bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low-Income Women with Breast Abnormalities: System Predictors of Timely Diagnostic Resolution
Authors: Mojica Cynthia M. , Bastani Roshan , Boscardin W. John , Ponce Ninez A. 
Published: August 2017

BackgroundIncomplete or delayed diagnostic resolution of breast abnormalities suspicious for cancer may contribute to poor breast cancer outcomes. We examine system predictors of timely diagnostic resolution in low-income, mostly Latina women with breast abnormalities at two Los Angeles County public hospitals.MethodsWe collected medical record data on 1,671 women. The outcome – timely diagnostic resolution – was defined as receipt of definitive diagnosis (malignant or benign) within six months of the index referral. Predictors of the outcome were examined with bivariate and multivariate logistic regression models.ResultsOnly 56% of women received timely diagnostic resolution; however, the proportion was higher at Hospital B (67%) compared to Hospital A (51%). The effect of predictors differed by hospital. At Hospital B, the odds of timely diagnostic resolution were lower for women with self-identified abnormalities (P<.033) and higher for women referred to Radiology rather than Surgery for their first appointment (P<.005). At Hospital A, the odds of timely diagnostic resolution were higher for women with self-identified abnormalities (P<.043) and lower for women referred to Radiology rather than Surgery for their first appointment (P<.001).ConclusionsRates and predictors of timely diagnostic resolution differed by hospital. System barriers may be a function of referral processes and patient tracking. Interventions may need to be tailored to a hospital's unique culture.
Therapy for Unresectable Recurrent and In-Transit Extremity Melanoma
Authors: Gimbel Mark I. , Delman Keith A. , Zager Jonathan S. 
Published: August 2017

Background Unresectable recurrent and in-transit extremity melanoma presents a dilemma for the treating physician. While the disease is confined to the involved limb, the survival mimics that of multiple nodal metastases, with a 10-year survival rate of approximately 40%. This represents late-stage disease for which curative treatment options are limited. Methods To review the current treatment strategies for stage IIIB (N2c) in-transit and recurrent melanoma focusing on the options for unresectable disease, MEDLINE was searched for studies of known and experimental treatments for in-transit and recurrent extremity melanoma. Further results were obtained after review of the initial citations. Results For unresectable recurrences and in-transit metastases, therapies are limited to palliative (radiation), local (intratumoral injection, laser ablation and electroporation), regional (isolated limb perfusion/infusion), and systemic (chemotherapy) when local or regional techniques are not feasible. Conclusions In this patient population, intratumoral techniques have a limited role with current treatment regimens, but with the development of new drugs, these techniques may have more utility. If not contraindicated, regional techniques provide the greatest control and have minimal operative morbidity. Until new regimens are available, systemic therapy continues to be associated with considerable toxicity and only marginal response rates.
Employment and Quality of Survivorship among Women with Cancer: Domains not Captured by Quality of Life Instruments
Authors: Frazier Linda M. , Miller Virginia A. , Horbelt Douglas V. , Delmore James E. , Miller Brigitte E. , Averett Ellen P. 
Published: August 2017

Background Many quality of life instruments assess the amount of paid work in combination with role function at home in the same items and do not specifically assess social support in the workplace. The goal of this study was to obtain women's views on the relationship between employment and health-related quality of life. Methods A focus group and questionnaire study was conducted among 73 women with gynecologic cancer who were employed at diagnosis and 25 people who provided them with psychosocial support. Results The women held a variety of blue collar and white collar jobs at diagnosis. Employment provided a strong sense of accomplishment and a welcome distraction during treatment. The employment experience was described as distinct from role function at home. No one equated working more hours with better quality of life. Social support at work could be poor at the same time that support from family and friends grew stronger. Conclusions The contribution to their quality of life that cancer survivors feel they receive from employment may not be linearly related to the quantity of their role function in the workplace. Employment-related items could be useful as an adjunct to standard quality of life measures.
Limiting the Morbidity of Inguinal Lymphadenectomy for Metastatic Melanoma
Authors: Sarnaik Amod A. , Puleo Christopher A. , Zager Jonathan S. , Sondak Vernon K. 
Published: August 2017

