bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Agents and Targets in Managing Patients with Metastatic Prostate Cancer
Authors: Tan Winston W.
Published: August 2017

Background

Docetaxel has recently been found to improve survival in patients with metastatic androgen-independent prostate cancer (AIPC). Chemotherapy as a first-line option leaves room for improvement, while second-line options are multiple and somewhat controversial.

Methods

Clinically relevant articles focusing on chemotherapy drugs for metastatic prostate cancer and their mechanism of action and efficacy were reviewed from January 2004 through April 2006.

Results

Docetaxel is the standard of care for AIPC. However, for doublets with docetaxel or second-line chemotherapy, multiple studies have shown interesting and promising results with calcitriol, thalidomide, bevacizumab, satraplatin, vaccines, ixabepilone, and atrasentan.

Conclusions

Docetaxel should be considered for first-line treatment of metastatic AIPC. Due to its progression-free survival of only 6 months, more effective drugs and drug combinations need to be developed to treat patients with AIPC. Combination treatments with docetaxel and other new agents are promising, but adequately powered phase III trials need to be conducted with survival as the principal endpoint for these promising drug combinations.
Management of Locally Advanced Renal Cell Carcinoma
Authors: Rodriguez Alejandro , Sexton Wade J.
Published: August 2017

Background

Renal cell carcinoma accounts for approximately 3% of adult malignancies and over 90% of primary renal tumors. Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high.

Methods

The authors review literature regarding prognostic factors, potential biomarkers, surgical strategies, and adjuvant therapy trials for patients with LARCC.

Results

Molecular tumor markers may improve existing staging systems for predicting prognosis. Surgery is the best initial treatment for most patients with clinically localized renal tumors, although complete surgical resection can be challenging for patients with large tumors, bulky regional lymph node involvement, or inferior vena cava tumor thrombus. Significant recurrence rates for patients with LARCC undergoing nephrectomy indicate the presence of undetected micrometastases at the time of surgery. Adjuvant radiation, chemotherapy, and immunotherapy have been ineffective. Other trials of adjuvant therapy are ongoing.

Conclusions

Aggressive surgical resection alone for LARCC is not sufficient to prevent disease recurrence in a significant number of patients. Adjuvant therapies are needed to improve cancer-specific survival.
Challenges in Community-Based Participatory Research Implementation: Experiences in Cancer Prevention with Pacific Northwest American Indian Tribes
Authors: Strickland C. June
Published: August 2017

Background

Much has been written about community-based participatory research (CBPR) history and principles, but few have addressed challenges in implementation in transcultural situations. The goal of this discussion is to address CBPR implementation issues in cancer prevention research with American Indian tribal communities in the Pacific Northwest.

Method

Information in this discussion is drawn from qualitative research conducted over a 10-year period in which CBPR was employed in cancer prevention research with Pacific Northwest Indian tribes. CBPR principles provide the framework for the discussion: establishing trusting relationships, assuring participation, sharing power, and communicating.

Results

In this work, we found that CBPR is appropriate for use in Pacific Northwest Indian tribal communities and is compatible with cultural values. We also found that there are many challenges. Recommendations are provided on needed institutional and structural changes.

Conclusions

CBPR is an important research approach in addressing cancer prevention health disparities among American Indian tribal communities. Continued effort needs to be directed toward creating systems and structures to support researchers in utilizing this method. Findings are of value to researchers aiming to implement CBPR in Indian communities and to practitioners, policy makers, and administrators who make decisions about CBPR funding and support structures.
Breast Ductal Secretions: Clinical Features, Potential Uses, and Possible Applications
Authors: Lang Julie E. , Kuerer Henry M.
Published: August 2017

Background

Nipple discharge accounts for approximately 5% of visits to a breast specialist surgical practice and may be encountered as the chief complaint by many other types of physicians. The vast majority of breast cancers originate in the ductal system, which prompted interest in the evaluation of the intraductal approach to breast cancer. Ductoscopy, nipple aspiration, and ductal lavage have emerged as innovative fields of study that may have clinical applications.

Methods

We performed a literature search of published manuscripts using the keywords nipple discharge, breast ductal secretions, and intraductal approach. We also report our single-institution experience in managing nipple discharge.

Results

We present our institutional algorithm for the management of nipple discharge. The possible etiologies of nipple discharge and the appropriate workup are reviewed. Three evolving minimally invasive techniques for the evaluation of high-risk patients include ductoscopy, nipple aspiration, and ductal lavage. Nipple aspiration and ductal lavage fluid may be assayed for cytology, genomic, gene expression, and proteomic studies. Several different translational approaches are being undertaken to investigate the local microenvironment associated with the development and progression of breast carcinoma.

