bluuebunny/crossref_metadata_2025_split huggingface dataset:
The New Approaches to Brain Tumor Therapy (NABTT) CNS Consortium: Organization, Objectives, and Activities
Authors: Grossman Stuart A. , Fisher Joy D. , Piantadosi Steven , Brem Henry 
Published: August 2017

Background: Despite advances in neuro-imaging, neurosurgery, radiation therapy, and chemotherapy, limited progress has been made in the treatment of patients with high-grade astrocytomas. The National Cancer Institute has attempted to speed advances in this field by funding CNS consortia to conduct innovative clinical trials in this patient population since 1994. Methods: The NABTT CNS Consortium is composed of a consortium headquarters and nine member institutions with outstanding multidisciplinary expertise, clinical and laboratory research capabilities, and access to large numbers of patients with brain tumors. Results: The objectives of the NABTT Consortium are to improve the therapeutic outcome for adults with primary brain tumors, to conduct basic science and clinical research, and to improve the care and quality of life of adults with primary brain tumors. NABTT's clinical studies have discovered important drug interactions between anticonvulsant and antineoplastic agents, defined the activity of paclitaxel and 9-aminocamptothecin in glioblastoma multiforme, tested a novel dose escalation strategy for brain tumor trials, and established new protocol “classes” to expedite and standardize clinical research in this field. Conclusions: Significant progress in the care of patients with primary brain tumors is likely to result from the highly focused and multidisciplinary efforts of the NIH-funded CNS consortia.
Interferon in the Treatment of Multiple Myeloma
Authors: Shustik Chaim 
Published: August 2017

BackgroundThe role of interferon (IFN) in the treatment of multiple myeloma has been investigated for nearly two decades. The mechanisms underlying antitumor activity of IFN may be mediated by antiproliferative and immunomodulatory effects. The benefits of treatment remain controversial, and guidelines for the use of IFN in myeloma are needed. This review evaluates available data on the impact of IFN therapy on multiple myeloma.MethodsA MEDLINE search of published prospective, randomized trials of IFN in multiple myeloma provided the data included in this review, as well as selected abstracts presented at international meetings.ResultsIFN has complex and pleiotropic effects on human myeloma lines and ex vivo myeloma cells. An antiproliferative effect with disruption of the IL-6-mediated growth loop may be crucial, but biologic heterogeneity in myeloma may have important clinical implications for response to IFN. IFN has demonstrable antitumor activity in multiple myeloma but appears to have a modest effect on overall survival when combined with chemotherapy during induction or when used as maintenance therapy. Most studies have shown a prolongation of the plateau phase of disease with IFN of variable duration of between four and 12 months.ConclusionsA reliable estimate of the benefit of IFN in the overall population of patients with myeloma is difficult to determine with discordant results from different trials. Possible sources of heterogeneity in randomized trials need to be identified, and recognition of subsets of patients who may benefit is important. Cost-benefit analyses with integration of quality-of-life data are essential for developing guidelines for the use of IFN in myeloma.
Retinoblastoma
Authors: Margo Curtis E. , Harman Lynn E. , Mulla Zuber D. 
Published: August 2017

BackgroundRetinoblastoma is the most common intraocular malignancy of infants and children. With early diagnosis and treatment, survival is greater than 90%; however, patients with a germline retinoblastoma mutation have a substantial risk of having a second high-grade malignancy.MethodsThe recent developments in the diagnosis and treatment of retinoblastoma are reviewed.ResultsIdentification of the retinoblastoma germline mutation is now possible with the discovery of the retinoblastoma gene. Patients with the germline mutation have a 51% cumulative risk over 50 years of developing a second malignancy. Several pilot studies using primary chemotherapy for retinoblastoma have shown promising results.ConclusionsRisk assessment and genetic counseling have become more precise with the development of laboratory methods to identify the retinoblastoma gene. The development of primary chemotherapy regimens to reduce the size of retinoblastoma tumors may decrease the need for radiation therapy and thereby reduce the risk of radiation-related malignancies in patients with the germline mutation.
Intraocular Lymphoma
Authors: Bardenstein David S. 
Published: August 2017

