bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overview of Diagnosis and Management of Metastatic Disease to Bone
Authors: Michael Hsiang-Hsuan , Tsai Ya-Yu , Hoffe Sarah E. 
Published: August 2017

Background Bone metastases occur frequently in patients with advanced cancer and are a serious complication of cancer. The decision to treat is often individualized, based on each patient's clinical presentation, life expectancy, and quality of life. Methods We reviewed the current literature pertaining to management of metastatic disease to bone, and the medical, radiotherapeutic, and surgical treatment options for management of bone metastasis are discussed. Results Current management of skeletal metastasis includes analgesia, systemic therapy, radiation therapy, and surgery. We propose treatment algorithms for management of vertebral and nonvertebral bone metastases and suggest individualized interventions based on clinical presentation. Conclusions Management of bone metastases is complex and requires a multidisciplinary approach. The goal of treatment is often palliative, and intervention and treatment regimens should be individualized based on the specific clinical presentation of each patient.
Current Management Considerations for the Incidentally Detected Small Renal Mass
Authors: Buethe David D. , Spiess Philippe E. 
Published: August 2017

BackgroundNephron-sparing treatments remain underutilized for the management of small renal masses despite a rise in incidentally detected renal cell carcinoma and a downward stage migration.MethodsHistorical publications representative of currently accepted paradigms were reviewed, and the results of a contemporary scientific literature search conducted in PubMed focusing on studies involving humans, published in English, and inclusive of clinical trials, meta-analyses, randomized controlled trials, and practice guidelines are included. Results from contemporary retrospective trials augment the data when level I or II evidence is absent.ResultsPhase III clinical trial results substantiate the long-held tenet that partial nephrectomy is equivalent to radical nephrectomy with respect to safety and oncologic efficacy. Further, minimally invasive techniques using laparoscopy and robotic assistance to achieve partial nephrectomy appear equally effective to traditional open techniques. Although no prospective randomized studies are available, large retrospective studies support the notion that active surveillance and thermal ablative techniques are viable options for carefully selected patients.ConclusionsThe management of small renal masses encompasses a host of therapeutic options, all of which must be considered and discussed with the individual patient.
Palliative Strategies for the Management of Primary and Metastatic Spinal Tumors
Authors: Kaloostian Paul E. , Yurter Alp , Etame Arnold B. , Vrionis Frank D. , Sciubba Daniel M. , Gokaslan Ziya L. 
Published: August 2017

Background Technological advances during the last few decades have improved the success rate of surgery for the treatment of malignant spinal tumors. Nonetheless, many patients present with widespread tumor burden and minimal life expectancy, which excludes them from being surgical candidates. For these patients, palliative management is recommended. Methods The authors reviewed prospective and retrospective clinical studies as well as case series regarding palliative treatments for primary and metastatic spinal tumors. Results Analgesics, ranging from nonopioids to strong opioids, may be used depending on the degree of pain. Steroids may also improve pain relief, although they are associated with a number of adverse events. Vertebroplasty and kyphoplasty are conservative treatments with high rates of pain relief and vertebral body stabilization. Radiotherapy is the gold standard for palliative management, with approximately 60% of patients experiencing a decrease in tumor-related spinal pain and up to 35% experiencing complete relief. Stereotactic radiosurgery delivers high doses of radiation to patients to provide pain relief while also sparing delicate anatomical structures. Conclusion Palliative management of spinal tumors is diverse. Analgesics may be used in conjunction with radiotherapy and/or kyphoplasty or vertebroplasty to offer pain relief.
Management of Locally Advanced Pancoast (Superior Sulcus) Tumors with Spine Involvement
Authors: Setzer Matthias , Robinson Lary A. , Vrionis Frank D. 
Published: August 2017

Background The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection. Methods A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence. Results A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%. Conclusions Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
Surgical and Molecular Pathology of Barrett Esophagus
Authors: Zibadi Sherma , Coppola Domenico 
Published: August 2017