Conclusions

Nipple aspiration fluid and ductal lavage offer the opportunity to study the local microenvironment of the ductal system, which is where most breast cancers originate. These powerful approaches to biomarker analysis could be applied to the prevention and treatment of breast cancer.
Therapeutic Potential of Directed Tyrosine Kinase Inhibitor Therapy in Sarcomas
Authors: Shor Audrey C. , Agresta Samuel V. , D'amato Gina Z. , Sondak Vernon K.
Published: August 2017

Background

Sarcomas are rare mesenchymally derived tumors for which there are limited treatment options. This paper discusses the current therapeutic potential of directed tyrosine kinase inhibitors (TKIs) in sarcoma.

Methods

The authors review antibody-based strategies and small molecular inhibitors of TKIs, with specific emphasis placed on the potential use of these targeted agents as therapeutic options for the treatment of sarcomas that are not gastrointestinal stromal tumors.

Results

Many TKs have been shown to be mutated or overexpressed in human sarcoma tumors and cell lines and may serve as potential targets for promising new sarcoma therapies. Furthermore, the novel mechanism of targeting TKs may complement the antitumor activity of existing sarcoma treatment options.

Conclusions

TKIs such as imatinib, sunitinib, and sorefanib are promising new therapeutic options for the management of patients with soft tissue sarcoma.
Colorectal Cancer Screening and African Americans: Findings from a Qualitative Study
Authors: Palmer Richard C. , Midgette Lynn A. , Dankwa Irene
Published: August 2017

Background

Colorectal cancer (CRC) screening has been found to be an effective tool for the control and prevention of this type of cancer, yet it is underutilized by African Americans. Consequently, African Americans with CRC are diagnosed at late stages and suffer disproportionately higher mortality rates for CRC.

Methods

To understand factors that influence the decision to participate in CRC screening, in-depth personal interviews were conducted with 36 African Americans in the Washington, DC, metropolitan area. Predisposing factors, enabling factors, and reinforcing factors were identified and categorized using the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation (PRECEDE) framework.

Results

Findings suggest that distinct differences exist between individuals who are adherent to screening guidelines and those who have not undergone screening. Adherent individuals were more knowledgeable about CRC and held positive beliefs about the benefits of screening. Nonadherent individuals placed little importance on prevention and early detection. Physician recommendation and insurance coverage/cost also differentiated the two groups.

Conclusions

Study findings suggest that efforts to increase awareness and promote the benefits of CRC screening are needed among African Americans. Also, efforts by healthcare providers to recommend CRC screening are important in promoting adherence. Further, low- or no-cost CRC screening is needed to increase participation by individuals who are economically disadvantaged.
Surgical Management of Melanoma in Situ on Chronically Sun-Damaged Skin
Authors: Clark Graham S. , Pappas-Politis Effie C. , Cherpelis Basil S. , Messina Jane L. , Möller Mecker G. , Cruse C. Wayne , Glass L. Frank
Published: August 2017

Background

Lentigo maligna (LM) commonly presents as a slow-growing pigmented macular lesion in chronically sun-damaged skin and may progress to invasive melanoma. Many regard it as a subtype of melanoma in situ (MIS), and surgical excision remains the preferred treatment, but standard 5-mm surgical margins recommended for typical MIS are often insufficient for LM due to its indistinct borders both clinically and histologically.

Methods

A search of the literature was conducted to review specialized surgical techniques for the treatment of LM, focusing on methods that employ total peripheral margin assessment prior to definitive closure, using either frozen or permanent histologic sections.

Results

Many investigators have reported surgical modalities utilizing permanent sections for margin control, including variations of the “square” procedure and “perimeter” technique. Recurrence rates are low with these methods, but only short-term data have been reported. Similarly, several studies have demonstrated the efficacy of Mohs micrographic surgery (MMS) for treatment of MIS, with recurrence rates generally less than 1% over 3 to 5 years of follow-up. Many investigators have had success with immunohistochemical stains to identify melanocytes on frozen sections, aiding margin assessment in MMS.

Conclusions

Compared to standard excision, methods that employ surgical margin control offer superior cure rates for LM and should be utilized when available. Total peripheral margin assessment using staged excisions and permanent sections is a simple and effective alternative to MMS for institutions that lack the resources for intraoperative frozen section analysis.
Cytoreductive Nephrectomy vs Medical Therapy as Initial Treatment: A Rational Approach to the Sequence Question in Metastatic Renal Cell Carcinoma
Authors: Spiess Philippe E. , Fishman Mayer N.
Published: August 2017

Background

Renal cell carcinoma (RCC) can be considered as two distinct entities: localized and metastatic disease.

Methods

We conducted a review of the scientific literature published within the past decade pertaining to cytoreductive nephrectomy for metastatic RCC.

Results

Retrospective data and historical prospective series have demonstrated the survival benefit of debulking nephrectomy in well-selected RCC patients. New medical therapies, including vascular endothelial growth factor and mTOR pathway blocking drugs, are active biological agents, with survival improvement and potential regression of metastatic and primary tumors. Our current therapeutic challenge is the optimal integration of multimodal therapy consisting of systemic therapy and surgery including cytoreductive nephrectomy, debulking, and metastasectomy. Empiric data to guide this decision are limited.

