bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Review and Case Series Report of Acinar Cell Carcinoma of the Pancreas
Authors: Glazer Evan S. , Neill Kevin G. , Frakes Jessica M. , Coppola Domenico , Hodul Pamela J. , Hoffe Sara E. , Pimiento Jose M. , Springett Gregory M. , Malafa Mokenge P. 
Published: August 2017

BackgroundAcinar cell carcinoma of the pancreas is a rare malignancy representing less than 1% of all pancreatic malignancies.MethodsWe report on a case series of 21 patients with acinar cell carcinoma of the pancreas treated at a high-volume quaternary center. A systematic review of the medical literature was performed that described typical therapeutic management approaches for acinar cell carcinoma of the pancreas and reported on disease control and survival rates. Data for the case series were obtained from a prospective database.ResultsIn our systematic review of 6 articles, study patients had a median age of 61 years, 66% were male, 52% had stage I/II disease, and 55% of lesions were located in the pancreatic head. The rates of median survival were approximately 47 months after resection with adjuvant therapy, 38 months for nonmetastatic, locally unresectable disease, and 17 months for metastatic disease treated with chemotherapy. Combination fluoropyrimidine-based chemotherapy regimens had better rates of disease control than other therapies. Our case series included 21 study patients, 14 of whom required resection and 7 who had metastatic disease. The rates of median survival were 40.2 + 31.9 months in those who underwent surgery and were treated with adjuvant therapy and 13.8 + 11.3 months for patients with metastatic disease.ConclusionsMultidisciplinary treatment for acinar cell carcinoma of the pancreas should be considered due to the rarity of the disease and its lack of high-level therapeutic data. Progress in the molecular analysis of this tumor may improve outcomes through the use of personalized therapy based on underlying tumor mutations.
Imaging Management of Breast Density, a Controversial Risk Factor for Breast Cancer
Authors: Falcon Shannon , Williams Angela , Weinfurtner R. Jared , Drukteinis Jennifer S. 
Published: August 2017

Background Breast density is well recognized as an independent risk factor for the development of breast cancer. However, the magnitude of risk is controversial. As the public becomes increasingly aware of breast density as a risk factor, legislation and notification laws in relation to breast density have become common throughout the United States. Awareness of breast density as a risk factor for breast cancer presents new challenges for the clinician in the approach to the management and screening of women with dense breasts. Methods The evidence and controversy surrounding breast density as a risk factor for the development of breast cancer are discussed. Common supplemental screening modalities for breast cancer are also discussed, including tomosynthesis, ultrasonography, and magnetic resonance imaging. A management strategy for screening women with dense breasts is also presented. Results The American College of Radiology recognizes breast density as a controversial risk factor for breast cancer, whereas the American Congress of Obstetricians and Gynecologists recognizes breast density as a modest risk factor. Neither organization recommends the routine use of supplemental screening in women with dense breasts without considering additional patient-related risk factors. Conclusions Breast density is a poorly understood and controversial risk factor for the development of breast cancer. Mammography is a screening modality proven to reduce breast cancer–related mortality rates and is the single most appropriate tool for population-based screening. Use of supplemental screening modalities should be tailored to individual risk assessment.
Cardiac Magnetic Resonance Imaging in Oncology
Authors: Jeong Daniel , Patel Aarti , François Christopher J. , Gage Kenneth L. , Fradley Michael G. 
Published: August 2017

Background Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies. Methods An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment. Results Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques. Conclusions Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.
Psychosocial Aspects of Palliative Care
Authors: Jacobsen Paul B. , Breitbart William 
Published: August 2017

BackgroundRelief of suffering is a central goal for palliative care. Achievement of this goal can be difficult, however, due to the complex nature of suffering.MethodsA psychosocial perspective is used to understand suffering and to identify interventions to relieve suffering in patients with advanced disease.ResultsClinical experience and research suggest that attending to the psychosocial aspects as well as the medical aspects of palliative care has the potential of further reducing the suffering experienced by patients with advanced disease.ConclusionsSuffering is best viewed as a subjective phenomenon t hat can be influenced by biological, psychological and social processes. Interventions in each of these areas can help to relieve patient suffering.
Barriers to Palliative Care
Authors: Rhymes Jill A. 
Published: August 2017

