, EGFR, ALK, and ROS1, as well as agents targeting the T790M mutation, may offer options for patients whose disease fails to respond to initial therapy or relapses following an initial response. The emergence of immunotherapy as second-line standard therapy has changed the treatment paradigm. Some patients will have more favorable outcomes in the first-line setting with immunotherapy. However, managing lung cancer has become more complex than it was 15 years ago when the challenge of treatment was seen as being only binary, ie, small-cell vs non–small-cell disease.
Thrombotic Microangiopathy in a Patient Treated with Gemcitabine
Authors: Nanjappa Sowmya , Singh Vivek , Uttamchandani Shyam , Pabbathi Smitha
Published: August 2017

Thrombotic microangiopathy syndromes consist of a collection of disorders with a varied etiology that share common clinical and pathological features. Although thrombotic microangiopathy is rare, it is associated with significant morbidity and mortality. Without early recognition and intervention, the prognosis of the disease is poor. This report illustrates the case of a 56-year-old man with advanced-stage metastatic pancreatic cancer who presented with hemolytic uremic syndrome associated with gemcitabine use. His condition was managed with eculizumab, a monoclonal antibody, although he was dependent on dialysis. This report reflects the importance of considering thrombotic microangiopathy syndromes in the differential diagnosis, because many malignancies and use of chemotherapeutic agents can trigger hemolytic uremic syndrome.
Genetics of Cutaneous Malignant Melanoma
Authors: Su Yan A. , Trent Jeffrey M.
Published: August 2017

An increase in the clinical significance of cutaneous malignant melanoma has paralleled a dramatic increase in the rate of death from this disease. The critical genetic changes associated with the genesis and progression of this disease are only beginning to be identified. This review highlights genetic changes in cutaneous melanoma and discusses the genetics of predisposition, cytogenetics, changes in proto-oncogenes and oncogenes, and evidence for the role of tumor suppressor genes in this malignancy. The viewpoint of this article is that malignant melanoma is a genetic disease.
Screening, Early Detection, and Early Intervention Strategies for Lung Cancer
Authors: Wagner Henry , Ruckdeschel John C.
Published: August 2017

Screening for lung cancer has been utilized for several decades without demonstrating overall survival benefit. However, recent advances in treatment of lung cancer, improvements in our biologic understanding of lung cancer development, and an increasing population of healthy ex-smokers provide cause for optimism. Several chemoprevention trials suggest that it may be possible to intervene in the oncologic process prior to the development of invasive malignancy, resulting in a delay or reversal of these changes.
The Lynch Syndrome: Melding Natural History and Molecular Genetics to Genetic Counseling and Cancer Control
Authors: Lynch Henry T. , Lynch Jane F.
Published: August 2017

Hereditary nonpolyposis colorectal cancer (HNPCC), also referred to as Lynch syndromes I and II, is an autosomal, dominantly inherited disorder that accounts for approximately 5% of all colorectal cancers. While colorectal cancer is the most frequently occurring malignancy in HNPCC, other types of cancer occur with increased statistical significance. A better understanding of its natural history, particularly early age of onset and the pattern of multiple primary cancer excess, is essential for the diagnosis and management of HNPCC.
Avoiding Colostomy with Conservative Multimodality Management of Distal Rectal Cancer
Authors: Marcet Jorge , Yeatman Timothy J.
Published: August 2017

While abdominoperineal resection with permanent colostomy has been the surgical benchmark in the treatment of distal rectal carcinoma, different approaches to treatment have been sought for decades to decrease the morbidity and mortality associated with radical surgical procedures for this disease. The advent of alternative methods of sphincter preservation that afford excellent functional results has led to a decline in the incidence of abdominoperineal resection. With appropriate patient selection, accurate preoperative staging data, and the selection of a surgical approach appropriate to the tumor stage, conservative surgical approaches now can be considered in the treatment of cancer at every level of the rectum.
Natural History Studies and the Evolution of Regional Treatment Modalities for Patients Withy Isolated Liver Metastases from Primary Colon and Rectum Carcinoma
Authors: Steele Glenn
Published: August 2017

Estimates for 1995 indicate that 150,000 cases of colon and rectum adenocarcinoma occurred in North America, 58,000 patients died of colorectal cancer, and 18,000 patients died with liver as the predominant or only site of metastatic disease from recurrent colon and rectum adenocarcinoma. Results from several trials can now better define the therapeutic and survival benefit of surgical resection, cryosurgical ablation, and intrahepatic arterial therapy in the treatment of patients with metastatic colorectal cancer in the liver.
Screening for Ovarian Cancer
Authors: Fiorica James V. , Roberts William S.
Published: August 2017