Conclusions

The decision concerning whether medical or surgical therapy should be the primary treatment approach selected must be made on an individual basis, taking into account patient performance status, clinical parameters, and physician expertise and recommendations, thus making each case a unique therapeutic challenge.
Microarray-Based Gene Expression Studies in Ovarian Cancer
Authors: Chon Hye Sook , Lancaster Johnathan M.
Published: August 2017

Background

DNA microarray technology is a powerful genomic tool that has the potential to elucidate the relationship between clinical features of cancers and their underlying biological alterations.

Methods

We performed a systemic search in PubMed and Medline databases for recently published articles. The search terms used included “genome-wide,” “microarrays,” “ovarian cancer,” “prognosis” “gene expression profiling,” “molecular marker,” and “molecular biomarker.”

Results

Genome-wide expression profiling using DNA microarray technology has enhanced our understanding of the genes that influence ovarian cancer development, histopathologic subtype, progression, response to therapy, and overall survival.

Conclusions

Gene expression profiling has demonstrated its utility in ovarian cancer research. It is hoped that with technologic, statistical, and bioinformatic advances, the reliability and reproducibility of this technique will increase, spawning clinical applications that may enhance our understanding of the disease and our ability to care for patients in the future.
Screening for Ovarian Cancer
Authors: Cragun Janiel Marie
Published: August 2017

Background

Ovarian cancer remains the most deadly of the gynecologic cancers. It is difficult to diagnose until in advanced stages. An effective screening test may help to decrease mortality from ovarian cancer. Due to the low incidence of ovarian cancer in the general population, a good screening test must have high sensitivity and specificity to allow accurate detection without excessive false-positive results. Thus, effective screening for ovarian cancer has remained elusive.

Methods

Studies evaluating screening methods for ovarian cancer are reviewed. Screening methods investigated include ultrasound, CA-125, and serum proteins.

Results

The use of CA-125 or ultrasound alone does not result in adequate sensitivity or specificity for routine screening. A combination of the two modalities improves sensitivity, specificity, and positive predictive value. Using a combination of serum proteins may also improve sensitivity, specificity, and positive predictive value, but such studies have yet to be validated.

Conclusions

No effective screening methods for ovarian cancer that have been adequately validated are available. Routine screening for ovarian cancer in the general population is not currently recommended.
The Role of Surgery in the Management of Epithelial Ovarian Cancer
Authors: Ramirez Ingrid , Chon Hye Sook , Apte Sachin M.
Published: August 2017

Background

Epithelial ovarian cancer is the most deadly gynecologic cancer in the United States. Multiple modalities of therapy are utilized in the management of the disease. The role of surgery remains important in the treatment of this disease and is described herein.

Methods

Medline and PubMed were utilized to search the English language medical literature up to March 2010. A broad range of studies and quality of data were analyzed, including prospective studies, case control analyses, and meta-analyses. When possible, the highest level of evidence was reviewed and presented.

Results

For the medically fit patient, optimal cytoreductive surgery positively impacts survival. For some highly selected patients, there is a role for a minimally invasive approach. In the recurrent setting, factors such as interval to recurrence and the distribution of disease will determine the utility of secondary cytoreductive surgery. A subgroup of patients may benefit from palliative surgical procedures in the recurrent setting.

Conclusions

Despite advances in the use of chemotherapy and biologic agents, surgery remains an important modality in the diagnosis and treatment of ovarian cancer.
Antiangiogenic Therapies in Epithelial Ovarian Cancer
Authors: Teoh Deanna G. K. , Secord Angeles Alvarez
Published: August 2017

Background

Angiogenesis is a critical component of tumor development and proliferation, and increased angiogenesis has been associated with a worse clinical outcome in a number of solid tumors, including ovarian cancer. Therefore, agents that target the angiogenic process are of considerable interest in the treatment of ovarian cancer.

Methods

Studies evaluating the efficacy of antiangiogenic agents in ovarian cancer are reported. Antiangiogenic agents examined include vascular endothelial growth factor (VEGF) pathway inhibitors, including monoclonal antibodies, tyrosine kinase inhibitors (TKIs), and a soluble receptor decoy, as well as inhibitors of other angiogenic factors and vascular disrupting agents.

Results

The VEGF inhibitor bevacizumab has been shown to have efficacy in ovarian cancer in phase II trials and a progression-free survival advantage in one phase III trial. TKIs block the VEGF receptors and secondary angiogenic pathways and have shown activity in phase I and II trials. Alternative angiogenesis inhibitors include EphA2 inhibitors and a selective angiopoietin 1/2-neutralizing peptibody. Another strategy is to destroy the existing tumor vasculature, and a number of vascular disrupting agents are being studied in preclinical and phase I trials. Antiangiogenic agents have a unique side effect profile, likely due to inhibition of normal physiologic angiogenesis.