Background Patients with Barrett esophagus (BE) are predisposed to developing dysplasia and cancer. Adenocarcinoma, which is associated with BE, is the most common type of esophageal tumor and, typically, it has an aggressive clinical course and a high rate of mortality. Methods The English-language literature relating to tumor epidemiology, etiology, and the pathogenesis of BE was reviewed and summarized. Results The role of pathologists in the diagnosis and pitfalls associated with grading Barrett dysplasia is addressed. Current molecular testing for Barrett neoplasia, as well as testing methods currently in development, is discussed, focusing on relevant tests for diagnosing tumor types, determining prognosis, and assessing therapeutic response. Conclusions Grading is essential for developing appropriate treatment plans, follow-up visits, and therapeutic interventions for each patient. Familiarity with current molecular testing methods will help physicians correctly diagnose the disease and select the most appropriate therapy for each of their patients.
Risk of Colorectal Cancer by Subsite in a Swedish Prostate Cancer Cohort
Authors: Lu Yunxia , Ljung Rickard , Martling Anna , Lindblad Mats 
Published: August 2017

BackgroundThe relationship between sex hormone–related treatment for prostate cancer and the risk of colorectal cancer is controversial.MethodsA prostate cancer cohort was initiated from the Swedish Cancer Registry of patients diagnosed between 1961 and 2008. Patients diagnosed with prostate cancer between 1961 and 1980 were generally treated with estrogen. The cohort diagnosed between 1981 and 2008 was further divided into 3 subcohorts of orchiectomy, prostatectomy, and other treatment. Standardized incidence ratios (SIRs) for developing colorectal adenocarcinoma were estimated and 95% confidence intervals (CIs) were used to compare relative risk among these patients and the general male population.ResultsOf 601,542 person-years of follow-up, 1,698 cases of colorectal adenocarcinoma were identified. Compared with the general male population, no association was detected in the cohort diagnosed between 1961 and 1980, whereas an increased risk of colorectal adenocarcinoma was observed among patients diagnosed with prostate cancer who received treatments other than estrogen. Following bilateral orchiectomy, the SIR was 1.30 (95% CI: 1.14–1.47); after prostatectomy, the SIR was 1.22 (95% CI: 1.04–1.43); among those who received treatment other than estrogen, the SIR was 1.37 (95% CI: 1.29–1.45). The increased risks were more apparent in cases of adenocarcinoma of the distal colon and rectum than in the proximal colon.ConclusionsPatients with prostate cancer undergoing bilateral orchiectomy, prostatectomy, or other treatments, including antiandrogen therapy and radiation, may be at increased risk for colorectal adenocarcinoma.
Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease
Authors: Ahmed Kamran A. , Torres-Roca Javier F. 
Published: August 2017

Background The treatment of oligometastatic disease has become common as imaging techniques have advanced and the management of systemic disease has improved. Use of highly targeted, hypofractionated regimens of stereotactic body radiotherapy (SBRT) is now a primary management option for patients with oligometastatic disease. Methods The properties of SBRT are summarized and the results of retrospective and prospective studies of SBRT use in the management of oligometastases are reviewed. Future directions of SBRT, including optimizing dose and fractionation schedules, are also discussed. Results SBRT can deliver highly conformal, dosed radiation treatments for ablative tumors in a few treatment sessions. Phase 1/2 trials and retrospective institutional results support use of SBRT as a treatment option for oligometastatic disease metastasized to the lung, liver, and spine, and SBRT offers adequate toxicity profiles with good rates of local control. Future directions will involve optimizing dose and fractionation schedules for select histologies to improve rates of local control while limiting toxicity to normal structures. Conclusions SBRT offers an excellent management option for patients with oligometastases. However, additional research is still needed to optimize dose and fractionation schedules.
Feasibility, Preliminary Efficacy, and Lessons Learned from a Garden-Based Lifestyle Intervention for Cancer Survivors
Authors: Spees Colleen K. , Hill Emily B. , Grainger Elizabeth M. , Buell Jackie L. , White Susan E. , Kleinhenz Matthew D. , Clinton Steven K. 
Published: August 2017

Background Cancer survivors remain at increased risk for secondary malignancies, comorbidities, and all-cause mortality. Lifestyle behaviors, such as diet and physical activity, are strongly linked to a decreased risk of chronic disease and improved health outcomes, yet a paucity of research has been conducted in this vulnerable population. Methods Adult cancer survivors were recruited to participate in Growing Hope, an experimental single-group study designed to assess the feasibility and efficacy of a theory-driven and evidence-based intervention. For 4 months, 22 participants received group and individual education and had access to harvesting fresh produce at an urban garden. Data on program satisfaction, compliance, diet, and physical activity were collected via surveys; anthropometrics, blood values, and skin carotenoids were objectively measured. Results The intervention resulted in significant improvements in consumption of fruits and vegetables (P = .003), decreased consumption of red and processed meats (P = .030) and sugar-sweetened beverages (P = .020). Levels of skin carotenoids, fasting blood glucose, and non–high density lipoprotein cholesterol were also significantly improved (P = .011, P = .043, and P = .05, respectively). Conclusions The results of this study support the feasibility and efficacy of a multifaceted, garden-based intervention for cancer survivors. In addition, these preliminary results demonstrate a positive impact aligning with the current lifestyle recommendations for cancer survivorship. Larger randomized controlled trials are warranted to define impact on sustained health outcomes.
Tobacco-Related Health Disparities across the Cancer Care Continuum
Authors: Simmons Vani Nath , Piñeiro Bárbara , Hooper Monica Webb , Gray Jhanelle E. , Brandon Thomas H. 
Published: August 2017