Background Primary ocular lymphoma is a distinct subtype of intraocular lymphoma. Its clinical presentation can mimic benign conditions. Diagnosis is often based on obtaining an intraocular biopsy. Optimal management is not yet realized. Methods This report combines the experience of the author with a review of the current literature pertaining to intraocular lymphoma. Results Primary ocular lymphoma, a subtype of primary central nervous system (CNS) lymphoma, has a variable clinical course and frequently mimics benign inflammatory disease. Even when suspected, diagnosis can be elusive. Chemoradiation is the most effective treatment, but significant ocular and cerebral morbidity is associated with its use. Novel treatment regimens may reduce or eliminate side effects while preserving life, vision, and CNS function. Conclusions Primary CNS lymphoma with ocular involvement should be considered in patients with refractory uveitis, yellow-white choroidal masses, and CNS lymphoma. Aggressiveness in making the diagnosis should be tempered by the potential complications of the diagnostic process and advanced by the life-threatening nature of the disease. Treatment should attempt to maximize efficacy while incorporating considerations such as extent of disease and the patient's age, health, and mental state.
Management of Ocular Metastasis
Authors: Small William 
Published: August 2017

Background Intraocular metastasis is a significant clinical problem in patients with metastatic cancer. The frequency of intraocular metastasis in all patients dying of cancer is approximately 12%, but in breast cancer patients, the frequency can be as high as 37%. Methods A review of pertinent literature and the author's experience are used to describe the epidemiology, diagnosis, and management of metastatic tumors of the eye. Results Intraocular metastases occur frequently and are diagnosed by ophthalmologic examination. Radiotherapy remains the cornerstone of therapy and allows the majority of patients to maintain useful vision for the remainder of their lives. Conclusions The recognition and treatment of intraocular metastasis are important clinical oncologic issues. With proper management, patients with ocular metastasis can maintain vision and thus maximize quality of life.
High-Dose Chemotherapy in the Adjuvant Treatment of Breast Cancer: Benefit/Risk Analysis
Authors: Djulbegovic Benjamin , Hozo Iztok , Fields Karen K. , Sullivan Daniel 
Published: August 2017

Backgroundg High-dose chemotherapy (HDRx) may improve the prognosis of patients with high-risk breast cancer but at the expense of increased toxicity. However, no randomized, controlled trials have been published that clearly demonstrate the superiority of HDRx over conventional adjuvant chemotherapy. Methods We developed a simple model to compare benefits and risks of HDRx with conventional adjuvant chemotherapy (SDRx). The model integrates data on efficacy and risks of two competing treatment strategies into a single decision rule. Results and Conclusions Using data from phase II studies, we show that if a disease-free survival is considered to be the most important outcome, HDRx should be administered when the probability of breast cancer relapse at five years exceeds 54% to 71% for patients with 4 to 9 positive nodes and exceeds 29% to 40% for patients with >9 positive nodes. If the endpoint of interest is five-year overall survival, then the treatment should be administered when the probability of relapse exceeds 77% to 83% for patients with 4 to 9 nodes involved and 22% to 31% for those with >9 lymph nodes involved. While awaiting results of randomized, controlled trials to definitively establish the efficacy rate of HDRx, we also found that HDRx could be considered in the management of high-risk breast cancer if its efficacy rate is at least 54% to 60% superior to SDRx in reducing relapse risk in breast cancer patients with 4 to 9 nodes and at least 31% to 38% for >9 positive nodes. If survival data are used instead of disease-free survival outcomes, HDRx efficacy should be at least 47% to 48% superior to SDRx in reducing death risk in breast cancer patients with 4 to 9 nodes and at least 27% to 30% superior for >9 positive nodes to consider its use in the adjuvant setting.
Minimal Residual Cancer Detection in Hematopoietic Stem Cell Products and its Prognostic Significance in Patients with Breast Cancer, Lymphoma, or Multiple Myeloma
Authors: Moss Thomas J. 
Published: August 2017