Conclusions

Phase II and early phase III trials have demonstrated that antiangiogenic therapies have significant activity in ovarian cancer. The results of phase III trials in the front-line and recurrent settings will determine the extent of clinical benefit of antiangiogenic therapies in combination with chemotherapy. Antiangiogenic agents have a distinct side effect profile, and further studies are necessary to evaluate how to minimize the incidence of these events and to identify women most likely to benefit from these therapies.
Quality of Life in Ovarian Cancer
Authors: Grzankowski Kassondra S. , Carney Michael
Published: August 2017

Background

Ovarian cancer and its management interventions can produce significant impairments in health-related quality of life (HRQOL). These effects have been studied in both localized and advanced disease settings.

Methods

The authors assessed research reports that focus on the evaluation of HRQOL in patients with ovarian cancer in order to describe the findings and to suggest approaches that might maintain or maximize the quality of life in these patients.

Results

Evaluation of quality of life and functional impairment can include consideration of several issues such as the effects of the disease and its treatments on symptomatology, systemic therapy effects, the balance between life-prolonging but toxic protocols, and the sexual, psychosocial, social, and financial effects of treatment. The Gynecologic Oncology Group is actively studying these issues in its protocols.

Conclusions

HRQOL evaluation is a valuable measure in optimizing care of patients with ovarian cancer, but more research is needed to make such evaluations sufficiently inexpensive and easy to perform so that they can be more fully incorporated into general oncologic practice.
Umbilical Cord Blood Transplantation for the Treatment of Hematologic Malignancies
Authors: Brunstein Claudio G.
Published: August 2017

Background

The use of unrelated umbilical cord blood (UCB) has grown as an allogeneic source of hematopoietic cells for transplantation of patients with hematologic malignancies. As the number of UCB transplantation procedures has grown, an increasing number of publications have focused on disease-specific outcomes.

Methods

This review focuses on the outcome data following UCB transplantation in subsets of hematologic malignancies in which experience with this graft source is greater.

Results

Registry and single-institution reports regarding the outcomes of children and adults with acute leukemias after UCB transplantation include many patients, while data on the clinical outcomes of other leukemias are limited due in part to the small number of patients with these diseases. UCB is now routinely used as a source of hematopoietic stem cells (HSCs) in pediatric allogeneic transplantation when a suitable sibling donor is not available. Data also support the use of UCB as an alternative source of HSC for transplantation of patients with hematologic malignancies who lack a more conventional donor. Current data also support UCB for patients who require an allograft in the setting of prospective clinical trials.

Conclusions

Along with safety and feasibility in UCB transplantation, continued study is needed that focuses on issues such as accelerating engraftment, extending access, ensuring quality, and examining outcomes in specific subgroups of patients.
Surgical Management of Metastatic Spinal Tumors
Authors: Laufer Ilya , Sciubba Daniel M. , Madera Marcella , Bydon Ali , Witham Timothy J. , Gokaslan Ziya L. , Wolinsky Jean-Paul
Published: August 2017

Background

The spine is the most common site of skeletal metastases. The evolution of surgical methods, medical treatment, and radiation therapy has led to improved survival, functional status, and quality of life for patients with cancer. The role of surgery in the treatment of patients with spinal metastases has evolved over time.

Methods

A review of publications describing the role of open surgery and vertebroplasty was performed and the results are summarized.

Results

The treatment goals of spinal metastases include the preservation and restoration of neurologic function and spinal stability. Modern imaging modalities provide accurate methods of tumor diagnosis. A variety of approaches and stabilization techniques are available and should be tailored to the location of the tumor and systemic comorbidities.

Conclusions

As part of multidisciplinary treatment that includes radiation therapy and chemotherapy, surgery provides an effective method of restoration and preservation of neurologic function and spinal stability for patients with metastatic spinal tumors.
Evolution of Axillary Nodal Staging in Breast Cancer: Clinical Implications of the ACOSOG Z0011 Trial
Authors: Shah-Khan Miraj , Boughey Judy C.
Published: August 2017

Background

Management of the axilla in breast cancer patients has evolved from routine axillary lymph node dissection (ALND) for all patients to a highly selective approach based on the assessment of the sentinel lymph nodes (SLNs) as well as tumor and patient characteristics. Although ALND continues to have an important role in staging and regional control for many breast cancer patients, recent trial results question the need for routine ALND in patients who have positive SLNs.

Methods

Not all axillary disease becomes clinically detectable or relevant with respect to recurrence and survival. Therefore, recent trends indicate that many surgeons have omitted ALND in subgroups of patients, particularly those with clinically node-negative, SLN-positive, early-stage breast cancer undergoing breast-conserving therapy with postoperative irradiation. This review explores trends in axillary management, focusing primarily on the clinical implications of the results from the American College of Surgeons Oncology Group (ACOSOG) Z0011 randomized controlled trial.

Results

According to the results of the ACOSOG Z0011 trial, the use of SLN dissection alone did not result in inferior survival compared with ALND in patients with limited SLN disease treated with breast-conserving therapy. This subgroup of women was spared the morbidity associated with ALND. However, several points of debate, including the smaller than anticipated sample size, the older study population, and the length of follow-up, suggest caution when applying these findings to all women with breast cancer.

