bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Locally Advanced Renal Cell Carcinoma
Authors: Rodriguez Alejandro , Sexton Wade J. 
Published: August 2017

Background Renal cell carcinoma accounts for approximately 3% of adult malignancies and over 90% of primary renal tumors. Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. Methods The authors review literature regarding prognostic factors, potential biomarkers, surgical strategies, and adjuvant therapy trials for patients with LARCC. Results Molecular tumor markers may improve existing staging systems for predicting prognosis. Surgery is the best initial treatment for most patients with clinically localized renal tumors, although complete surgical resection can be challenging for patients with large tumors, bulky regional lymph node involvement, or inferior vena cava tumor thrombus. Significant recurrence rates for patients with LARCC undergoing nephrectomy indicate the presence of undetected micrometastases at the time of surgery. Adjuvant radiation, chemotherapy, and immunotherapy have been ineffective. Other trials of adjuvant therapy are ongoing. Conclusions Aggressive surgical resection alone for LARCC is not sufficient to prevent disease recurrence in a significant number of patients. Adjuvant therapies are needed to improve cancer-specific survival.
Challenges in Community-Based Participatory Research Implementation: Experiences in Cancer Prevention with Pacific Northwest American Indian Tribes
Authors: Strickland C. June 
Published: August 2017

Background Much has been written about community-based participatory research (CBPR) history and principles, but few have addressed challenges in implementation in transcultural situations. The goal of this discussion is to address CBPR implementation issues in cancer prevention research with American Indian tribal communities in the Pacific Northwest. Method Information in this discussion is drawn from qualitative research conducted over a 10-year period in which CBPR was employed in cancer prevention research with Pacific Northwest Indian tribes. CBPR principles provide the framework for the discussion: establishing trusting relationships, assuring participation, sharing power, and communicating. Results In this work, we found that CBPR is appropriate for use in Pacific Northwest Indian tribal communities and is compatible with cultural values. We also found that there are many challenges. Recommendations are provided on needed institutional and structural changes. Conclusions CBPR is an important research approach in addressing cancer prevention health disparities among American Indian tribal communities. Continued effort needs to be directed toward creating systems and structures to support researchers in utilizing this method. Findings are of value to researchers aiming to implement CBPR in Indian communities and to practitioners, policy makers, and administrators who make decisions about CBPR funding and support structures.
Breast Ductal Secretions: Clinical Features, Potential Uses, and Possible Applications
Authors: Lang Julie E. , Kuerer Henry M. 
Published: August 2017

Background Nipple discharge accounts for approximately 5% of visits to a breast specialist surgical practice and may be encountered as the chief complaint by many other types of physicians. The vast majority of breast cancers originate in the ductal system, which prompted interest in the evaluation of the intraductal approach to breast cancer. Ductoscopy, nipple aspiration, and ductal lavage have emerged as innovative fields of study that may have clinical applications. Methods We performed a literature search of published manuscripts using the keywords nipple discharge, breast ductal secretions, and intraductal approach. We also report our single-institution experience in managing nipple discharge. Results We present our institutional algorithm for the management of nipple discharge. The possible etiologies of nipple discharge and the appropriate workup are reviewed. Three evolving minimally invasive techniques for the evaluation of high-risk patients include ductoscopy, nipple aspiration, and ductal lavage. Nipple aspiration and ductal lavage fluid may be assayed for cytology, genomic, gene expression, and proteomic studies. Several different translational approaches are being undertaken to investigate the local microenvironment associated with the development and progression of breast carcinoma. Conclusions Nipple aspiration fluid and ductal lavage offer the opportunity to study the local microenvironment of the ductal system, which is where most breast cancers originate. These powerful approaches to biomarker analysis could be applied to the prevention and treatment of breast cancer.
Therapeutic Potential of Directed Tyrosine Kinase Inhibitor Therapy in Sarcomas
Authors: Shor Audrey C. , Agresta Samuel V. , D'amato Gina Z. , Sondak Vernon K. 
Published: August 2017

BackgroundSarcomas are rare mesenchymally derived tumors for which there are limited treatment options. This paper discusses the current therapeutic potential of directed tyrosine kinase inhibitors (TKIs) in sarcoma.MethodsThe authors review antibody-based strategies and small molecular inhibitors of TKIs, with specific emphasis placed on the potential use of these targeted agents as therapeutic options for the treatment of sarcomas that are not gastrointestinal stromal tumors.ResultsMany TKs have been shown to be mutated or overexpressed in human sarcoma tumors and cell lines and may serve as potential targets for promising new sarcoma therapies. Furthermore, the novel mechanism of targeting TKs may complement the antitumor activity of existing sarcoma treatment options.ConclusionsTKIs such as imatinib, sunitinib, and sorefanib are promising new therapeutic options for the management of patients with soft tissue sarcoma.
Colorectal Cancer Screening and African Americans: Findings from a Qualitative Study
Authors: Palmer Richard C. , Midgette Lynn A. , Dankwa Irene 
Published: August 2017