Background Palliative care is received by a small number of patients with terminal illness, most of them with cancer. Methods Data are reviewed and evaluated that relate to the barriers and problems that limit access of patients to appropriate palliative and/or hospice care. Results Palliative care generally is not well integrated into the health care system. Access is limited, and many health care professionals and laypeople are unaware of its possible benefits. Cultural and religious barriers often apply, and problems exist in obtaining narcotics. Palliative care for patients other than those with cancer may be especially difficult to achieve. Conclusions Recognizing and overcoming the barriers to the provision of palliative care can bring about changes in education, health care practices, and administration to achieve the desired goals.
Management of Toxicities of Combined Modality Therapy for Intrathoracic Malignancies
Authors: Weakland Tina , Wagner Henry 
Published: August 2017

Background Combined radiation and chemotherapy for intrathoracic tumors can produce appreciable morbidity. Apprehension about the severity of these toxicities may inhibit optimal patient care. Methods The literature on recognition, diagnosis, prophylaxis, and management of these toxicities is reviewed and combined with the experiences of the authors to produce management recommendations. Results Toxicities include acute and chronic esophagitis, early and late pneumonitis with fibrosis, myelosuppression, and neurologic deficits. Measures are available to minimize their severity and to reduce their impact on the patient. Conclusions The morbidity of combined radiation and chemotherapy patients with intrathoracic tumors can be minimized by recognizing potential toxicities and by applying appropriate prophylactic and management measures.
Regional Transcatheter Therapy of Hepatic Neoplasms
Authors: Choi Junsung 
Published: August 2017

Background Surgical resection of hepatocellular carcinomas and metastases to the liver cannot always be performed, and systemic therapies for these entities are of limited value. The techniques of chemoembolization and hepatic artery infusion have been used for patients who are not candidates for surgery. Methods Chemoembolization uses percutaneous intra-arterial infusion of chemotherapeutic agents and embolic material. This provides longer contact of the agents with the tumor cells and induces ischemia. Hepatic arterial chemoinfusion uses the knowledge that hepatic cancers are supplied predominantly by the hepatic artery. Results Chemoembolization using Lipiodol, doxorubicin, and Gelfoam has promoted necrosis of unresectable hepatocellular tumors and may have prolonged patient survival. Hepatic arterial infusion with fluorinated pyrimidines produces more objective responses than systemic chemotherapy but probably does not alter survival. Conclusions The nonsurgical treatments of chemoembolization and hepatic arterial infusion of chemotherapy have expanded our armamentarium to manage many primary and metastatic tumors in the liver. Additional approaches are needed.
Non-Hodgkin's Lymphoma in the Elderly
Authors: Balducci Lodovico , Ballester Oscar F. 
Published: August 2017

Background The incidence of non-Hodgkin's lymphoma in the elderly continues to increase. There has been a tendency among some treating physicians to minimize appropriate workup and treatment, which may produce a negative effect on outcomes. Methods Several characteristics of non-Hodgkin's lymphoma in the elderly are reviewed, including classification and staging, pathophysiology, clinical presentation, and treatment strategies. Results The Working Formulation remains the principal classification used. In older and younger individuals, the prevalence of histologic subtypes and the stage at presentation are similar. Regardless of the regimen chosen, doxorubicin or mitoxantrone should be included if optimal responses are to be obtained. New purine analogs extend the therapeutic armamentarium. Conclusions Advanced age and comorbidities can impair the capability for treatments to control non-Hodgkin's lymphoma. To enhance results, more studies that focus on the elderly are needed on drug combinations and the newer purine analogs.
Systemic Therapy for Invasive Bladder Cancer
Authors: Javle Milind , Raghavan Derek 
Published: August 2017

Background Bladder cancer is one of the most common malignancies in Western society. In the United States, approximately 10,000 of these patients present with invasive disease, and more progress from superficial bladder cancer. Methods The authors review the literature on systemic treatment for both localized and metastatic bladder cancer, and they include their experience in defining approaches to various stages of disease. Results Cisplatin-based combination chemotherapy is the most effective systemic approach for advanced bladder cancers, although few patients are cured. Neoadjuvant, perspective, and adjuvant trials, as well as concurrent chemoradiation studies, are in progress to attempt to demonstrate better outcomes. Conclusions The combination of systemic chemotherapy and definitive local therapy may have a useful role in the management of locally advanced bladder cancers, but optimal schedules and true survival benefit have not been established.
Bladder Replacement and Urinary Diversion after Radical Cystectomy
Authors: Pow-Sang Julio M. , Spyropoulos Evangelos , Helal Mohammed , Lockhart Jorge 
Published: August 2017

