bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent Paclitaxel and Radiation Therapy for Solid Tumors
Authors: Choy Hak , Akerley W. , Glantz M. , Safran H. , Graziano S. , Chung C. 
Published: August 2017

Background Combination radiation and chemotherapy has an intuitive appeal for improving cancer treatment. Experimental results suggest that paclitaxel plus radiation might produce additive or synergistic effects. Methods A series of phase I and II trials to test tolerance and begin to evaluate effectiveness were performed on patients with non-small cell lung cancer, high-grade astrocytic brain tumors, and pancreatic and gastric cancers. Results Tolerance of the combined drug and radiation programs was generally good. Esophagitis was dose-limiting for the intrathoracic tumors. Hematologic toxicity was mild, but peripheral neuritis and cutaneous reactions were common. Conclusions These trials show that paclitaxel plus concurrent radiation is feasible at the dose levels and schedules tested. Antitumor responses have been observed.
Surgical Resection of Hepatocellular Carcinoma
Authors: Liu Chi-Leung , Lo Chung-Mau , Fan Sheung-Tat 
Published: August 2017

Background Surgical management of hepatocellular carcinoma is challenging. Advances in patient selection and operative techniques are taking place in various parts of the world. Methods The literature on diagnosis, evaluation, and surgical treatment of hepatocellular carcinoma is reviewed and combined with the extensive clinical experience of the authors. Results While alpha-fetoprotein levels often are elevated in patients with large hepatocellular tumors, a combination of hepatic arteriography and Lipiodol computed tomography is the most sensitive imaging approach. An indocyanine green retention of more than 14% at 15 minutes predicts a poor outcome from surgery. Intraoperative ultrasound and ultrasonic dissector assist surgery. One-, three-, and five-year survival rates of 68%, 44%, and 35%, respectively, have been reported. Conclusion Methods to diagnose and assess the suitability of patients with hepatocellular carcinoma for surgical resection are now available, and operative and postoperative care has improved. Surgery remains the “gold standard” to which other treatments can be compared.
Cryosurgery in the Treatment of Hepatic Tumors
Authors: Sotomayor Ramon , Ravikumar T.S. 
Published: August 2017

Background Primary and metastatic tumors in the liver are difficult to treat. When surgical resection is not feasible, cryotherapy is one of the several alternative approaches. Methods The data on outcomes from hepatic resections are reviewed, and the rationale and techniques of performing cryosurgery for unresectable hepatic cancers are described. The literature is reviewed and combined with the experiences of the authors on cryosurgery for management of hepatic tumors. Results The indications and techniques for performing cryosurgery are now well established. The procedure is relatively safe, and long-term survival rates of over 20% may be achieved. Conclusion While cryotherapy is effective for localized tumors in the liver, additional adjuvant approaches are required to control disease in the untreated liver. Endoscopic techniques may minimize patient morbidity.
Gene Therapy of Bladder Control
Authors: Seigne John D. 
Published: August 2017

Background The incidence of bladder cancer has been steadily increasing and, despite improvements in treatment, many patients will not survive five years. Gene therapy is a promising approach that may improve the management of this disease. Methods Gene therapy involves two steps: (1) selection of an appropriate gene and (2) transfer of that gene to the target cells. Results Five broad categories of cancer gene therapy are undergoing clinical evaluation: (1) immunological augmentation by cytokine or (2) foreign gene transfer into tumor cells, (3) insertion of a suicide gene into tumor cells, (4) tumor suppressor gene reconstitution, and (5) bone marrow protection by insertion of a multidrug resistence gene. Conclusions Although many gene transfer approaches have great intuitive appeal, several constraints, including problems with methods of gene transfer, must be overcome before this biologic approach can reach its potential.
Hormonal and Chemotherapeutic Systemic Therapy for Metastatic Prostate Cancer
Authors: Panvichian Ravat , Pienta Kenneth J. 
Published: August 2017