Background Despite the initial success of high-dose therapy and bone marrow transplant, the major reason for posttransplant failure is relapse of disease. Reinfusion of tumor cells may contribute to relapse in autologous stem cell transplants. We now have ultra-sensitive methods of tumor cell detection that can determine the presence of minimal residual cancer (MRC) in marrow and peripheral blood stem cells. Methods The author has conducted a critical review of the literature on this issue. Results The factors that are associated with an increase in contamination of the graft include (1) the number of cycles of induction therapy, (2) the type of mobilization regimen used, (3) the presence of tumor cells in the marrow, and (4) the number of phereses. A number of studies show that the presence of occult breast cancer in the marrow and/or stem cell product predicts for a poor posttransplant clinical outcome. The presence of clonogenic breast cancer or lymphoma cells in the graft is also associated with a very poor outcome. Published data regarding contamination in graft and outcome for patients with myeloma are limited. Conclusions Testing for minimal MRC in the oncology patient provides prognostic information that may be useful to the transplant physician.
Radiation-Induced Sarcoma following Treatment of Breast Cancer
Authors: Brenin Christiana M. , Small William , Talamonti Mark S. , Gradishar William J. 
Published: August 2017

Background Radiation therapy (XRT) is an important modality in the treatment of cancer, and XRT is now commonly utilized in the treatment of early-stage breast cancer. However, its use has occasionally resulted in the development of secondary malignancies. We present a critical review of radiation- induced sarcoma (RIS) that develops after irradiation for the treatment of breast cancer. Methods The case of a patient who developed sarcoma after radiation for breast cancer is presented, and current literature on RIS is reviewed. The role of XRT in the development of RIS is examined, and the evaluation and treatment of these malignancies are reviewed. Results RIS occurs in 0.2% of patients following treatment of breast cancer. The role of radiation in the development of RIS has been clearly demonstrated. Clinical presentation varies, and diagnosis is commonly delayed. Treatment consists of wide surgical excision. The role of chemotherapy is controversial. Conclusions The occurrence of RIS following treatment of breast cancer is rare. Its development has an average latency of over 10 years and likely correlates with the dose and technique of the radiation treatment. The prognosis of patients with RIS following treatment for breast cancer is poor predominantly due to a delay in diagnosis. However, the benefit derived by breast cancer patients from XRT far outweighs the risk of RIS and should not affect the decision to treat these patients with this modality.
Management of Hormone-Sensitive and Hormone-Refractory Metastatic Prostate Cancer
Authors: Rago Randall 
Published: August 2017

Background Prostate cancer is a significant health problem in the United States and is the focus of increasing attention in our society. With the aging of the US population, it is likely that prostate cancer will continue to grow in importance. The options for systemic therapy of metastatic prostate cancer should be familiar to physicians, including nonspecialists, whose patients seek their advice and counsel. Methods Past and recent literature was surveyed to provide an understanding of the systemic treatment of advanced prostate cancer. The author presents a review of the systemic treatment of metastatic prostate cancer in different clinical circumstances and addresses the current status of chemotherapy in the management of advanced prostate cancer. Results Early androgen deprivation used over prolonged periods appears to be modestly superior to delayed androgen deprivation with a small potential survival advantage and an advantage in delaying disease progression in advanced prostate cancer. Patients with hormone-refractory prostate cancer may benefit from secondary hormonal therapy (eg, adrenal enzyme inhibitors, antiandrogens, glucocorticoids) and chemotherapy. Conclusions The choices of therapy for metastatic prostate cancer depend on individual patient preference. Patients and physicians should be aware of the possible side effects associated with the therapeutics options for treatment of metastatic prostate cancer.
Barrett's Esophagus and Barrett's-Associated Neoplasia: Etiology and Pathologic Features
Authors: Coppola Domenico , Karl Richard C. 
Published: August 2017