BackgroundThe optimal mode of urinary tract reconstruction following cystectomy continues to challenge the urologic surgeon. Disadvantages with bowel conduits have prompted the search for better techniques to improve patient outcomes.MethodsThe development of urinary tract reconstruction is reviewed, and results from several forms of continent urinary diversion and bladder replacement construction are presented. The authors report on their experience in creating continent reservoirs or neobladders in over 400 patients.ResultsSeveral surgical approaches are now available for continent urinary diversion. Metabolic and nutritional abnormalities, stone formation, infection, and cancer formation are potential complications.ConclusionsAdvances in surgical techniques, an understanding of the physiology of isolated bowel segments, and improvements in pre- and post-operative care have altered the field of urinary reconstruction after cystectomy for bladder cancer. Most patients can expect minimal morbidity and mortality.
Use of G-CSF to Sustain Dose Intensity in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Pilot Study
Authors: Webster Jack , Kuderer Nicole , Lyman Gary H. 
Published: August 2017

Background Adjuvant chemotherapy for breast cancer is frequently accompanied by neutropenia requiring dose reduction or treatment delay that can potentially compromise therapeutic effectiveness. Recombinant granulocyte-colony stimulating factor (G-CSF) reduces the duration and severity of neutropenia. Methods Nineteen patients with newly diagnosed breast cancer receiving adjuvant systemic chemotherapy met criteria for dose reduction or treatment delay due to neutropenia. All were treated with G-CSF. The mean duration of G-CSF therapy was five days. Results An increase in mean absolute neutrophil count was seen in cycles with G-CSF. Chemotherapy treatment was delayed less often following the use of G-CSF. Conclusions Breast cancer patients receiving adjuvant chemotherapy who face treatment delays or dose reductions can continue on full-dose intensity therapy using supportive G-CSF. Prospective trials are needed to accurately measure the impact of G-CSF on dose intensity and long-term disease control.
Local Management of Primary Breast Cancer
Authors: Small William , Morrow Monica 
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.
The Role of Selective Lymphadenectomy in Breast Cancer
Authors: Reintgen Douglas , Joseph Emmanuella , Lyman Gary H. , Yeatman Tim , Balducci Lodovico , Ku Ni Ni , Berman Claudia , Shons Alan , Wells Karen , Horton John , Greenberg Harvey , Nicosia Santo , Clark Robert , Shivers Steven , Li Weiguo , Wang Xiangning , Cantor Alan , Cox Charles 
Published: August 2017

Background Axillary node dissection is considered a standard staging procedure in patients with breast cancer. The procedure is associated with significant morbidity and provides pathologists with many lymph nodes to evaluate. Methods A total of 174 women participated in a trial that included preoperative lymphoscintigraphy and intraoperative lymphatic mapping using a combination of a vital blue dye and radiocolloid mapping. Results The intraoperative lymphatic mapping correctly identified a sentinel lymph node (SLN) in 160 (92%) of 174 patients. One skip metastasis (0.7%) occurred in 136 women who had a subsequent complete node dissection. Conclusions Lymphatic mapping and SLN biopsy using a combination of mapping techniques provide accurate nodal staging for women with breast cancer. With this technique, approximately 70% to 80% of women with no axillary metastases could be spared the morbidity of a complete node dissection.
Conservation Therapy of the Breast: Optimizing Long-term Results
Authors: Greenberg Harvey M. 
Published: August 2017

Background Radiation therapy is a key component of breast conservation therapy for breast cancer. There is great interest in safety and long-term outcome issues for this still underutilized approach. Methods The author reviews a series of factors that may affect the end results of conservation therapy and highlights those that are likely to be of clinical significance. Results Daily dose fractions are usually less than 2 Gy and a homogeneous whole-breast dose is used. Care is needed with patients with collagen vascular diseases, large breasts, breast trauma, and prior infections, but these factors are not absolute contraindications to breast conservation therapy. Acute skin reactions are not predictive of long-term complications. Conclusions With adherence to proper surgical and radiation techniques, most patients presenting with localized breast cancer can be managed safely and effectively with breast conservation.
Management Issues for Stage IV Non-Small-Cell Lung Cancer
Authors: Earle Craig C. , Evans William K. 
Published: August 2017