BackgroundProstate cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in men in the United States. It is estimated that over 300,000 men will have been diagnosed with prostate cancer in 1996, and more than 40,000 will have died of this disease.MethodsThe authors combined their experience with a review of the literature on management of this disease to examine the effectiveness of treatments for both localized and metastatic prostate cancer.ResultsSurgery and radiation therapy are potentially curative modalities for cancer still limited to the gland. Androgen ablation therapy results in stabilization or regression of metastatic disease in most instances but is not curative. Some new approaches are described for patients with hormone-refractory prostate cancer.ConclusionsNewer tumor-biology-based combinations are promising in the treatment of hormone-refractory prostate cancer, but their effect on patient survival needs to be evaluated in larger clinical trials.
Hürthle Cell Carcinoma
Authors: Grossman Richard F. , Clark Orlo H. 
Published: August 2017

Background Hürthle cell carcinoma represents approximately 3% of all differentiated thyroid cancers. The terminology is often confusing, and discrimination between Hürthle cell carcinoma and benign Hürthle cell tumors can be unclear. Thus, optimal treatment of patients with these diseases remains unsettled. Methods The authors reviewed published evidence on the presentation, biologic behavior, and treatment outcomes for this disease. In addition, they summarized their experience involving a series of 14 patients with Hürthle cell carcinoma. Results Hürthle cell carcinoma generally produces thyroglobulin and rarely takes up radioactive iodine. It is frequently bilateral or multifocal within the thyroid gland and often presents with local invasion. Hürthle cell carcinoma is associated with a high rate of locoregional recurrence and significant mortality. Conclusions The authors advocate total thyroidectomy with central neck dissection as the therapy of choice for patients with Hürthle cell carcinoma.
Medullary Thyroid Cancer
Authors: Franz Michael G. 
Published: August 2017

BackgroundMedullary thyroid cancer, a tumor of the parafollicular C cells, accounts for approximately 10% of all thyroid malignancies. An estimated 75% of cases are sporadic, and the remaining 25% are familial.MethodsThe author reviews the clinical features and diagnostic tests for this entity, as well as the surgical treatment of recurrent or persistent medullary carcinoma.ResultsSporadic medullary thyroid cancer typically presents as an isolated unilateral mass. Familial tumors tend to be multifocal and bilateral. In patients with multiple endocrine neoplasia type 2A, pheochromocytomas and parathyroid hyperplasia also may develop. Care is taken to avoid operating on a patient with occult pheochromocytoma. Total thyroidectomy and central lymph node dissection are the keys for successful surgical treatment.ConclusionsSurgery is the cornerstone of treatment for medullary carcinoma of the thyroid. Genetic testing using the ret oncogene allows identification of individuals who are at risk for the disease or those with early-stage disease.
Gastrinoma: State of the Art
Authors: Godellas Constantine A. , Fabri Peter J. 
Published: August 2017

Background The Zollinger-Ellison syndrome, implicating a gastrinoma, was first recognized as a disease entity in 1955. At that time, total gastrectomy was the most common treatment approach. Advances in several aspects of the disease have occurred since that time. Methods The authors reviewed the changes that have developed since 1955 in the diagnosis, imaging studies, operative and nonoperative management, and follow-up of patients with this disease. Results The presence of a gastrinoma can be confirmed by a secretin stimulation test. A variable number of patients have hyperparathyroidism as part of the multiple endocrine neoplasm syndrome type 1 (MEN 1). Localization of the primary gastrinoma has been assisted by selective angiography, endoscopic ultrasonography, and the octreotide scan. H2-blockers or omeprazole, sometimes at high doses, usually controls acid secretion. Surgical removal of the primary gastrinoma is performed when feasible, and parathyroidectomy is indicated in those patients with hyperparathyroidism in the MEN 1 syndrome. Follow-up is facilitated by measurement of fasting serum gastrin levels. Conclusions Several innovations have improved our capability to diagnose and effectively manage patients with gastrinoma.
Ethical Issues of Chemoprevention Clinical Trials
Authors: Vogel Victor G. , Parker Lisa S. 
Published: August 2017