Background Surgery is currently the primary treatment modality for metastatic mela-noma involving the inguinal lymph nodes. However, inguinal lymph node dissections are associated with substantial morbidity including infection, wound dehiscence, lymphedema, seroma, and deep venous thromboembolism (DVT). Improved understanding is needed regarding the factors predisposing patients to complications and the operative and perioperative maneuvers that can decrease morbidity. Methods We reviewed recently published literature regarding the morbidity associated with lymphadenectomy in the treatment of inguinal metastatic melanoma. Where available, emphasis was focused on appropriately designed studies aimed at reducing treatment-related morbidity. When appropriate, the review was supplemented by our personal experience. Results Strategies to limit treatment-related morbidity involve optimizing the preoperative assessment, operative technique, and postoperative care. Establishing the diagnosis of nodal metastasis early using minimally invasive techniques is critical to reduce subsequent perioperative complications. Morbidity is higher for inguinal compared to cervical or axillary lymphadenectomy, and many variations in extent of inguinal lymphadenectomy and operative technique have been reported. The lack of definitive trials has led to controversy regarding surgical technique such as indications for pelvic lymphadenectomy (“deep” node dissection), saphenous vein preservation, and sartorius transposition. In the postoperative period, the use of DVT and lymphedema prophylaxis should be considered to potentially improve patient outcomes. Conclusions While the morbidity of inguinal lymphadenectomy can be substantial, several straightforward pre- and postoperative measures can be instituted to limit morbidity. Controversy persists regarding the indications for and benefit of pelvic lymphadenectomy, saphenous vein preservation, and sartorius muscle transposition. A multi-institutional trial is currently in progress to investigate the safety of avoiding lymphadenectomy in patients with microscopic metastases in the sentinel node.
Molecular and Functional Imaging of Breast Cancer
Authors: Tafreshi Narges K. , Kumar Virendra , Morse David L. , Gatenby Robert A. 
Published: August 2017

BackgroundSignificant efforts have been directed toward developing and enhancing imaging methods for the early detection, diagnosis, and characterization of small breast tumors. Molecular and functional imaging sets the stage for enhancement of current methodology.MethodsCurrent imaging modalities are described based on the molecular characteristics of normal and malignant tissue. New molecular imaging methods that have the potential for clinical use are also discussed.Results:Dynamic contrast-enhanced magnetic resonance imaging is more sensitive than mammography in BRCA1 carriers. It is used in screening and in the early evaluation of neoadjuvant therapy. Positron emission mammography is 91% sensitive and 93% specific in detecting primary breast cancers. Sentinel node scintigraphy is a key component of axillary lymph node evaluation. Other imaging modalities being studied include Tc99m sestamibi, radiolabeled thymidine or uridine, estrogen receptor imaging, magnetic resonance spectroscopy, and diffusion magnetic resonance imaging.ConclusionsMolecular and functional imaging of the breast will likely alter clinical practice in diagnosing and staging primary breast cancer and assessing response to therapy since it will provide earlier information regarding the underlying biology of individual breast cancers, tumor stage, potential treatment strategies, and biomarkers for early evaluation of treatment effects.
Emerging Technologies in Prostate Cancer Radiation Therapy: Improving the Therapeutic Window
Authors: Biagioli Matthew C. , Hoffe Sarah E. 
Published: August 2017

Background Radiation therapy is a standard of care in the treatment of prostate cancer. Relatively recent advances in technologies in the delivery of radiation therapy are altering our current approach to treatment of prostate cancer. Methods This review discusses the results of retrospective, prospective, and randomized clinical trials that have evaluated clinical outcomes in prostate cancer treated with newer radiation therapy technologies. Results Randomized trials have demonstrated that higher doses of radiation therapy improve clinical outcomes but with increased toxicity to normal tissue. The introduction of more conformal radiation therapy techniques such as intensity-modulated radiation therapy, proton therapy, stereotactic body radiotherapy, and brachytherapy have allowed for further dose escalation with simultaneous reduction in toxicity. However, use of more conformal treatments requires a better understanding of prostate motion and the ability to track prostate movements in real time. Conclusions Technological advancements have improved radiation dose delivery to the prostate and have reduced normal tissue toxicity. Randomized trials are warranted to ultimately evaluate clinical benefit and outcomes.
Graft-vs-Host Disease following Allogeneic Hematopoietic Cell Transplantation
Authors: Pidala Joseph 
Published: August 2017

Background Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative therapy with proven efficacy in the management of hematologic malignancies. However, it is complicated by the syndromes of acute and chronic graft-vs-host disease (GVHD). Methods A narrative review is provided to summarize major biologic insights into the pathogenesis of these immune-mediated disorders, as well as advances in diagnosis, classification, prevention, management, and allied supportive care with the aim of providing essential understanding for clinicians with or without subspecialty experience in the field of blood and marrow transplantation. Results Major scientific advances have contributed to enhanced understanding of the pathogenesis of these disorders, and clinical investigation has provided more effective preventive and therapeutic strategies for GVHD. However, since acute GVHD and chronic GVHD remain leading sources of transplantation-related morbidity and mortality, ongoing investigation is needed to develop new approaches to addressing these syndromes. Conclusions The major challenge for future investigation will be to capitalize on biologic insights in order to develop novel strategies for the prevention and therapy of acute and chronic GVHD that will address the current shortcomings in existing therapeutic approaches.
Imaging of Prostate Carcinoma
Authors: Outwater Eric K. , Montilla-Soler Jaime L. 
Published: August 2017

