-related event (SRE). 4 , 5 Considerable evidence from randomized controlled trials supports the use of bisphosphonates. Pamidronate and zoledronic acid have been shown to significantly reduce SREs (defined as pathologic fracture, radiation to bone, surgery on
Siyang Leng, Yizhen Chen, Wei-Yann Tsai, Divaya Bhutani, Grace C. Hillyer, Emerson Lim, Melissa K. Accordino, Jason D. Wright, Dawn L. Hershman, Suzanne Lentzsch, and Alfred I. Neugut
Timothy J. Wilt and Philipp Dahm
the United Kingdom–based ProtecT screening trial are expected soon and will be informative. 16 Recent treatment trials for localized disease demonstrate that reductions as a result of surgery compared with observation in prostate cancer or all
Timothy Paul Hanna, Geoffrey Paul Delaney, and Michael Bernard Barton
absolute proportional benefit (LC or OS) of RT alone over no treatment for radical RT indications. For adjuvant indications, RT benefit was the benefit of RT over surgery alone. For radical indications, the survival benefit was estimated to be equal to the
Yuefeng Wang, Xinhua Yu, Nan Zhao, Jiajing Wang, Chi Lin, Enrique W. Izaguirre, Michael Farmer, Gary Tian, Bradley Somer, Nilesh Dubal, David L. Schwartz, Matthew T. Ballo, and Noam A. VanderWalde
squamous cell carcinoma of the anus treated with upfront chemotherapy ( supplemental eFigure 1, available with this article at JNCCN.org ). Patients who received no treatments, whose treatment was unknown, who received RT alone or surgery, and who were
Arkadiusz Spychala, Michal Oko, Olga Zając-Spychala, and Witold Kycler
’ knowledge about their disease and treatment, while thyroid-specific HRQOL was measured using Polish version of ThyPRO questionnaire and stress level by COPE Inventory. Assessments were done directly before the surgery (T1), 3 months after (T2), and 6 months
Mark H. Kawachi
Robot-assisted laparoscopic prostatectomy (RALP) has gained immense popularity. This article examines the most critical outcome measures in prostate cancer surgery and shows the reasons why this technique is gaining in popularity. Operative time, length of stay, blood loss, transfusions, postoperative pain, continence, potency, and cancer control all favor or tend toward improvement and benefit in RALP compared with traditional radical retropubic prostatectomy. In addition, as even greater experience and technological improvements are incorporated, further outcome improvements will be appreciated. RALP is now an accepted treatment option for prostate cancer and may soon be the most desirable treatment of prostate cancer patients.
Advanced germ cell cancer can be cured in most patients using chemotherapy with or without surgery. A small fraction of patients with nonseminomatous tumors (NSGCT) and an even smaller percentage of seminoma patients are destined to have a less favorable outcome, due to an inadequate response to first-line chemotherapy (failure to achieve remission, finding of residual viable carcinoma at post-chemotherapy surgery, or relapse after achieving a remission). Despite the apparent salvage potential for regimens containing ifosfamide or paclitaxel, no proof exists that such combinations are superior to the standard regimen of four cycles of cisplatin, etoposide, and bleomycin (PEB) in the front-line therapy of patients with advanced NSGCT. Other modifications of first-line therapy, such as the addition of paclitaxel or the use of escalated doses of cisplatin, also have failed to increase the cure rate. The use of single or tandem cycles of high-dose chemotherapy (HDT with autologous hematopoietic cell transplant [aHCT]) in various settings (for selected patients with poor prognostic features before therapy, patients predicted to have a poor outcome based on the rate of serum tumor marker decline while on therapy, and patients in relapse or failure to achieve adequate response to standard therapy) has been evaluated in many phase II and a limited number of phase III trials, which are summarized in this review. Important questions that remain to be answered include the role of new agents and the use of more sophisticated techniques to understand prognostic and predictive factors in selecting therapy for GCT.
The 2007 National Comprehensive Cancer Network Breast Cancer Clinical Practice Guidelines in Oncology include a consideration for hyperthermia (HT) and radiation for women with recurrent locoregional advanced breast cancers after first-line surgery or radiation failed. Although HT in this setting has been used for several decades, recent reports are few. This article reviews the data from several recent studies, selected because they included at least 100 patients. Unresolved issues of radiation dose, optimal temperature and timing of HT, and quality assurance problems with thermometry are apparent from these studies. Although clearly an effective treatment option in this clinical scenario, more research on HT and radiation is needed before this treatment combination can be considered standard care.
Jacob P. Laubach, Constantine S. Mitsiades, Anuj Mahindra, Robert L. Schlossman, Teru Hideshima, Dharminder Chauhan, Nicole A. Carreau, Irene M. Ghobrial, Noopur Raje, Nikhil C. Munshi, Kenneth C. Anderson, and Paul G. Richardson
Multiple myeloma (MM) is a clonal B-cell malignancy characterized by aberrant expansion of plasma cells within bone marrow and extramedullary sites. In 2009, 20,580 new cases of MM and 10,580 deaths from the disease occurred in the United States. Treatment traditionally consists of systemic chemotherapy, with adjunctive use of radiation or surgery in selected cases associated with extramedullary disease. The therapeutic landscape in MM has changed markedly in the past decade with the introduction of the novel immunomodulatory agents thalidomide and lenalidomide, and the first-in-class proteasome inhibitor bortezomib. Although MM remains an incurable malignancy, new approaches to therapy incorporating these agents have produced significantly higher response rates and improved intervals of both progression-free and overall survival in the context of randomized, controlled trials. In aggregate, the use of novel therapies in MM has been associated with substantial improvements in patient outcome.
Andrew H. Ko and Margaret A. Tempero
Pancreatic adenocarcinoma represents the fourth-leading cause of cancer-related mortality in the United States. The vast majority of patients are diagnosed at advanced stages of the disease when surgery is no longer an option. For these patients, systemic therapy remains the mainstay of care. Although single-agent gemcitabine has remained the standard of care since its approval in 1997, improvements in patient outcomes may potentially be realized by (1) applying pharmacokinetic principles to optimize drug delivery, such as the administration of gemcitabine at a “fixed-dose rate” infusion; (2) combining gemcitabine with other cytotoxic agents for which evidence of synergy exists, such as platinum compounds; and (3) integrating novel targeted agents such as bevacizumab, erlotinib, and cetuximab into treatment paradigms, based on an increasing understanding of the molecular pathways that govern pancreatic tumor growth and maintenance. This article provides the evidence to support each of these approaches and highlights future directions in the management of metastatic pancreatic cancer.