BackgroundChemoprevention of malignancy is a new concept in clinical medicine, and little is written about the ethics of identifying and enrolling eligible subjects in chemoprevention clinical trials.MethodsThe authors identify the ethical issues raised in the conduct of clinical chemoprevention trials and review the ethical considerations that should guide clinical researchers in the design and conduct of this new type of clinical trial.ResultsThe ethics of chemoprevention clinical trials are complicated because (1) chemoprevention lies at the intersection of disease management and health promotion, (2) there are conflicting interests competing in these trials, and (3) multiple values play a role in determining the nature and magnitude of the risks and benefits of chemoprevention of cancer. Ethical questions related to these trials concern the enrollment of healthy individuals rather than cancer patients, confidentiality in recruitment, the enrollment of “high-risk” subjects, randomization, informed consent, trial monitoring, and competing outcomes and toxicities.ConclusionsThese issues will be resolved with the accumulating clinical experience and ethical deliberations that accompany ongoing clinical chemoprevention research studies.
Malignancy and Rheumatic Disease
Authors: Valeriano Joanne 
Published: August 2017

Background A wide variety of clinically significant interactions occur between neoplastic and rheumatic diseases, and many are clinically significant. Methods The types of interactions between rheumatologic and neoplastic diseases and their clinical manifestations are reviewed and described. Results Several diseases included in the classic definition of rheumatology are associated with an increased incidence of specific neoplasms. Conversely, many neoplasms, by a variety of mechanisms, can cause or simulate many rheumatic diseases. Conclusions Knowledge of the increased propensity for neoplasia in certain conditions and of the possibility that cancer may be the cause of specific rheumatologic syndromes will assist the physician in providing optimal clinical care to affected patients.
Primary Gastric Lymphoma
Authors: Al-Sheneber Ibrahim , Shibata Henry R. 
Published: August 2017

Background Gastric lymphoma is a common presentation of non-Hodgkin's lymphoma. Controversy reigns about many aspects of its classification and management, especially regarding roles for surgical resection. Methods The authors review the clinical features, staging, pathology, prognosis, and management issues with an emphasis on the role of surgical resection. Results Staging usually can be completed using noninvasive techniques. Those with a low-grade B-cell MALT type lymphoma with Helicobacter pylori infection may be treated with antibiotics and close follow-up. Patients with stage I or II disease may be treated with chemotherapy and radiation. Surgery is indicated for those with perforation or uncontrolled bleeding. Conclusions Gastric lymphoma, primarily a B-cell tumor, can be diagnosed and managed effectively with various approaches. Few prospective, randomized trials of alternative approaches have been performed.
Postoperative and Preoperative Chemotherapy for Non-Small-Cell Lung Cancer
Authors: Bonomi Philip , Faber L. Penfield 
Published: August 2017

Background Few randomized trials of preoperative and postoperative adjuvant systemic therapy have been performed in patients with non-small-cell lung cancer (NSCLC). Methods The authors reviewed the recent literature on comparative trials and meta-analyses to determine the current status of adjuvant therapy for patients with NSCLC. Results Postoperative adjuvant therapy with cisplatin-containing regimens reduces the risk of death by 3% at two years and by 5% at five years. Preoperative therapy can clear tumor in the resected specimen in approximately 15% of cases, and two small trials report substantial survival benefit. Conclusions The development of new and more active regimens for NSCLC may provide the biologic basis for clinical trials to demonstrate more pronounced benefit for adjuvant systemic therapy.
Current Therapy for Mesothelioma
Authors: Sugarbaker David J. , Norberto Jose J. , Bueno Raphael 
Published: August 2017

Background Diffuse malignant pleural mesotheliomas (DMPMs) are highly lethal tumors that are becoming more common. Standard management approaches have provided limited effectiveness. Methods The literature on management has been revised, and the authors present their data on outcomes for 120 patients treated with an aggressive trimodality approach. Results An aggressive trimodality approach including extrapleural pneumonectomy followed by chemoradiation produces low mortality and acceptable morbidity. The five-year survival rate in patients with epithelial histology and negative nodes approaches 40%. Conclusions Nodal status and histologic subtype are major predictors for survival in patients with early DMPM. A uniformly accepted staging system would allow comparison of treatment approaches from various institutions. More effective management interventions are required.
Menopausal Status and the Impact of Early Recurrence on Breast Cancer Survival
Authors: Lyman Gary H. , Kuderer Nicole M. , Lyman Stephen L. , Debus Markus , Minton Susan , Balducci Lodovico , Horton John , Reintgen Douglas , Cox Charles 
Published: August 2017