Background Imaging of prostate carcinoma is an important adjunct to clinical evaluation and prostate-specific antigen measurement for detecting metastases and tumor recurrence. In the past, the ability to assess intraprostatic tumor was limited. Methods Pertinent literature was reviewed to describe the capabilities and limitations of the currently available imaging techniques for assessing prostate carcinoma. Evaluation of primary tumor and metastatic disease by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques is discussed. Results Ultrasonography and MRI have limited usefulness for local staging of prostate cancer because of suboptimal sensitivity and specificity for identifying tumor extent and capsular penetration. Additional MRI techniques such as magnetic resonance-based perfusion imaging, diffusion imaging, and spectroscopy may provide incremental benefit. CT and bone scanning provide an assessment of metastatic disease but are also limited by the poor sensitivity of lymph node size as a criterion for detecting metastases. Novel imaging techniques such as hybrid imaging devices in the form of single-photon emission CT/CT gamma cameras, positron emission tomography/CT cameras, and, in the near future, positron emission tomography/MRI combined with tumor-specific imaging radiotracers may have a significant impact on tumor staging and treatment response. Conclusions Cross-sectional imaging and scintigraphy have an important role in assessing prostate carcinoma metastases and treatment response. Increasingly, the incremental value of primary tumor imaging through MRI is being realized.
Surgical Management of Primary and Metastatic Spinal Tumors
Authors: Kaloostian Paul E. , Zadnik Patricia L. , Etame Arnold B. , Vrionis Frank D. , Gokaslan Ziya L. , Sciubba Daniel M. 
Published: August 2017

Background The axial skeleton is a common site for primary tumors and metastatic disease, with metastatic disease being much more common. Primary and metastatic spinal tumors have a diverse range of aggressiveness, ranging from benign lesions to highly infiltrative malignant tumors. Methods The authors reviewed the results of articles describing the treatment and outcomes of patients with metastatic disease or primary tumors of the spinal column. Results En bloc resection is the mainstay of treatment for malignant primary tumors of the spinal column. Intralesional resection is generally appropriate for benign primary tumors. Low-quality evidence supports the use of chemotherapy in select primary tumors; however, radiation therapy is often used for incompletely resected or unresectable lesions. Surgical considerations for the treatment of metastatic disease are more nuanced and require that the health care professional consider patient performance status and the pathology of the primary tumor. Conclusions The treatment of metastatic and primary tumors of the spinal column requires a multidisciplinary approach in order to offer patients the best opportunity for long-term survival.
Advances in the Molecular Analysis of Breast Cancer: Pathway toward Personalized Medicine
Authors: Rosa Marilin 
Published: August 2017

Background Breast cancer is a heterogeneous disease that encompasses a wide range of clinical behaviors and histological and molecular variants. It is the most common type of cancer affecting women worldwide and is the second leading cause of cancer death. Methods A comprehensive literature search was performed to explore the advances in molecular medicine related to the diagnosis and treatment of breast cancer. Results During the last few decades, advances in molecular medicine have changed the landscape of cancer treatment as new molecular tests complement and, in many instances, exceed traditional methods for determining patient prognosis and response to treatment options. Personalized medicine is becoming the standard of care around the world. Developments in molecular profiling, genomic analysis, and the discovery of targeted drug therapies have significantly improved patient survival rates and quality of life. Conclusions This review highlights what pathologists need to know about current molecular tests for classification and prognostic/predictive assessment of breast carcinoma as well as their role as part of the medical team.
Treatment of Head and Neck Paragangliomas
Authors: Hu Kenneth , Persky Mark S. 
Published: August 2017