Background: The incidence of Barrett's esophagus (BE) has been increasing in recent years. Patients with BE have 30- to 125-fold increased risk of developing adenocarcinoma. New techniques allowing early diagnosis, in addition to the identification of markers capable of predicting tumor progression, are needed. Methods: The authors discuss the diagnostic features of BE and BE-associated neoplasia. Results: BE can exhibit different types of metaplastic mucosa, but only the specialized (intestinal) mucosa has the potential to progress to dysplasia and carcinoma. The problems associated with diagnosing BE and with predicting the behavior of this condition are outlined. Conclusions: Studies are underway to identify molecular markers capable of predicting which BE patient will progress to carcinoma. Brush cytology and flow cytometry may become useful tools in the early detection of this disease.
Endosonographic Staging of Esophageal Cancer
Authors: Boyce H. Worth 
Published: August 2017

Background:Endosonography (ES) is an important tool for staging malignant esophageal cancer with the TNM staging classification. ES is a safe procedure and an accurate method of staging tumor invasion (T) and lymph node involvement (N).Methods:The author reviewed the literature on the comparative roles of computed tomography and ES as complementary staging procedures.Results:Advantages of ES in staging esophageal cancer include the ability to accurately determine the layer depth of mural infiltration and to detect metastatic involvement of regional lymph nodes. Its disadvantages include its inability to identify distant metastases, to differentiate inflammation from malignant infiltration of wall layers or in lymph nodes, and to examine beyond obstructing tumors unless esophageal dilation is performed. A recent review indicates the accuracy for T staging to be 84% and N staging to be 77%.Conclusions:ES is a valuable tool in staging esophageal cancer and should be used in combination with computed tomography for highest accuracy.
Surgical Approaches to Esophageal Cancer
Authors: Teng Steven , Karl Richard 
Published: August 2017

Background: Esophageal cancer is a highly lethal malignancy. Esophageal resection remains the primary treatment in most centers. A number of approaches to esophageal resection have been described. Methods: The authors review the current approaches to esophageal resection and adjuvant therapy for esophageal cancer. Results: Transthoracic, transhiatal, and minimally invasive techniques are currently employed in esophageal surgery for malignancy. A number of authors favor extended mediastinal and cervical lymphadenectomy in hopes of improving survival. Combined chemotherapy and radiotherapy in the neoadjuvant setting appears to offer some promise. Conclusions: No consensus of opinion exists regarding the optimal approach or extent of esophageal resection for cancer. Prospective, randomized trials of neoadjuvant therapy may determine its efficacy. Newer approaches may enhance quality of life.
The Role of Radiation Therapy in the Management of Esophageal Cancer
Authors: Raman N. V. , Small William 
Published: August 2017

Background: Esophageal cancer is a challenging clinical problem with an estimated 12,300 new cases diagnosed in 1998. Methods: A detailed review of pertinent literature is used to describe the epidemiology and management of this disease. Results: Radiation therapy remains an important cornerstone of therapy. In combination with chemotherapy and/or surgery, radiation therapy may offer an improved therapeutic outcome. Conclusions: Radiation therapy remains an important therapy in the treatment of esophageal cancer.
Nutritional Management of Patients with Esophageal and Esophagogastric Junction Cancer
Authors: Riccardi Diane , Allen Kathryn 
Published: August 2017