BackgroundBreast cancer represents the leading form of invasive cancer among American women, killing nearly 50,000 annually. Several prognostic factors that are associated with survival include age, race, menopausal status, and the stage of disease at presentation.MethodsPatient characteristics were collected based on a systematic chart audit of demographic features and medical, family, and social histories. We studied the survival of 220 patients with recurrent disease out of 1,429 consecutive patients with breast cancer seen over a 15-year period.ResultsPatients with a disease-free interval following diagnosis of less than 24 months were more frequently premenopausal and hormone receptor-negative than those with a disease-free interval of 24 months or greater. Patients with early recurrence had a shorter survival than patients with late recurrence. Menopausal status, nodal involvement, receptor status, and the site of recurrent disease were independent predictors of survival following recurrence.ConclusionsPremenopausal women with early recurrence of breast cancer experience a significantly shorter survival than those with late recurrence, even after adjustment for hormone receptor status and site of recurrence. This effect was not seen in postmenopausal women.
Cytogenetic and Molecular Evaluation in Myelodysplastic Syndrome and in Acute and Chronic Leukemia
Authors: Papenhausen Peter R. , Moscinski Lynn C. , Binnie Cameron G. 
Published: August 2017

Background The majority of the presently known nonrandom chromosome changes in hematologic malignancy were described during the 1970s and 1980s. The last 10 years have been devoted to the location of oncogenes and tumor suppressor genes altered as a consequence of those changes. New molecular methodology has helped speed this process, which has resulted in DNA sequencing of many of the genes involved, permitting molecular detection of abnormal clones. Methods This review examines the most common alteration-based subgroups of cytogenetics and molecular genetics in hematologic disorders with the exclusion of lymphoma. Prognosis has been updated to reflect improving treatment protocols. Results The versatility of cytogenetics for delineating genetic changes is difficult to match by molecular testing. Once a clonal anomaly is identified, molecular methodology can detect residual disease with far greater sensitivity than cytogenetics, but relies on translocation junction targets that exclude clones characterized by deletion or trisomy. Conclusions Cytogenetic and molecular testing offers independent diagnostic and prognostic evaluation for most patients with hematologic malignancy.
Leukemia Support Groups: How Are They Doing?
Authors: Moss Donna Corwin 
Published: August 2017

Background Support groups help their participants to cope with the emotional and practical impact of their illnesses. Methods The effectiveness of the Leukemia Society of America support groups in enhancing the quality of life for their participants is reviewed. The groundwork, purpose, and structure of such groups, as well as alternate sources of support, are presented. Evaluation and future directions for oncology groupwork are discussed. Results Support groups complement the therapies provided by clinical practitioners and scientists by addressing the additional needs of cancer patients over the course of illness and survival. Conclusions New concepts and methods that address the needs of specific age-groups and incorporate the newly generated data on cancer treatments will further enhance the benefits provided by support groups.
Lymphatic Mapping for Melanoma: Long-term Results of Regional Nodal Sampling with Radioguided Surgery
Authors: Ramnath Erik M. , Kamath Deepa , Brobeil Andrea , Stall Alec , Kamath Vidya , Cruse C. Wayne , Glass Frank , Messina Jane , Fenske Neil , Berman Claudia , Ross Merrick I. , Cantor Alan , Cuthbertson David , Reintgen Douglas S. 
Published: August 2017