Background Commonly occurring in the head and neck, paragangliomas are typically benign, highly vascular neoplasms embryologically originating from the extra-adrenal paraganglia of the neural crest. Frequently, these tumors are associated with the vagus, tympanic plexus nerve, the carotid artery, or jugular bulb. Their clinical presentation can vary across a wide spectrum of signs and symptoms. Methods We reviewed and compared standard treatment approaches for paragangliomas of the head and neck. Results In general, surgery is the first-line choice of therapy for carotid body tumors, whereas radiotherapy is the first-line option for jugular and vagal paragangliomas. Conclusions Because of the complexity of clinical scenarios and treatment options for paragangliomas, a multidisciplinary algorithmic approach should be used for treating paragangliomas. The approach should emphasize single-modality treatment that yields excellent rates of tumor control, low rates of severe, iatrogenic morbidity, and the preservation of long-term function in this patient population.
Black Heterogeneity in Cancer Mortality: US-Blacks, Haitians, and Jamaicans
Authors: Pinheiro Paulo S. , Callahan Karen E. , Ragin Camille , Hage Robert W. , Hylton Tara , Kobetz Erin N. 
Published: August 2017

IntroductionThe quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the United States is virtually unknown.MethodsWe computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (United States, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan.ResultsWe analyzed 185,113 cancer deaths from 2008 to 2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97–2.17) and 1.6 (95% CI: 1.55–1.71) times higher for US-born blacks than black Caribbean men and women, respectively (P < .001).ConclusionsRace alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for 2 obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of “aggressive” prostate cancer in the world, rather than Caribbean men.
Overview of Hospice and Palliative Care in Oncology
Authors: Schonwetter Ronald S. 
Published: August 2017

BackgroundThe concept of palliative care in oncology has not yet reached the forefront of American medicine, and hospice care may be underused.MethodsData on increasing needs for palliative care and the development of the hospice movement are compared with practice behavior patterns of physicians in regard to palliative care.ResultsHospice/palliative care has grown from an alternative health care movement to an accepted part of the American health field. Limitations of hospice/palliative care include health professionals’ discomfort with care of the terminally ill as well as difficulties in predicting limited prognoses that may hinder access to such care.ConclusionsHospice/palliative care principles should be integrated into other elements of cancer control to ensure comprehensive care for all cancer patients.
Intermediate Markers and Molecular Genetics of Lung Carcinogenesis
Authors: Szabo Eva , Shaw Gail L. 
Published: August 2017

Background Various options are available for the local control of cancer in the breast - mastectomy, conservation therapy, and mastectomy with reconstruction. Methods To evaluate the benefits and drawbacks of the available management options, the authors combine their extensive experience with a review of the literature on outcomes from these approaches. Results Conservation therapy provides survival outcomes similar to those from mastectomy. Differences in local recurrence rates can be minimized by close adherence to guidelines for patient selection, operative approach, and radiation technique. Conclusions The role of the physician in selecting a local therapy for breast cancer has changed from one of informing the patient of the treatment to assessing the presence of medical contraindications to any of the treatments, educating the patients on each treatment approach, providing access to multidisciplinary consultation, and allowing the patient to choose an appropriate treatment approach.
New Agents in the Management of Non-Small-Cell Lung Cancer
Authors: Chiappori Alberto , Devore Russell F. , Johnson David H. 
Published: August 2017

BackgroundNon-small-cell carcinoma of the lung has long been considered a chemotherapeutically resistant neoplasm. Newer agents and combinations are being tested.MethodsThe authors have reviewed data on recent and active phase I and phase II trials of several new agents and combinations.ResultsNew drugs that affect both response rates and survival include vinorelbine, paclitaxel, docetaxel, gemcitabine, topotecan, and irinotecan.ConclusionsThe advent of several relatively well-tolerated agents that alone have beneficial effects in advanced non-small-cell lung cancer provides reasonable hope that more effective drug combinations will soon be available for this disease.
Radioimmunoguided Surgery for Gastrointestinal Malignancies: An Analysis of 14 Years of Clinical Experience
Authors: Martinez Deborah A. , Barbera-Guillem Emilio , Lavalle Gregory J. , Martin Edward W. 
Published: August 2017

Background The identification of all sites of intra-abdominal adenocarcinoma is key to optimal surgical resection and tumor staging. Conventional imaging methods and direct visualization and palpation have limited sensitivity and specificity. Radioimmunoguided surgery (RIGS) has a potential to improve these parameters. Methods The development of the RIGS concept is presented, and the studies of tumor localization, detection of disseminated disease, staging, and survival are correlated with the tumor biopsy of gastrointestinal carcinoma, particularly colorectal carcinoma. Results RIGS can detect clinically and histologically occult neoplasm. Also, by providing immediate intraoperative information, the RIGS approach improves surgical staging, impacts on surgical and medical care, and affects patient prognosis. Conclusions RIGS may become the standard of care for the surgical staging and treatment of colorectal cancer and other gastrointestinal malignancies.