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Indications for Minimally Invasive Surgery for Ovarian Cancer

Ernest S. Han and Mark Wakabayashi

ascites volume, to predict which patients may likely undergo optimal debulking procedure. Those that are not candidates for possible optimal tumor debulking surgery would then undergo neoadjuvant chemotherapy followed by interval debulking surgery if an

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Integrating Perioperative Chemotherapy into the Treatment of Muscle-Invasive Bladder Cancer: Strategy Versus Reality

S. Machele Donat

cancer . J Clin Oncol 2005 ; 23 : 4602 – 4608 . 10 Schultz PK Herr HW Zhang ZF . Neoadjuvant chemotherapy for invasive bladder cancer: prognostic factors for survival of patients treated with M-VAC with 5-year follow-up . J Clin Oncol

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Clinical Significance of Histologic Variants of Bladder Cancer

Joshua I. Warrick

-invasive cancers are thus managed definitively, typically with radical cystectomy, which improves survival. 4 Survival is further improved by the addition of neoadjuvant chemotherapy (NAC), usually gemcitabine and cisplatin, or MVAC (methotrexate

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Expanding the Use of Nephron-Sparing Surgery for Wilms Tumor

Christopher J. Long, Sameer Mittal, and Thomas F. Kolon

), depending on the stage of the tumor. Alternatively, SIOP recommends neoadjuvant chemotherapy followed by delayed nephrectomy. Regardless of the approach, surgical resection is a mainstay of treatment. Although nephrotoxicity from chemotherapy, radiation, and

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Optimal Neoadjuvant Strategies for Locally Advanced Rectal Cancer by Risk Assessment and Tumor Location

Anurag Saraf, Hannah J. Roberts, Jennifer Y. Wo, and Aparna R. Parikh

rectal cancer . JAMA Oncol 2018 ; 4 : e180071 . 29566109 10.1001/jamaoncol.2018.0071 25. Conroy T , Bosset JF , Etienne PL , Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally

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A Novel Clinically Based Staging System for Gallbladder Cancer

Siddhartha Yadav, Sri Harsha Tella, Anuhya Kommalapati, Kristin Mara, Kritika Prasai, Mohamed Hamdy Mady, Mohamed Hassan, Rory L. Smoot, Sean P. Cleary, Mark J. Truty, Lewis R. Roberts, and Amit Mahipal

In addition, the current AJCC TNM staging system may not be optimal for patients undergoing neoadjuvant chemotherapy. Therefore, the current staging system is only applicable to a subset of patients with GBC who undergo upfront surgical resection. A

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Cancer Signature Investigation: ERBB2 (HER2)-Activating Mutation and Amplification-Positive Breast Carcinoma Mimicking Lung Primary

Jennifer Shih, Babar Bashir, Karen S. Gustafson, Mark Andrake, Roland L. Dunbrack, Lori J. Goldstein, and Yanis Boumber

, she has experienced an ongoing partial response. Discussion Recurrence of TNBC with residual disease after neoadjuvant chemotherapy is common and predictable. The most common sites for breast recurrence are bones, liver, and lung, and TNBC has

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Sequential Versus Concurrent Chemoradiation Therapy by Surgical Margin Status in Resected Non–Small Cell Lung Cancer

Vivek Verma, Amy C. Moreno, Waqar Haque, Penny Fang, and Steven H. Lin

inclusion criterion for this study was newly diagnosed, primary NSCLC treated with upfront surgery followed by postoperative chemotherapy and RT. Patients who received neoadjuvant chemotherapy and/or RT were excluded. Surgery was defined as an oncologic

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Overuse of Chest CT in Patients With Stage I and II Breast Cancer: An Opportunity to Increase Guidelines Compliance at an NCCN Member Institution

Barbara Dull, Andrew Linkugel, Julie A. Margenthaler, and Amy E. Cyr

, as well as results of fine-needle aspiration or biopsy, if performed. Patients who underwent neoadjuvant chemotherapy were excluded from this study because of inconsistencies in accurately determining stage at diagnosis. Patients with a recurrent

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Practice Patterns and Guideline Adherence of Medical Oncologists in Managing Patients with Early Breast Cancer

Jill A. Foster, Maziar Abdolrasulnia, Hamidreza Doroodchi, Joan McClure, and Linda Casebeer

Background

Studies of adherence to breast cancer guidelines have often focused on primary therapies, but concordance with other guideline recommendations has not been examined as extensively. This study assesses the knowledge and practice patterns of medical oncologists in the United States to inform education and quality improvement initiatives that can improve breast cancer care.

Methods

A survey containing case vignettes and related questions was developed to examine oncologists' clinical decision-making in evaluating and treating women with early breast cancer. The instrument was distributed to a random sample of 742 oncologists in the United States and yielded 205 responses (27.6% response rate). Responses from 184 practicing medical oncologists were analyzed relative to the 2007 NCCN Clinical Practice Guidelines in Oncology: Breast Cancer.

Results

Most oncologists made guideline-consistent choices in clarifying indeterminate human epidermal growth factor 2 (HER2) status (85%), initial treatment for early breast cancer (95%), and postsurgical management of locally advanced breast cancer (82%). Guideline-discordant choices were seen in the lack of clip placement before neoadjuvant chemotherapy (36%), unnecessary use of PET scanning for initial assessment (34%), inappropriate assessment of menopausal status (33%), inappropriate use of tumor markers (22%), and use of chest imaging (16%) during posttherapeutic surveillance.

Conclusions

Oncologists often make guideline-consistent choices, but discordant clinical decisions may occur in important aspects of care for early breast cancer. Broadening the diffusion and adoption of guideline recommendations is an important mechanism for addressing these gaps and may substantially improve the quality of breast cancer care.