Conclusions

Although the findings of ACOSOG Z0011 are impressive, in clinical practice they are applicable to a limited number of women with breast cancer: those with T1-2 primary tumors with clinically negative axilla and 1 to 2 positive SLNs undergoing breast-conserving surgery and adjuvant whole-breast irradiation. The next generation of clinical trials may answer some of the remaining questions regarding how best to manage the axilla in additional subsets of patients undergoing treatment of breast cancer.
Separation Surgery for Spinal Metastases: Effect of Spinal Radiosurgery on Surgical Treatment Goals
Authors: Moussazadeh Nelson , Laufer Ilya , Yamada Yoshiya , Bilsky Mark H.
Published: August 2017

Background

The treatment of epidural spinal cord compression due to metastatic cancer represents an important clinical challenge. The NOMS (neurologic, oncologic, mechanical, and systemic) framework facilitates the determination of the optimal combination of systemic, radiation, and surgical therapies for individual patients. Spinal stereotactic radiosurgery (SRS) is an effective and safe modality for achieving durable control of local disease. Integrating SRS into the postoperative treatment plan allows surgical goals to be modified, thus decreasing the extent of tumor resection required.

Methods

Separation surgery is indicated for patients with spinal cord compression secondary to solid tumor metastases. During separation surgery, the spinal column is stabilized and the epidural tumor is resected without requiring significant vertebral body resection.

Results

Tumor separation from the spinal cord allows patients to undergo postoperative SRS.

Conclusions

The combination of separation surgery and high-dose hypofractionated or single-fraction SRS results in high local tumor control at 1 year and is an effective palliative paradigm for this patient population.
Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis
Authors: Rajeev Rahul , Turaga Kiran K.
Published: August 2017

Background

Malignant peritoneal disease can lead to significant debility due to bowel obstructions, ascites, and cancer cachexia. Moreover, inadequate imaging techniques can lead to the suboptimal detection of disease, and the poor vascularity of tumors can lead to a poor response to systemic chemotherapy. However, combination cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising novel treatment for patients with this disease.

Methods

The medical literature focusing on diagnostic updates and the management of peritoneal disease was reviewed. The application principles of HIPEC for use in peritoneal disease were also summarized.

Results

Improvements in imaging and the application of laparoscopic techniques have significantly increased the rate of diagnosis of early peritoneal disease with consequently less morbid cytoreductive procedures. Appropriate patient selection based on prognostic scores along with complete cytoreduction can identify a cohort of patients likely to derive durable benefit from this combination treatment.

Conclusions

Advances in diagnostic and therapeutic techniques, including surgical cytoreductive techniques, have demonstrated significant survival gains in patients with peritoneal disease. Although HIPEC can be used for the management of various types of histologies, further development of high-level evidence is necessary to advance the field.
Surgical Treatment for Leptomeningeal Disease
Authors: Volkov Andrey A. , Filis Andreas K. , Vrionis Frank D.
Published: August 2017

Background

Advancements in cancer treatment have led to more cases of leptomeningeal disease, which requires a multimodal approach.

Methods

Treatment modalities are reviewed from a neurosurgical standpoint, focusing on intrathecal chemotherapy and shunting devices. Potential complications and how to avoid them are discussed.

Results

The Ommaya reservoir and the chemoport are used for administering intrathecal chemotherapy. Use of ventriculo-lumbar perfusion can efficiently deliver chemotherapeutic agents and improve intracerebral pressure. Shunting systems, in conjunction with all of their variations, address the challenge of hydrocephalus in leptomeningeal carcinomatosis. Misplaced catheters, malfunction of the system, and shunt-related infections are known complications of treatment.

Conclusions

From an oncological perspective, the surgical treatment for leptomeningeal disease is limited; however, neurosurgery can be used to aid in the administration of chemotherapy and address the issue of hydrocephalus. Minimizing surgical complications is important in this sensitive patient population.
Tamoxifen and Endometrial Cancer
Authors: Barakat Richard R.
Published: August 2017

Tamoxifen is commonly used in the management of patients with breast cancer. Clinical trials of tamoxifen involving over 75,000 patients demonstrate an improved recurrence-free and overall survival benefit in both pre- and post-menopausal women. Large-scale trials also are evaluating the role of tamoxifen as a chemopreventive agent in women considered to be at high risk for developing breast cancer based on family history. Endometrial cancer is an uncommon complication of tamoxifen therapy. Since the majority of these cancers will be detected at an early stage when they are highly curable, however, the overall benefit of tamoxifen treatment in breast cancer patients outweighs this risk. All women receiving tamoxifen who have a uterus should undergo regular gynecologic examinations.
Quality-of-Life Assessment in Palliative Care
Authors: Mcmillan Susan C.
Published: August 2017

Background

Understanding the effects of cancer on the quality of life of affected patients is critical to clinical research as well as to optimal management and care.

Methods

Nine instruments for assessing quality of life in patients with cancer are identified, and their effectiveness during palliative care is analyzed.