Background Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups. Methods We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities. Results Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established. Conclusions To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.
A Single-Institution Study of Demographics and Outcomes of Adult Patients with Multiple Cancers
Authors: Ho Thanh P. , Foster Nathan R. , Jatoi Aminah 
Published: August 2017

Background Few studies have described the demographics and outcomes in patients with multiple cancers. Methods We reviewed the health records of patients with at least 3 invasive solid-tumor malignancies (lung, colorectal, pancreatic, prostate, breast, or ovarian) diagnosed between 1995 and 2014 at our institution. Results A total of 163 patients were identified. The median age at first cancer diagnosis was 61 years. Sixteen (10%) had a family history of cancer, and 7 (4%) had a cancer-predisposing syndrome. Most had early-stage malignancies and underwent a series of surgical resections. The median survival from the first cancer diagnosis was 14 years (95% confidence interval: 12–16). Forty-three percent developed 4 or more cancers. In univariate analyses, older age, male sex, smoking history, concurrent cancer, and stage IV disease were associated with worse survival; by contrast, breast cancer as the first cancer diagnosis yielded better survival. In multivariate analyses, older age, smoking history, and stage IV disease were associated with worse survival. Conclusions A small group of patients with no ostensible risk factors develop multiple early-stage cancers, receive curative therapy (often surgery), and live for years. These patients merit further study to ascertain the broader prevalence rates of individuals with multiple invasive cancers and to better understand factors that contribute to cancer risk.
Chemosaturation with Percutaneous Hepatic Perfusion in Unresectable Hepatic Metastases
Authors: Glazer Evan S. , Zager Jonathan S. 
Published: August 2017

Background In patients with hepatic metastases from solid-organ malignancies, surgical resection may be a potentially curative option, but it is not possible in most cases. Chemosaturation with percutaneous hepatic perfusion was developed for the management of unresectable metastases to the liver. Methods Relevant medical literature was summarized with regard to the outcomes and limitations of chemosaturation with percutaneous hepatic perfusion. Results Six articles were identified that contained data on 91 individuals who received chemosaturation with percutaneous hepatic perfusion. More than 60% of these study patients were diagnosed with ocular melanoma. The overall response rate was 48% and the rate of disease control was 90%. Chemosaturation with percutaneous hepatic perfusion improved the rates of overall and hepatic progression-free survival (PFS). The data are limited but suggest that the rate of PFS was improved in study patients with isolated melanoma hepatic metastases who received chemosaturation with percutaneous hepatic perfusion compared with those assigned to standard care. Conclusions Our results suggest that chemosaturation with percutaneous hepatic perfusion produces favorable tumor response rates in select individuals with unresectable hepatic metastases from multiple primary cancers, particularly ocular and cutaneous melanomas. Data from a single randomized clinical trial have also shown that chemosaturation with percutaneous hepatic perfusion can affect hepatic PFS in certain patients.
Role of Radiation Therapy and Fluoropyrimidines in the Treatment of Gastrointestinal Malignancies
Authors: Wong William W. , Schild Steven E. , Martenson James A. 
Published: August 2017

Background The use of combined chemotherapy and radiation for gastrointestinal malignancies has several theoretical advantages, and clinical trials to determine the type and extent of clinical benefits have been performed. Methods The basic science and clinical trial data evaluating such combinations are reviewed, with an emphasis on the interactions between fluoropyrimidines and radiation. Results Improved outcomes from chemoradiotherapy have been demonstrated in patients with selected stages of anal, esophageal, rectal, and pancreatic cancer. Conclusion Despite these positive results, further work is needed to demonstrate even more effective and less toxic treatment regimens.
Metastatic Adenoid Cystic Carcinoma of Salivary Glands: Case Reports and Review of the Literature
Authors: Spiers Alexander S.D. , Esseltine Dixie Lee W. , Ruckdeschel John C. , Davies Jack N.P. , Horton John 
Published: August 2017