Ovarian cancer is difficult to manage because the disease is most often diagnosed at an advanced stage when survival chances are poor. Early detection of ovarian cancer would increase long-term survival, since effective treatment modalities are available for early-onset disease. Screening with transvaginal ultrasound and serum CA 125 suggests promising results, but studies comparing mortality rates for screened vs unscreened populations are needed, and strategies must be developed for prevention or early diagnosis in order to control this disease process.
Programmed Cell Death (Apoptosis) and Cancer Chemotherapy
Authors: Denmeade Samuel R. , Isaacs John T.
Published: August 2017

Background

Programmed cell death involves a genetic reprogramming of the cell to promote an energy-dependent cascade of biochemical and morphological changes within the cell that result in its death and elimination.

Methods

The regulations and mechanisms of programmed cell death are reviewed with an emphasis on how derangement of this mechanism may be involved in modulating responsiveness to chemotherapy.

Results

Activation of this programmed death process is controlled by a series of endogenous cell-type-specific signals. In addition, a variety of exogenous cell-damaging treatments (eg, radiation, chemicals, and viruses) and most chemotherapeutic drugs can activate this pathway if sufficient injury to the cell occurs. Resistance to chemotherapy can involve alterations in the ability of a malignant cell to activate the programmed cell death (apoptotic) pathway when damaged by these exogenous agents.

Conclusion

The most important determinant of tumor resistance may be a generalized resistance to induction of programmed cell death rather than resistance based on specific alteration in drug/target interactions.
Concurrent Paclitaxel and Radiation Therapy for Solid Tumors
Authors: Choy Hak , Akerley W. , Glantz M. , Safran H. , Graziano S. , Chung C.
Published: August 2017

Background

Combination radiation and chemotherapy has an intuitive appeal for improving cancer treatment. Experimental results suggest that paclitaxel plus radiation might produce additive or synergistic effects.

Methods

A series of phase I and II trials to test tolerance and begin to evaluate effectiveness were performed on patients with non-small cell lung cancer, high-grade astrocytic brain tumors, and pancreatic and gastric cancers.

Results

Tolerance of the combined drug and radiation programs was generally good. Esophagitis was dose-limiting for the intrathoracic tumors. Hematologic toxicity was mild, but peripheral neuritis and cutaneous reactions were common.

Conclusions

These trials show that paclitaxel plus concurrent radiation is feasible at the dose levels and schedules tested. Antitumor responses have been observed.
Surgical Resection of Hepatocellular Carcinoma
Authors: Liu Chi-Leung , Lo Chung-Mau , Fan Sheung-Tat
Published: August 2017

Background

Surgical management of hepatocellular carcinoma is challenging. Advances in patient selection and operative techniques are taking place in various parts of the world.

Methods

The literature on diagnosis, evaluation, and surgical treatment of hepatocellular carcinoma is reviewed and combined with the extensive clinical experience of the authors.

Results

While alpha-fetoprotein levels often are elevated in patients with large hepatocellular tumors, a combination of hepatic arteriography and Lipiodol computed tomography is the most sensitive imaging approach. An indocyanine green retention of more than 14% at 15 minutes predicts a poor outcome from surgery. Intraoperative ultrasound and ultrasonic dissector assist surgery. One-, three-, and five-year survival rates of 68%, 44%, and 35%, respectively, have been reported.

Conclusion

Methods to diagnose and assess the suitability of patients with hepatocellular carcinoma for surgical resection are now available, and operative and postoperative care has improved. Surgery remains the “gold standard” to which other treatments can be compared.
Cryosurgery in the Treatment of Hepatic Tumors
Authors: Sotomayor Ramon , Ravikumar T.S.
Published: August 2017

Background

Primary and metastatic tumors in the liver are difficult to treat. When surgical resection is not feasible, cryotherapy is one of the several alternative approaches.

Methods

The data on outcomes from hepatic resections are reviewed, and the rationale and techniques of performing cryosurgery for unresectable hepatic cancers are described. The literature is reviewed and combined with the experiences of the authors on cryosurgery for management of hepatic tumors.

Results

The indications and techniques for performing cryosurgery are now well established. The procedure is relatively safe, and long-term survival rates of over 20% may be achieved.

Conclusion

While cryotherapy is effective for localized tumors in the liver, additional adjuvant approaches are required to control disease in the untreated liver. Endoscopic techniques may minimize patient morbidity.