Results

Most of the instruments included physical, functional, and symptom control, as well as psychologic and social aspects. Financial and spiritual aspects were included less often. While all but two of the instruments had adequate validity and reliability data published, only two - the Spitzer Quality-of-Life Index and the Hospice Quality-of-Life Index - were designed and validated for palliative care populations.

Conclusions

Although a variety of instruments is currently available, none is ideal for all palliative care settings. Further development and refinement of instruments are needed.
Therapeutic Options in the Management of Acute Myelogenous Leukemia in Adults
Authors: Saez Ruben A.
Published: August 2017

Background

The treatment of acute myelogenous leukemia has evolved in recent years due to advances in supportive care, the identification of prognostic factors, and the careful evaluation of chemotherapeutic modalities in randomized clinical trials.

Methods

The classification and prognostic features are reviewed, and the results from clinical trials have been evaluated with an emphasis on randomized trials and on both remission induction and postremission phases of management.

Results

The combination of an anthracycline and standard-dose Ara-C form the basis of remission induction. High-dose Ara-C has greater toxicity. For postremission therapy, high-dose Ara-C improves results in those with good risk features or normal cytogenetics. Acute promyelocytic leukemia management includes all-trans-retinoic acid.

Conclusions

Once a patient relapses from a nontransplant approach, high-dose therapy and allogeneic marrow transplantation are considered. Autologous stem cell transplantation cures some patients who do not have a donor.
Biology of the Transition of Monoclonal Gammopathy of Undetermined Significance (MGUS) to Multiple Myeloma
Authors: Lust John A. , Donovan Kathleen A.
Published: August 2017

Background

Approximately 25% of patients with monoclonal gammopathy of undetermined significance (MGUS) eventually develop multiple myeloma (MM) or a related plasma cell disorder that is universally fatal. In this report, we examine the changes that occur in the clonal plasma cell that are likely to be important in the progression of MGUS to active myeloma.

Methods

Studies that investigate the mechanisms involved in the multistep pathogenesis of monoclonal gammopathies are reviewed. Cytokines such as IL- 6 and IL-1β, adhesion molecules, viruses, and oncogenes including ras, bcl-2, Rb, and p53 are discussed.

Results

IL-1β is produced by plasma cells from virtually all MM patients but is undetectable in most MGUS patients. IL-1β has potent osteoclast activating factor activity, can increase the expression of adhesion molecules, and can induce paracrine IL-6 production. The increased production of adhesion molecules could explain why myeloma cells are found predominantly in the bone marrow. Subsequently, these “fixed” monoclonal plasma cells could now stimulate osteoclasts through the production of IL-1β and paracrine generation of IL-6 resulting in osteolytic disease. With continued progression of the myeloma, the monoclonal plasma cells may later acquire the ability to produce IL-6 in an autocrine fashion that will be manifested clinically by an elevated labeling index.

Conclusions

A better understanding of the progression of MGUS to myeloma may lead to novel therapeutic strategies to prevent the development of MM.
Breast Cancer Care: Developments in 1998
Authors: Horton John
Published: August 2017

Background

Breast cancer is a significant cause of mortality and morbidity worldwide, although death rates in the United States and some other countries are beginning to fall.

Methods

Several sources of information in 1998, including publications and presentations at the 1998 meeting of the American Society of Clinical Oncology, are pertinent to contemporary breast cancer care.

Results

It is now possible to prescribe hormonal therapy that will reduce the incidence of breast cancer. Methods are available to reduce the morbidity from axillary node dissection, and improvements in adjuvant therapy and management of metastatic breast cancer are now at hand.

Conclusions

The information presented provides a broad-based platform for new standards of care for breast cancer that will serve as a sound base for further progress in this important disease.
Circulating Prostate Cancer Cells Detected by Reverse Transcription-Polymerase Chain Reaction (RT-PCR): What Do They Mean?
Authors: Moreno Jose G. , Gomella Leonard G.
Published: August 2017

Background

Molecular techniques have been developed recently to assess for circulating tumor cells. This “molecular staging” of prostate cancer uses the reverse transcription-polymerase chain reaction (RT-PCR) to detect cells that contain PSA or PSMA in the bloodstream. Currently, the clinical application of this concept is controversial.

Methods

The authors discuss the current status of molecular biologic methods to detect circulating prostate cancer cells. They report on the limitations of the technology and the advances that will allow the quantification of these circulating cells.

Results

Studies generally indicate an increasing level of PSA RT-PCR positivity as disease advances. However, reports have been significantly diverse, and there is no clear explanation for this disparity.