Background The management of stage IV non-small-cell lung cancer (NSCLC) has been a controversial subject over the past several decades. Data from randomized trials and from phase II trials on new cancer agents are changing physician attitudes and treatment practices. Methods The literature on the management of metastatic lung cancer was reviewed and interpreted. Results There is good evidence from randomized controlled trials and meta-analyses that chemotherapy provides a modest survival benefit in stage IV NSCLC. There is indirect evidence of improvement in quality of life, as systemic chemotherapy palliates cancer-related symptoms in the majority of patients. New drug combinations are likely to improve recent treatment results with less morbidity than older chemotherapy regimens. Despite the relatively high cost of these treatments, chemotherapy is cost effective in the Canadian health care environment relative to other accepted medical interventions. Conclusions Chemotherapy will play an increasing role in the management of patients with advanced NSCLC.
A Primer for Evaluating Clinical Trials
Authors: Lyman Gary H. , Kuderer Nicole M. 
Published: August 2017

Background Evidence-based medicine demands the use of information from clinical trials to direct medical care. Knowledge of the principles of trial design and conduct is important to assess the validity of results. Methods The authors review the key principles behind clinical study design and conduct, and they summarize important biases and confounding issues. Results Clear hypotheses, a well-described study population, precise measurements, freedom from bias, and consideration of any interactions are attributes of good clinical trials. Conclusions The greatest level of evidence in support of a difference in outcome is associated with randomized, controlled clinical trials, particularly when combined with other randomized trials in a systematic fashion (meta-analysis).
T-cell Prolymphocytic Leukemia
Authors: Matutes Estella 
Published: August 2017

Background: T-cell prolymphocytic leukemia (T-PLL) is a post-thymic T-cell malignancy with aggressive clinical course. Although T-PLL has been referred to under different designations, it is a distinct clinico-biological entity and should be distinguished from other T-cell disorders. Methods: The literature on T-PLL is reviewed. Experience on the clinical and laboratory features, differential diagnosis, and therapy on a large series of T-PLL patients is presented. Results: T-PLL affects adults and occurs more frequently in men. The principal disease characteristics are organomegaly, skin lesions, and a raised lymphocyte count. Immunological markers show a post-thymic T-cell phenotype (TdT– CD2+ CD5+ CD3±) with strong expression of CD7. A CD4+ CD8– phenotype is seen in two thirds of cases. CD4 and CD8 are coexpressed in 25%, and a CD4– CD8+ phenotype is rare. Cytogenetics show a recurrent abnormality inv(14)(q11;q32) that is always associated to other aberrations (particularly iso8q or trisomy 8). Differential diagnosis between T-PLL and other T-cell malignancies is based on a constellation of clinical and laboratory features. Generally, T-PLL patients are refractory to the therapy used in lymphoid disorders. Median survival is short but is improving with the use of 2'-deoxycoformycin and the humanized monoclonal antibody, anti-CDw52 (Campath-1H). Conclusions: T-PLL is a distinct T-cell disorder with characteristic clinical and laboratory features and a poor prognosis. A precise diagnosis of this disease is important in determining patient management and treatment.
Progress in the Systemic Treatment of Advanced Soft-Tissue Sarcomas
Authors: Okuno Scott H. , Edmonson John H. 
Published: August 2017

Background: Despite the plethora of chemotherapeutic remedies for advanced soft-tissue sarcomas, little evidence has developed to indicate that these efforts have been curative. No controlled comparison has yet proven that patients receiving multidrug regimens survive longer than those receiving doxorubicin alone. Methods: The authors review current systemic treatments and then discuss some investigational efforts now in progress. Also, they seek to demonstrate how the therapies currently available can be integrated with surgery and radiation therapy to accomplish more than might be anticipated from chemotherapy alone. Results: While working to develop better systemic therapies for advanced soft-tissue sarcomas, the integrated use of our best chemotherapy regimens in combination with selected surgical and radiotherapy efforts may provide patients with the best available therapy. Some recent observations involving the use of molgramostim plus chemotherapy have been intriguing. Conclusions: Progress in the systemic treatment of advanced soft-tissue sarcomas may be gradual, but it is real. Our daily challenge is to be certain that we offer each patient the best available multimodality treatment applicable to his or her clinical situation. Molgramostim should be made available for further study with chemotherapy in controlled clinical trials.