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PET/CT and Occult Primary Tumors

Donald A. Podoloff

Within the past 5 years, F-18 fluorodeoxyglucose (FDG) PET/CT has become one of the more frequent imaging modalities in the management of patients with cancer of unknown primary origin. FDG PET/CT detects more sites of metastasis than other modalities, and in 20% to 40% of cases it discloses the site of the primary tumor. Its exact role is yet to be defined because of a lack of prospective clinical trials comparing the performance of PET/CT with conventional anatomic imaging modalities. This article reviews the available literature, attempts to place PET/CT using F-18–labeled FDG in clinical perspective and compares the combined modality with conventional anatomic imaging technologies.

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NCCN Task Force Report: Bone Health in Cancer Care

Julie R. Gralow, J. Sybil Biermann, Azeez Farooki, Monica N. Fornier, Robert F. Gagel, Rashmi Kumar, Georgia Litsas, Rana McKay, Donald A. Podoloff, Sandy Srinivas, and Catherine H. Van Poznak

Bone health and maintenance of bone integrity are important components of comprehensive cancer care. Many patients with cancer are at risk for therapy-induced bone loss, with resultant osteoporotic fractures, or skeletal metastases, which may result in pathologic fractures, hypercalcemia, bone pain, and decline in motility and performance status. Effective screening and timely interventions are essential for reducing bone-related morbidity. Management of long-term bone health requires a broad knowledge base. A multidisciplinary health care team may be needed for optimal assessment and treatment of bone-related issues in patients with cancer. Since publication of the previous NCCN Task Force Report: Bone Health in Cancer Care in 2009, new data have emerged on bone health and treatment, prompting NCCN to convene this multidisciplinary task force to discuss the progress made in optimizing bone health in patients with cancer. In December 2012, the panel members provided didactic presentations on various topics, integrating expert judgment with a review of the key literature. This report summarizes issues surrounding bone health in cancer care presented and discussed during this NCCN Bone Health in Cancer Care Task Force meeting.

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NCCN Task Force Report: Bone Health and Cancer Care

Richard L. Theriault, J. Sybil Biermann, Elizabeth Brown, Adam Brufsky, Laurence Demers, Ravinder K. Grewal, Theresa Guise, Rebecca Jackson, Kevin McEnery, Donald Podoloff, Peter Ravdin, Charles L. Shapiro, Matthew Smith, and Catherine H. Van Poznak

Higher incidences of osteoporosis and osteopenia are found in cancer patients, particularly in women receiving aromatase inhibitors or with chemotherapy-induced ovarian failure, or in men with prostate cancer and androgen deprivation therapy. Therefore, management of long-term bone health is emerging as an important aspect of comprehensive cancer care. Patients with cancer typically have a number of additional risk factors for osteoporosis that should prompt screening, regardless of patient age or sex. Maintaining bone health requires a broad knowledge base, including understanding underlying bone metabolism and how it is affected by both cancer itself and the drugs used to treat cancer, the effect of chemotherapy-induced menopause on bone health, bone markers and imaging techniques used to assess bone health, therapeutic strategies to maintain bone health, and treatment of bone metastases, including surgery for pathologic fractures. Multiple members of the healthcare team may need to be involved in education and care of the patient. This report summarizes discussion of these and other issues regarding bone health and cancer care from the NCCN Bone Health and Cancer Care Task Force meeting in early 2006. (JNCCN 2006;4(Suppl 2):S1-S24)

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NCCN Task Force: Clinical Utility of PET in a Variety of Tumor Types

Donald A. Podoloff, Douglas W. Ball, Edgar Ben-Josef, Al B. Benson III, Steven J. Cohen, R. Edward Coleman, Dominique Delbeke, Maria Ho, David H. Ilson, Gregory P. Kalemkerian, Richard J. Lee, Jay S. Loeffler, Homer A. Macapinlac, Robert J. Morgan Jr., Barry Alan Siegel, Seema Singhal, Douglas S. Tyler, and Richard J. Wong

Use of PET is widespread and increasing in the United States, mainly for oncologic applications. In November 2006, the National Comprehensive Cancer Network (NCCN) gathered a panel of experts to review the literature and develop clinical recommendations for using PET scans in lymphoma and non–small cell lung, breast, and colorectal cancers. However, because its use is not restricted to these diseases, and evidence is accumulating for its application in other types of cancers, NCCN convened a second meeting in December 2008 to expand on the initial report. A multidisciplinary panel met to discuss the current data on PET application for various tumor types, including genitourinary, gynecologic, pancreatic, hepatobiliary, thyroid, brain, small cell lung, gastric, and esophageal cancers, and sarcoma and myeloma. This report summarizes the proceedings of this meeting, including discussions of the background of PET, the role of PET in oncology, principles of PET use, emerging applications, and possible future developments.

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NCCN Task Force Report: Positron Emission Tomography (PET)/Computed Tomography (CT) Scanning in Cancer

Donald A. Podoloff, Ranjana H. Advani, Craig Allred, Al B. Benson III, Elizabeth Brown, Harold J. Burstein, Robert W. Carlson, R. Edward Coleman, Myron S. Czuczman, Dominique Delbeke, Stephen B. Edge, David S. Ettinger, Frederic W. Grannis Jr., Bruce E. Hillner, John M. Hoffman, Krystyna Kiel, Ritsuko Komaki, Steven M. Larson, David A. Mankoff, Kenneth E. Rosenzweig, John M. Skibber, Joachim Yahalom, JQ Michael Yu, and Andrew D. Zelenetz

The use of positron emission tomography (PET) is increasing rapidly in the United States, with the most common use of PET scanning related to oncology. It is especially useful in the staging and management of lymphoma, lung cancer, and colorectal cancer, according to a panel of expert radiologists, surgeons, radiation oncologists, nuclear medicine physicians, medical oncologists, and general internists convened in November 2006 by the National Comprehensive Cancer Network. The Task Force was charged with reviewing existing data and developing clinical recommendations for the use of PET scans in the evaluation and management of breast cancer, colon cancer, non-small cell lung cancer, and lymphoma. This report summarizes the proceedings of this meeting, including discussions of the background of PET, possible future developments, and the role of PET in oncology. (JNCCN 2007;5(Suppl 1):S1–S22)