Conclusions

The determination of the “circulating prostate cancer cell load” by RT-PCR or other techniques may prove to be useful in the management of patients with prostate cancer, but questions remain to be answered before we can develop and assess new therapeutic strategies that will advance the treatment of prostate cancer before metastasis becomes evident. A better understanding of the biology of tumor cells present in the circulatory system is also needed.
The Physiologic Basis for the Pharmacologic Use of Recombinant Erythropoietin
Authors: Spivak Jerry L.
Published: August 2017

While many growth factors influence erythroid progenitor cell proliferation, the hematopoietic growth factor erythropoietin has the most impact on the production of erythrocytes.
Diagnosis and Management of Anemia in Patients with the Myelodysplastic Syndrome
Authors: Bennett John M. , Kouides Peter A.
Published: August 2017

While not appropriate for all patients with the myelodysplastic syndrome, recombinant erythropoietin (EPO) is a possible alternative to red blood cell transfusion. Specific factors such as the presence of cytopenias, the bone marrow blast percentage, and cytogenetic findings determine which patients are good candidates for treatment with EPO.
Anemia in Multiple Myeloma and Its Management
Authors: Dalton William S.
Published: August 2017

Anemia is a common feature of multiple myeloma. Its causation is multifactorial, but some patients benefit from recombinant human erythropoietin (rHuEpo).
Neoadjuvant Therapy for Cancer of the Esophagus
Authors: Green Robert J. , Haller Daniel G.
Published: August 2017

Background:

The standard of care for esophageal cancer has historically been surgical resection. However, survival following surgical treatment of esophageal cancer remains poor. In inoperable patients, both radiation therapy and chemotherapy alone and in combination have been used with some success. Consequently, these therapies have been utilized in the neoadjuvant setting to improve palliation and prolong survival.

Methods:

The author reviewed the literature regarding clinical trials that employed neoadjuvant chemotherapy and radiation therapy in the treatment of squamous cell carcinoma and adenocarcinoma of the esophagus.

Results:

In most patients, surgery alone is noncurative therapy, even when performed with curative intent. Most phase III trials of neoadjuvant therapy have not been designed with adequate statistical power to detect clinically relevant improvement. The available data are insufficient to determine a benefit to preoperative radiation therapy alone. Preoperative chemotherapy with 5-FU plus cisplatin followed by surgery probably offers little or no improvement over surgery alone. Trials of combined preoperative chemoradiation therapy have yielded promising but not definitive results.

Conclusions:

Outside of a clinical trial, neoadjuvant therapy for esophageal cancer should be reserved for only a select group of patients. Future clinical trials may determine a role for neoadjuvant chemoradiation and identify more active chemotherapeutic agents and populations most likely to benefit.
Physician-Assisted Suicide: The Influence of Psychosocial Issues
Authors: Breitbart William , Rosenfeld Barry D.
Published: August 2017

Background:

Physician-assisted suicide (PAS) is perhaps the most compelling and clinically relevant mental health issue in palliative care today. The desire for death, the consideration of suicide, the interest in PAS, and the relationship of these issues to depression and other psychosocial issues appear to be of paramount importance.

Methods:

Psychiatric and psychosocial perspectives are used to understand the factors contributing to the interest in PAS, as well as to guide interventions in the clinical care of patients with advanced disease.

Results:

Research and clinical experience suggest that attending to issues of depression, social support, and other psychosocial issues in addition to pain and physical symptom control are critical elements in interventions that are useful in reducing the distress of patients who desire hastened death.

Conclusions:

Psychosocial and psychiatric issues are among the most powerful predictors of desire for death and interest in PAS. Evaluation and intervention in these areas, particularly depression, is a critical component of compassionate care.
Testing for Hereditary Risk of Ovarian Cancer
Authors: Frank Thomas S.
Published: August 2017

Background

Approximately one out of every 10 ovarian cancers is caused by inherited mutations in identified genes. The characterization of hereditary ovarian cancer as an autosomal dominant disorder of specific gene mutations is more specific and useful than descriptive clinical syndromes such as “Lynch II,” “site-specific ovarian cancer,” or “breast-ovarian cancer.”

Methods

The author reviewed recent studies of the biology, epidemiology, and medical management of hereditary ovarian cancer risk.

Results

Most hereditary ovarian cancer is attributable to two genes, BRCA1 and BRCA2, with other genes accounting for a smaller fraction. Women who inherit a mutation in any of these genes are far more likely than the general population to develop an epithelial malignancy of the ovary. Appropriate evaluation of family history can identify women most likely to have hereditary cancer risk, and genetic testing can definitively identify women with germline mutations that place them and their family at increased risk of ovarian cancer.

Conclusions

Hereditary risk assessment, including genetic testing, can enhance medical management when used appropriately and should be accompanied by patient education and counseling.
Stage B Prostate Cancer: Correlation of DNA Ploidy Analysis with Histological and Clinical Parameters
Authors: Mora Linda B. , Moscinski Lynn C. , Diaz José I. , Blair Pamela , Cantor Alan B. , Pow-Sang Julio M.
Published: August 2017

Background

The ability to accurately predict tumor behavior and patient survival is a problem in managing patients with prostate cancer. Prognostic variables in predicting death from tumor include prostate-specific antigen (PSA) level, histological grade, and clinical stage. Observer subjectivity is inherent in determining grade and stage; thus, criteria that are more objective are needed to identify patients for appropriate treatment.

