intervention strategies . Health Promot Int 1997 ; 12 : 27 – 32 . 3. Jiles R Hughes E Murphy W . Surveillance for certain health behaviors among states and selected local areas: behavioral risk factor surveillance system, United States, 2003
Christopher E. Desch
Normal thyrocytes and thyroid cancer cells are characterized by possession of a sodium iodide symporter. Radioiodine administration is a unique and powerful means of treating differentiated thyroid cancer because of the ability of thyroid cancer cells to concentrate beta-emitting radiolabeled iodine. Several manipulations, such as iodine depletion and thyroid hormone-stimulating hormone elevation, are used to enhance uptake of radiolabeled iodine by tumor cells. Adjuvant radioiodine therapy, given to patients without evidence of residual disease, enhances the sensitivity of subsequent surveillance and may decrease recurrence rates and mortality. However, its exact role in the management of low-risk patients merits further investigation. In contrast, radioactive iodine therapy used in patients with residual or metastatic disease clearly improves outcomes. Several studies show decreased recurrence and mortality rates in patients treated with radioiodine compared with those not receiving radioactive iodine. Adverse events from radioiodine therapy include salivary gland dysfunction, bone marrow suppression, and reproductive disturbances. Side effects of radioiodine therapy are generally greater when higher activities of radioiodine are used and may be transient or permanent. Secondary malignancies also may occur after radioiodine therapy. These side effects must be weighed against potential benefits, especially when radioactive iodine is used as adjuvant therapy. Stimulation of the expression of the sodium iodide symporter, or its introduction de novo into nonthyroid cells, is promising in treating poorly differentiated thyroid cancer and nonthyroid malignancies, respectively.
Allan C. Halpern and Sanjay K. Mandal
Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.
Bethany L. Niell
% will be alive 5 years after diagnosis. 1 As a result, >3.4 million women in the United States are living with a breast cancer diagnosis. 1 Many of these women may undergo surveillance imaging for recurrent, metastatic, or second primary breast cancer
Stuart A. Grossman, Susannah Ellsworth, Jian Campian, Aaron T. Wild, Joseph M. Herman, Dan Laheru, Malcolm Brock, Ani Balmanoukian and Xiaobu Ye
Background: The immune system plays an important role in cancer surveillance and therapy. Chemoradiation can cause severe treatment-related lymphopenia (TRL) (<500 cells/mm3) that is associated with reduced survival. Materials and Methods: Data from 4 independent solid tumor studies on serial lymphocyte counts, prognostic factors, treatment, and survival were collected and analyzed. The data set included 297 patients with newly diagnosed malignant glioma (N=96), resected pancreatic cancer (N=53), unresectable pancreatic cancer (N=101), and non–small cell lung cancer (N=47). Results: Pretreatment lymphocyte counts were normal in 83% of the patient population, and no patient had severe baseline lymphopenia. Two months after initiating chemoradiation, 43% developed severe and persistent lymphopenia (P=.001). An increased risk for death was attributable to TRL in each cancer cohort (gliomas: hazard rate [HR], 1.8; 95% CI, 1.13–2.87; resected pancreas: HR, 2.2; 95% CI, 1.17–4.12; unresected pancreas: HR, 2.9; 95% CI, 1.53–5.42; and lung: HR, 1.7; 95% CI, 0.8–3.61) and in the entire study population regardless of pathologic findings (HR, 2.1; 95% CI, 1.54–2.78; P<.0001). Severe TRL was observed in more than 40% of patients 2 months after initiating chemoradiation, regardless of histology or chemotherapy regimen, and was independently associated with shorter survival from tumor progression. Conclusions: Increased attention and research should be focused on the cause, prevention, and reversal of this unintended consequence of cancer treatment that seems to be related to survival in patients with solid tumors.
Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Asher Chanan-Khan, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Cristina Gasparetto, Carol Ann Huff, Madan Jagasia, Bruno C. Medeiros, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Guido Tricot, Julie M. Vose, Donna Weber, Joachim Yahalom and Furhan Yunus
Susan O'Brien, Ellin Berman, Hossein Borghaei, Daniel J. DeAngelo, Marcel P. Devetten, Steven Devine, Harry P. Erba, Jason Gotlib, Madan Jagasia, Joseph O. Moore, Tariq Mughal, Javier Pinilla-Ibarz, Jerald P. Radich, Neil P. Shah, Paul J. Shami, B. Douglas Smith, David S. Snyder, Martin S. Tallman, Moshe Talpaz and Meir Wetzler
Karen Hock and Cari Utendorf
surveillance. Methods: The prehabiliation model of care at The Stefanie Spielaman Comprehensive Breast Center was initiated in January 2018. This model includes a comprehensive physical therapy evaluation; assessing shoulder range of motion, posture, girth
Surveillance Monitoring More Stringent in Updated NCCN Guidelines for Prostate Cancer Active surveillance or immediate treatment? The question that many men with prostate cancer and their clinicians struggle with continues to be a focus in the updated NCCN
Clair J. Beard, Shilpa Gupta, Robert J. Motzer, Elizabeth K. O'Donnell, Elizabeth R. Plimack, Kim A. Margolin, Charles J. Ryan, Joel Sheinfeld and Darren R. Feldman
testicle, who choose an active surveillance management strategy. Active surveillance implies careful monitoring of patients, with treatment reserved exclusively for those who experience disease relapse. Patients with stage I disease must have no