Background Colorectal cancer (CRC) screening has been found to be an effective tool for the control and prevention of this type of cancer, yet it is underutilized by African Americans. Consequently, African Americans with CRC are diagnosed at late stages and suffer disproportionately higher mortality rates for CRC. Methods To understand factors that influence the decision to participate in CRC screening, in-depth personal interviews were conducted with 36 African Americans in the Washington, DC, metropolitan area. Predisposing factors, enabling factors, and reinforcing factors were identified and categorized using the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation (PRECEDE) framework. Results Findings suggest that distinct differences exist between individuals who are adherent to screening guidelines and those who have not undergone screening. Adherent individuals were more knowledgeable about CRC and held positive beliefs about the benefits of screening. Nonadherent individuals placed little importance on prevention and early detection. Physician recommendation and insurance coverage/cost also differentiated the two groups. Conclusions Study findings suggest that efforts to increase awareness and promote the benefits of CRC screening are needed among African Americans. Also, efforts by healthcare providers to recommend CRC screening are important in promoting adherence. Further, low- or no-cost CRC screening is needed to increase participation by individuals who are economically disadvantaged.
Surgical Management of Melanoma in Situ on Chronically Sun-Damaged Skin
Authors: Clark Graham S. , Pappas-Politis Effie C. , Cherpelis Basil S. , Messina Jane L. , Möller Mecker G. , Cruse C. Wayne , Glass L. Frank 
Published: August 2017

Background Lentigo maligna (LM) commonly presents as a slow-growing pigmented macular lesion in chronically sun-damaged skin and may progress to invasive melanoma. Many regard it as a subtype of melanoma in situ (MIS), and surgical excision remains the preferred treatment, but standard 5-mm surgical margins recommended for typical MIS are often insufficient for LM due to its indistinct borders both clinically and histologically. Methods A search of the literature was conducted to review specialized surgical techniques for the treatment of LM, focusing on methods that employ total peripheral margin assessment prior to definitive closure, using either frozen or permanent histologic sections. Results Many investigators have reported surgical modalities utilizing permanent sections for margin control, including variations of the “square” procedure and “perimeter” technique. Recurrence rates are low with these methods, but only short-term data have been reported. Similarly, several studies have demonstrated the efficacy of Mohs micrographic surgery (MMS) for treatment of MIS, with recurrence rates generally less than 1% over 3 to 5 years of follow-up. Many investigators have had success with immunohistochemical stains to identify melanocytes on frozen sections, aiding margin assessment in MMS. Conclusions Compared to standard excision, methods that employ surgical margin control offer superior cure rates for LM and should be utilized when available. Total peripheral margin assessment using staged excisions and permanent sections is a simple and effective alternative to MMS for institutions that lack the resources for intraoperative frozen section analysis.
Cytoreductive Nephrectomy vs Medical Therapy as Initial Treatment: A Rational Approach to the Sequence Question in Metastatic Renal Cell Carcinoma
Authors: Spiess Philippe E. , Fishman Mayer N. 
Published: August 2017

Background Renal cell carcinoma (RCC) can be considered as two distinct entities: localized and metastatic disease. Methods We conducted a review of the scientific literature published within the past decade pertaining to cytoreductive nephrectomy for metastatic RCC. Results Retrospective data and historical prospective series have demonstrated the survival benefit of debulking nephrectomy in well-selected RCC patients. New medical therapies, including vascular endothelial growth factor and mTOR pathway blocking drugs, are active biological agents, with survival improvement and potential regression of metastatic and primary tumors. Our current therapeutic challenge is the optimal integration of multimodal therapy consisting of systemic therapy and surgery including cytoreductive nephrectomy, debulking, and metastasectomy. Empiric data to guide this decision are limited. Conclusions The decision concerning whether medical or surgical therapy should be the primary treatment approach selected must be made on an individual basis, taking into account patient performance status, clinical parameters, and physician expertise and recommendations, thus making each case a unique therapeutic challenge.
Microarray-Based Gene Expression Studies in Ovarian Cancer
Authors: Chon Hye Sook , Lancaster Johnathan M. 
Published: August 2017

Background DNA microarray technology is a powerful genomic tool that has the potential to elucidate the relationship between clinical features of cancers and their underlying biological alterations. Methods We performed a systemic search in PubMed and Medline databases for recently published articles. The search terms used included “genome-wide,” “microarrays,” “ovarian cancer,” “prognosis” “gene expression profiling,” “molecular marker,” and “molecular biomarker.” Results Genome-wide expression profiling using DNA microarray technology has enhanced our understanding of the genes that influence ovarian cancer development, histopathologic subtype, progression, response to therapy, and overall survival. Conclusions Gene expression profiling has demonstrated its utility in ovarian cancer research. It is hoped that with technologic, statistical, and bioinformatic advances, the reliability and reproducibility of this technique will increase, spawning clinical applications that may enhance our understanding of the disease and our ability to care for patients in the future.
Screening for Ovarian Cancer
Authors: Cragun Janiel Marie 
Published: August 2017