Methods

The authors correlated flow cytometric nuclear DNA ploidy with Gleason score, PSA level, and recurrence risk in patients who underwent radical retropubic prostatectomy and bilateral pelvic lymphadenectomy between 1987 and 1993 for histopathologic stage B prostate cancer (T2, N0, M0).

Results

Of the tumors analyzed, 64% were DNA diploid with a low proliferative fraction, 25% were DNA diploid with a high proliferative fraction, and 11% were DNA aneuploid. DNA aneuploidy was associated with high Gleason grade (7–10). All Gleason grade 10 tumors were DNA aneuploid. Both DNA aneuploidy and high proliferative fraction (S+G2M) were statistically correlated with high Gleason grade and adverse prognosis but not with PSA level or patient age.

Conclusions

A direct relationship is shown between both DNA aneuploidy and a high proliferation index with aggressive biological behavior in stage B prostatic cancer. Objective tumor criteria are needed to choose treatment more selectively for individual patients.
Technology, innovation, employment and power: Does robotics and artificial intelligence really mean social transformation?
Authors: Boyd Ross , Holton Robert J.
Published: August 2017

How far do recent innovations in robotics and artificial intelligence herald an unprecedented economic and social transformation? This article provides a critical evaluation of this question, challenging the relentless technological determinism of much debate, and reframing the issues involved within a political-economic and sociological approach. This focuses on the economic, political and historical dynamics of technological innovation, and its consequences for employment and economic re-structuring, mediated through sovereign and discursive power. A range of epistemological and empirical problems with the transformationist position are identified, and an alternative perspective proposed emphasizing complexity and uncertainty around contemporary and future trends.
Angela Merkel’s discourse about the past: Implications for the construction of collective memory in Germany
Authors: Yoder Jennifer A
Published: August 2017

This article examines German Chancellor Angela Merkel’s political discourse about the past. Through analysis of 54 of Merkel’s speeches over a 10-year period, I explore when and how she references the past and whether she links the past to particular foreign policy choices. I suggest that Merkel draws upon several pasts—from different points in time and from different configurations of Germany—to present an integrated collective memory for a unified Germany.
Type 2 diabetes in primary care
Authors: Price Hermione
Published: August 2017

Type 2 diabetes is common, and its prevalence is increasing. Most patients with type 2 diabetes are managed entirely in primary care. The National Diabetes Audit has provided evidence of large variations across the UK in the standard of available care in the community for patients with diabetes. Good diabetes care can prevent or delay complications and, as well as cost savings, this results in a better quality of life for patients. This article provides an overview of type 2 diabetes and the National Institute for Health and Care Excellence guidance for treatment proposed in 2015.
Harmonizing Goals for Agricultural Intensification and Human Health Protection in Sub-Saharan Africa
Authors: Trimmer John T. , Bauza Valerie , Byrne Diana M. , Lardizabal Amanda , Guest Jeremy S.
Published: August 2017

Increased agricultural production will be necessary to feed rapidly growing populations in sub-Saharan Africa, where many households currently practice low-input, subsistence farming. Efforts to expand food production will likely include agricultural intensification to enhance productivity of existing cropland, and holistic frameworks are needed to quantitatively evaluate trade-offs and synergies between intensification and other dimensions of development. Beyond well-documented interactions with environmental and economic issues, intensification’s complex relationship with human health should take a position of primary importance in any framework designed to advance food security. While intensification can lead to improvements in nutritional status, neglecting sources of potential adverse health impacts, including water source contamination and direct contact with agricultural inputs or environmental pathogens, may undermine prospective gains. Harmonizing goals will require interdisciplinary teams applying frameworks that integrate tools such as quantitative risk assessment, environmental life cycle assessment, and economic models to comprehensively evaluate potentially dissimilar strategies across common metrics while accounting for interdependencies and uncertainties. With local implementation partners, these teams will be well-equipped to develop holistic interventions that effectively promote food security and protect human health while considering local constraints and opportunities across multiple dimensions of development.
Leveraging Climate Regulation by Ecosystems for Agriculture to Promote Ecosystem Stewardship
Authors: Cohn Avery
Published: August 2017

One in every five patches of tropical forest near agriculture in Brazil appears to contribute more to agricultural production by preventing crop-killing extreme heat exposure than it could produce if it were converted to cropland itself. In this commentary, I refer to this and other forms of climate regulation by ecosystems and beneficial for agriculture as E4A. E4A is a readily employable and largely untapped concept for protecting and restoring tropical ecosystems. The promise of E4A lies in demonstrating sizeable production-protection synergies relevant for critical actors. Using a consultative research process, I gauged the current and future status of E4A science and action in tropical land use decision-making. Stakeholders flagged unmet demand for E4A in support of decisions tied to numerous regulatory, governance, and business processes. Results from a complementary literature review revealed gaps in research, advocacy, and entrepreneurship. I close by discussing opportunities to relieve E4A pain points to catalyze tropical ecosystem stewardship.