Background Lymphatic mapping and sentinel lymph node (SLN) biopsy are new techniques used in the surgical treatment of patients with malignant melanoma. These procedures have the potential to change the surgical treatment of the disease to provide a more rational approach to adjuvant therapy. Methods A prospective database of melanoma patients undergoing lymphatic mapping and SLN biopsy was reviewed to identify prognostic factors for overall and disease-free survival in this patient population. Results Five-year overall and disease-free survival was 92.3% and 79.0%, with a median follow-up of 17 months. The number of histologically positive SLNs was the most powerful predictor of overall and disease-free survival. Patients with no histologically positive SLNs had a five-year overall and disease-free survival of 97.9% and 93.3%, respectively. Tumor ulceration and Clark level greater than or equal to III were the significant prognostic factors for survival. Conclusions The use of lymphatic mapping and SLN biopsy effectively stages patients with primary cutaneous melanoma. Additionally, the presence of histologically positive SLNs is the most powerful indicator of overall and disease-free survival for these patients.
Cutaneous T-cell Lymphoma
Authors: Glass L. Frank , Keller Karen L. , Messina Jane L. , Dalton John , Yag-Howard Cynthia , Fenske Neil A. 
Published: August 2017

Background: Cutaneous T-cell lymphoma (CTCL) represents a spectrum of diseases composed of malignant helper T lymphocytes. An accurate diagnosis of early CTCL is difficult because of the varied clinical and histologic expressions of the disease. Methods: The authors review the epidemiology, possible risk factors, clinical manifestations, diagnostic techniques, staging, prognosis, and treatment options for CTCL. Results: The varied and often nonspecific clinical and histologic presentations of CTCL may delay diagnosis and staging, thus necessitating further studies such as immunophenotyping flow cytometry, and T-cell receptor gene rearrangement analysis. Conclusions: A multidisciplinary approach to the diagnosis, staging, and treatment of CTCL assists in optimizing outcomes from management of patients with this disease.
Management of Cerebral Metastases: The Role of Surgery
Authors: Lang Frederick F. , Wildrick David M. , Sawaya Raymond 
Published: August 2017

Background: Metastatic brain tumors represent the most common neurological complication in patients with systemic cancer. They are predominantly cerebrally located and constitute a significant source of morbidity and mortality. The overall incidence of brain metastases exceeds that of all other intracranial tumors, and as improved systemic cancer treatments have extended patients’ lives, this number is rising. Methods: The role of surgery in the management of cerebral metastases is reviewed by considering patient selection criteria, surgical approaches to metastases, intraoperative adjuncts, whole-brain irradiation as a postoperative adjuvant, resection of multiple vs single metastases, and the relative roles of stereotactic radiosurgery and conventional surgery. Results: Surgical resection of single or multiple metastases can be effective management for patients with otherwise good prognoses, providing all the known metastases can be removed without producing significant neurologic deficit. Radiosurgery, an alternate approach, can be used for smaller or inaccessible tumors. Conclusions: The presence of multiple brain metastases does not automatically contraindicate surgery because in properly selected patients, resection of multiple metastases can extend survival and enhance the quality of life. An awareness of how the modalities of open craniotomy, whole-brain radiotherapy, and stereotactic radiosurgery best complement each other will result in the best outcomes.
Hematopoietic Cell Transplantation for Multiple Myeloma
Authors: Bensinger William I. 
Published: August 2017

Background Multiple myeloma (MM) is a malignant plasma cell disorder with a median survival of three years. Despite the development of numerous conventional chemotherapy regimens and interferons, there has been little progress in improving the survival of patients with MM. Very high-dose chemoradiotherapy and autologous or allogeneic hematopoetic stem cell transplantation (HSCT) can result in high complete remission rates, even in patients with advanced disease. Methods A prospective, randomized study has shown that autologous HSCT results in superior response rates, progression-free survival, and disease-free survival compared with conventional chemotherapy. This is the first real advance in the treatment of this disease in 30 years. Unfortunately, few, if any, patients with MM who receive autologous HSCT are cured. Results Allogeneic HSCT can be curative for a fraction of patients with MM. However, very high transplant-related morbidity and mortality limit the application of allografts to younger patients with compatible donors. Conclusions Challenges for the future include the development of less intensive or more disease-specific chemotherapy regimens that preserve the antitumor activity but are less toxic, improvement in the control of graft-vs-host disease in the case of allografts and, for autologous graft recipients, the development of vaccines and cytotoxic lymphocytes to augment a graft vs myeloma effect.