Background Ovarian cancer remains the most deadly of the gynecologic cancers. It is difficult to diagnose until in advanced stages. An effective screening test may help to decrease mortality from ovarian cancer. Due to the low incidence of ovarian cancer in the general population, a good screening test must have high sensitivity and specificity to allow accurate detection without excessive false-positive results. Thus, effective screening for ovarian cancer has remained elusive. Methods Studies evaluating screening methods for ovarian cancer are reviewed. Screening methods investigated include ultrasound, CA-125, and serum proteins. Results The use of CA-125 or ultrasound alone does not result in adequate sensitivity or specificity for routine screening. A combination of the two modalities improves sensitivity, specificity, and positive predictive value. Using a combination of serum proteins may also improve sensitivity, specificity, and positive predictive value, but such studies have yet to be validated. Conclusions No effective screening methods for ovarian cancer that have been adequately validated are available. Routine screening for ovarian cancer in the general population is not currently recommended.
The Role of Surgery in the Management of Epithelial Ovarian Cancer
Authors: Ramirez Ingrid , Chon Hye Sook , Apte Sachin M. 
Published: August 2017

BackgroundEpithelial ovarian cancer is the most deadly gynecologic cancer in the United States. Multiple modalities of therapy are utilized in the management of the disease. The role of surgery remains important in the treatment of this disease and is described herein.MethodsMedline and PubMed were utilized to search the English language medical literature up to March 2010. A broad range of studies and quality of data were analyzed, including prospective studies, case control analyses, and meta-analyses. When possible, the highest level of evidence was reviewed and presented.ResultsFor the medically fit patient, optimal cytoreductive surgery positively impacts survival. For some highly selected patients, there is a role for a minimally invasive approach. In the recurrent setting, factors such as interval to recurrence and the distribution of disease will determine the utility of secondary cytoreductive surgery. A subgroup of patients may benefit from palliative surgical procedures in the recurrent setting.ConclusionsDespite advances in the use of chemotherapy and biologic agents, surgery remains an important modality in the diagnosis and treatment of ovarian cancer.
Antiangiogenic Therapies in Epithelial Ovarian Cancer
Authors: Teoh Deanna G. K. , Secord Angeles Alvarez 
Published: August 2017

Background Angiogenesis is a critical component of tumor development and proliferation, and increased angiogenesis has been associated with a worse clinical outcome in a number of solid tumors, including ovarian cancer. Therefore, agents that target the angiogenic process are of considerable interest in the treatment of ovarian cancer. Methods Studies evaluating the efficacy of antiangiogenic agents in ovarian cancer are reported. Antiangiogenic agents examined include vascular endothelial growth factor (VEGF) pathway inhibitors, including monoclonal antibodies, tyrosine kinase inhibitors (TKIs), and a soluble receptor decoy, as well as inhibitors of other angiogenic factors and vascular disrupting agents. Results The VEGF inhibitor bevacizumab has been shown to have efficacy in ovarian cancer in phase II trials and a progression-free survival advantage in one phase III trial. TKIs block the VEGF receptors and secondary angiogenic pathways and have shown activity in phase I and II trials. Alternative angiogenesis inhibitors include EphA2 inhibitors and a selective angiopoietin 1/2-neutralizing peptibody. Another strategy is to destroy the existing tumor vasculature, and a number of vascular disrupting agents are being studied in preclinical and phase I trials. Antiangiogenic agents have a unique side effect profile, likely due to inhibition of normal physiologic angiogenesis. Conclusions Phase II and early phase III trials have demonstrated that antiangiogenic therapies have significant activity in ovarian cancer. The results of phase III trials in the front-line and recurrent settings will determine the extent of clinical benefit of antiangiogenic therapies in combination with chemotherapy. Antiangiogenic agents have a distinct side effect profile, and further studies are necessary to evaluate how to minimize the incidence of these events and to identify women most likely to benefit from these therapies.
Quality of Life in Ovarian Cancer
Authors: Grzankowski Kassondra S. , Carney Michael 
Published: August 2017