Background: Malnutrition is common in patients with esophageal and esophagogastric cancer. Compared to patients with other digestive and extradigestive neoplasia, the highest incidence (78.9%) was found in those with esophageal cancer. Malnutrition is associated with postoperative complications, increased morbidity, and prolonged hospital stays. Methods: The authors review the impact and causes of malnutrition in esophageal cancer patients and present strategies that can be used to preserve or restore the nutritional status in this patient population throughout treatment. Results: Patients usually are unable to sustain weight on oral intake alone and require additional means of nutritional support. Several methods can be used to provide nutritional care to the esophageal cancer patient, such as diet modification, oral supplementation, and enteral or parenteral nutrition. The enteral route is preferred due to preservation of gut integrity, reduced risk of complications, and less expense. In terminally ill patients, minimal nutritional intervention may be all that is needed to achieve patient comfort. Conclusions: In order to improve clinical outcomes and the quality of life for patients with esophageal and esophagogastric cancers, the extent of malnutrition must be identified and treated.
Palliation of Dysphagia of Esophageal Cancer by Endoscopic Lumen Restoration Techniques
Authors: Boyce H. Worth 
Published: August 2017

Background: Cure of patients with esophageal cancer has remained rare over the past four decades. The overall five-year survival rate for squamous cell and adenocarcinoma of the esophagus currently is reported as 12% in whites and 8% in blacks. The five-year survival rate for localized disease at initial staging is only 26% for whites and 13% for blacks. With regional involvement, these rates are 11% and 7%, respectively. Methods: The author reviews the literature on optimal endoscopic lumen restoration techniques, including dilation, thermal laser and chemical ablation, photodynamic therapy, and stents. Procedures for pain relief and nutritional support are also presented. Results: Lumen restoration to relieve dysphagia and provide the opportunity for sustaining reasonable peroral nutrition is an essential element in the overall management. Nonsurgical lumen restoration procedures have much to offer for dysphagia palliation and are briefly reviewed in this presentation. The major options include ablation of intraluminal tumor mass by thermal laser, photodynamic laser, chemical ablation, peroral dilation, and placement of esophageal stents. Most patients require more than one palliative method to sustain lumen patency during the course of their disease. Conclusions: Most patients with esophageal cancer will require palliation for the multiple problems that develop during their limited life span. The responsibility of the palliation therapist is to provide the patient with safe and cost-effective treatments that provide the best possible dysphagia relief.
Ductal Carcinoma in Situ of the Breast
Authors: Dupont Elisabeth L. , Ku Ni Ni K. , Mccann Christa , Cox Charles E. 
Published: August 2017

Background: Ductal carcinoma in situ (DCIS) is detected more often since the advent of mammography. A standardized pathologic staging and grading system does not exist, but nuclear grade is assuming greater importance. The history of DCIS is long, and its treatment is a controversial issue in breast cancer today. Methods: Data have been reviewed regarding the role of HER-2 expression as a prognostic variable, as a predictive factor for response to chemotherapy and hormonal therapies, and as a directed therapeutic target for breast cancer. Results: The NSABP protocol B06 revealed a recurrence rate of 43% in patients treated with local excision alone. Half of recurrences are still DCIS, but 50% are invasive. Local control is markedly improved by the addition of radiation. Recurrence is also minimized by careful cytologic review of margins. Sentinel lymph node biopsy has resulted in more accurate nodal staging. Conclusions: As a heterogeneous lesion, DCIS may not lend itself to a uniform treatment approach. Careful analysis of resection margins is required. As our understanding of the diagnosis and treatment of this disease develops, a coordinated team approach is optimal.
Adenocarcinoma of the Endometrium: An Institutional Review
Authors: Cavanagh Denis , Fiorica James V. , Hoffman Mitchel S. , Durfee John , Nicosia Santo V. 
Published: August 2017

Background Many oncologists regard endometrial cancer as a relatively benign and easily treatable gynecologic tumor. Inadequate care can result in poor outcomes. Methods The authors review the epidemiology and pathology of the disease, and they compare disease characteristics and outcomes of FIGO staging with their own 11-year experience at a tertiary referral center. Results Patients referred to tertiary referral centers tend to present with more advanced stages of disease than those reported by FIGO, although the profile of histologic types is similar. Conclusions Prevention and early detection of endometrial cancer can minimize the impact of this disease. Complete staging and tumor removal including extrafascial hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and selective paraaortic lymphadenectomy are the cornerstones of surgical therapy.