Background Adenoid cystic carcinoma is an uncommon tumor of the salivary gland. Little has been published on the chemotherapy of this neoplasm. Methods The literature on this disease is reviewed, and data from seven unpublished cases are presented. Results Four patients received cyclophosphamide. One responded, and another had pain relief. The literature review did not identify any single drug or combination that might be regarded as the treatment of choice. Conclusions Systematic, multi-institutional studies are required to determine appropriate systemic treatment for metastatic adenoid cystic carcinoma of salivary gland origin.
Role of Retroperitoneal Lymph Node Dissection in the Management of Testicular Cancer
Authors: Rowland Randall G. 
Published: August 2017

BackgroundRetroperitoneal lymph node dissection is an important component of staging and management of nonseminomatous germ-cell carcinoma of the testis. Ejaculatory impotence has been a dominant aspect of operative morbidity.MethodsThe author has led the investigation of a series of modifications of operative techniques with the aim of reducing morbidity while retaining the prognostic and therapeutic benefits for retroperitoneal lymph node dissection.ResultsThe advances in surgical techniques have reduced the incidence of ejaculatory impotence to less then 5%. Guidelines for the type of retroperitoneal lymph node dissection for different clinical stages of disease are presented.ConclusionsThe advances in surgical techniques for retroperitoneal node dissection have minimized morbidity. The procedure plays a role in many clinical stages of testicular cancer.
Carcinoid Tumors of the Gut
Authors: Sweeney John F. , Rosemurgy Alexander S. 
Published: August 2017

BackgroundCarcinoid tumors are the most frequently encountered endocrine tumors of the gastrointestinal tract. They are most often found in the appendix, although they can arise in any location of the gut. Carcinoid tumors may secrete a variety of bioactive substances, which can cause the complex of symptoms associated with the carcinoid syndrome.MethodsThe authors reviewed the pathology, clinical presentation, and management of carcinoid tumors with an emphasis on the surgical management.ResultsThe primary treatment for a carcinoid tumor located anywhere in the gut is surgical. Those who have widely metastatic disease or who are anatomically unresectable may undergo cytoreductive surgical debulking and/or hepatic arterial embolization followed by palliation of symptoms with octreotide, the long-acting somatostatin analog.ConclusionsThe prognosis for patients with carcinoid tumors that are fully resected is excellent. Those with hepatic metastases and the carcinoid syndrome.
Chemoprevention of Bladder and Prostate Carcinoma
Authors: Joseph Jean V. , Messing Edward M. 
Published: August 2017

BackgroundThe incidence of bladder and prostate cancer continues to rise, with little accompanying improvement in management strategies. Opportunities exist for testing various types of chemopreventive interventions.MethodsThe authors review the biology of progression to invasive disease for cancers of the bladder and the prostate and identify intermediate disease and surrogate endpoint markers. Candidate interventions and initial clinical trial results are described.ResultsMarkers of cellular proliferation and differentiation, as well as antigens such as Lex, M344, DD23, and bladder tumor antigen, are promising for bladder cancer. Testing with prostate-specific antigen and prostate-specific membrane antigen is promising for prostate cancer. Several prevention intervention trials are in progress for both cancers.ConclusionsVitamins, polyamine synthesis inhibitors, and oltipras are undergoing clinical tests for chemopreventive effects in bladder cancer, and a large trial of finasteride to prevent prostate cancer is completing accrual. Results from these studies will direct future research.
Controversies in Breast Cancer
Authors: Cummings Frank J. , Saba Nabil 
Published: August 2017

Background A large number of controversies about the management of breast cancer produce uncertainties for patients and physicians alike. In addition, questions are constantly raised about the true value of new approaches or treatments. Methods The authors have conducted a critical review of the literature on several of these issues, and they present a balanced view that can be useful for clinical decision making. Results Although new staging systems for ductal carcinoma in situ have been proposed, a consensus has not yet been reached regarding the criteria to allow tumor excision alone. The extent of benefit of the main adjuvant therapies is becoming better established, and improvement in outcomes may accrue from dose-intensive treatments and autologous stem cell or hematopoietic growth factor support. Conclusions Progress in breast cancer management continues to evolve. Several new approaches either reduce morbidity or improve outcomes.