Background Ovarian cancer and its management interventions can produce significant impairments in health-related quality of life (HRQOL). These effects have been studied in both localized and advanced disease settings. Methods The authors assessed research reports that focus on the evaluation of HRQOL in patients with ovarian cancer in order to describe the findings and to suggest approaches that might maintain or maximize the quality of life in these patients. Results Evaluation of quality of life and functional impairment can include consideration of several issues such as the effects of the disease and its treatments on symptomatology, systemic therapy effects, the balance between life-prolonging but toxic protocols, and the sexual, psychosocial, social, and financial effects of treatment. The Gynecologic Oncology Group is actively studying these issues in its protocols. Conclusions HRQOL evaluation is a valuable measure in optimizing care of patients with ovarian cancer, but more research is needed to make such evaluations sufficiently inexpensive and easy to perform so that they can be more fully incorporated into general oncologic practice.
Umbilical Cord Blood Transplantation for the Treatment of Hematologic Malignancies
Authors: Brunstein Claudio G. 
Published: August 2017

BackgroundThe use of unrelated umbilical cord blood (UCB) has grown as an allogeneic source of hematopoietic cells for transplantation of patients with hematologic malignancies. As the number of UCB transplantation procedures has grown, an increasing number of publications have focused on disease-specific outcomes.MethodsThis review focuses on the outcome data following UCB transplantation in subsets of hematologic malignancies in which experience with this graft source is greater.ResultsRegistry and single-institution reports regarding the outcomes of children and adults with acute leukemias after UCB transplantation include many patients, while data on the clinical outcomes of other leukemias are limited due in part to the small number of patients with these diseases. UCB is now routinely used as a source of hematopoietic stem cells (HSCs) in pediatric allogeneic transplantation when a suitable sibling donor is not available. Data also support the use of UCB as an alternative source of HSC for transplantation of patients with hematologic malignancies who lack a more conventional donor. Current data also support UCB for patients who require an allograft in the setting of prospective clinical trials.ConclusionsAlong with safety and feasibility in UCB transplantation, continued study is needed that focuses on issues such as accelerating engraftment, extending access, ensuring quality, and examining outcomes in specific subgroups of patients.
Surgical Management of Metastatic Spinal Tumors
Authors: Laufer Ilya , Sciubba Daniel M. , Madera Marcella , Bydon Ali , Witham Timothy J. , Gokaslan Ziya L. , Wolinsky Jean-Paul 
Published: August 2017

Background The spine is the most common site of skeletal metastases. The evolution of surgical methods, medical treatment, and radiation therapy has led to improved survival, functional status, and quality of life for patients with cancer. The role of surgery in the treatment of patients with spinal metastases has evolved over time. Methods A review of publications describing the role of open surgery and vertebroplasty was performed and the results are summarized. Results The treatment goals of spinal metastases include the preservation and restoration of neurologic function and spinal stability. Modern imaging modalities provide accurate methods of tumor diagnosis. A variety of approaches and stabilization techniques are available and should be tailored to the location of the tumor and systemic comorbidities. Conclusions As part of multidisciplinary treatment that includes radiation therapy and chemotherapy, surgery provides an effective method of restoration and preservation of neurologic function and spinal stability for patients with metastatic spinal tumors.
Evolution of Axillary Nodal Staging in Breast Cancer: Clinical Implications of the ACOSOG Z0011 Trial
Authors: Shah-Khan Miraj , Boughey Judy C. 
Published: August 2017

Background Management of the axilla in breast cancer patients has evolved from routine axillary lymph node dissection (ALND) for all patients to a highly selective approach based on the assessment of the sentinel lymph nodes (SLNs) as well as tumor and patient characteristics. Although ALND continues to have an important role in staging and regional control for many breast cancer patients, recent trial results question the need for routine ALND in patients who have positive SLNs. Methods Not all axillary disease becomes clinically detectable or relevant with respect to recurrence and survival. Therefore, recent trends indicate that many surgeons have omitted ALND in subgroups of patients, particularly those with clinically node-negative, SLN-positive, early-stage breast cancer undergoing breast-conserving therapy with postoperative irradiation. This review explores trends in axillary management, focusing primarily on the clinical implications of the results from the American College of Surgeons Oncology Group (ACOSOG) Z0011 randomized controlled trial. Results According to the results of the ACOSOG Z0011 trial, the use of SLN dissection alone did not result in inferior survival compared with ALND in patients with limited SLN disease treated with breast-conserving therapy. This subgroup of women was spared the morbidity associated with ALND. However, several points of debate, including the smaller than anticipated sample size, the older study population, and the length of follow-up, suggest caution when applying these findings to all women with breast cancer. Conclusions Although the findings of ACOSOG Z0011 are impressive, in clinical practice they are applicable to a limited number of women with breast cancer: those with T1-2 primary tumors with clinically negative axilla and 1 to 2 positive SLNs undergoing breast-conserving surgery and adjuvant whole-breast irradiation. The next generation of clinical trials may answer some of the remaining questions regarding how best to manage the axilla in additional subsets of patients undergoing treatment of breast cancer.