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Davide Mauri, Antonis Valachis, Nikolaos P. Polyzos, Lamprini Tsali, Dimitris Mavroudis, Vassilis Georgoulias and Giovanni Casazza

adjuvant setting of breast cancer might have any effect on the natural course of the disease. Most specifically, they investigated for any beneficial effects on overall survival, prevention of disease recurrences, and occurrence of bone metastases

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Aatur D. Singhi, Siraj M. Ali, Jill Lacy, Andrew Hendifar, Khanh Nguyen, Jamie Koo, Jon H. Chung, Joel Greenbowe, Jeffrey S. Ross, Marina N. Nikiforova, Herbert J. Zeh, Inderpal S. Sarkaria, Anil Dasyam and Nathan Bahary

) resection. (A) An increase in serum CA 19-9 levels was associated with disease recurrence and the disease initially responded to gemcitabine and nab-paclitaxel. The patient soon developed chemotoxicity, which necessitated cessation of therapy. On

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Joyce Liu and Ursula Matulonis

Ovarian cancer remains the leading cause of death among women with gynecologic malignancies, and the fifth leading cause of cancer mortality in women in the United States. Although many patients respond to first-line platinum-based therapy, most will experience disease recurrence. The role of further therapy in the setting of recurrent ovarian cancer is palliative, and large randomized phase III trials on treatment options for recurrent ovarian cancer are rare. Controversies exist as to the optimal timing and duration of treatment, and many issues regarding treatment of recurrent disease remain.

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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.

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Maria A. Kouvaraki, Suzanne E. Shapiro, Jeffrey E. Lee, Douglas B. Evans and Nancy D. Perrier

Thyroid carcinoma has a unique biologic behavior characterized by early spread to regional lymph nodes and occasional extrathyroidal soft tissue extension but a low incidence of distant metastasis and infrequent disease-related death. Therefore, controversy exists over the proper extent of thyroidectomy and regional lymph node dissection in patients with differentiated thyroid carcinoma (DTC) and medullary thyroid carcinoma (MTC). The modest disease-specific mortality makes it unlikely that the extent of surgery will ever be the subject of a prospective randomized trial. Although more extensive cervical surgery may have only a limited effect on the duration of survival in patients with DTC, it may significantly improve quality of life by minimizing cervical recurrence. The high rates of cervical recurrence in patients with DTC and MTC have alerted physicians to the importance of fine-needle aspiration biopsy and ultrasonography for the diagnosis, preoperative staging, and follow-up of thyroid cancer. In patients with MTC, death caused by disease is uncommon in the absence of radiographically evident distant metastasis at the time of thyroidectomy. Cervical recurrence is even more common with MTC, and the need for compartment-oriented lymphadenectomy is accepted as standard surgical treatment to minimize disease recurrence. Postoperatively, calcitonin (CT) levels can be used to guide clinical management, but basal CT levels should not be used to direct the timing of prophylactic thyroidectomy in affected high-risk patients with familial MTC.

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Stuart L. Cramer, Rong Li, Siraj Ali, Julie A. Bradley, Hee K. Kim and Joseph G. Pressey

Primitive myxoid mesenchymal tumor of infancy (PMMTI) is a rare tumor with <20 cases reported to date. Recently PMMTI tumors have been found to harbor BCOR internal tandem duplication (ITD), the same genetic alteration detected in clear cell sarcoma of the kidney (CCSK). Complete surgical resection of PMMTI is often curative, but no standard of care has been established for unresectable tumors. We describe a female patient who presented at 13 months of age with a paraspinal mass and spinal cord compression. Histology was consistent with PMMTI, and the tumor was found to harbor BCOR ITD. The patient experienced disease recurrences after multiple surgical resections. After failing to respond to vincristine and actinomycin therapy, the patient demonstrated a nearly complete response to a doxorubicin-containing chemotherapy regimen. The patient's therapy was consolidated with proton beam radiotherapy, and she has remained in remission for >12 months after the conclusion of therapy. This case confirms BCOR ITD as a key finding in PMMTI. The therapeutic approach described here is similar to that used for CCSK and provides a model for the treatment of PMMTI not amenable to complete surgical resection.

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different time points: at diagnosis, after completion of induction chemotherapy, after completion of chemoradiation, after surgery, and at the time of disease recurrence, if this occurs. The aim is to correlate the ctDNA level with disease recurrence and

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different time points: at diagnosis, after completion of induction chemotherapy, after completion of chemoradiation, after surgery, and at the time of disease recurrence, if this occurs. The aim is to correlate the ctDNA level with disease recurrence and

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Rodger J. Winn

preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer . J Natl Cancer Inst 1998 ; 90 : 766 – 771 . 4 Cooperberg MR Broering JM Litwin MS . The contemporary management of prostate cancer in the United

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have an extremely high risk of disease recurrence and death despite definitive surgical resection. In this single-center phase II trial, patients with surgically resected stage IIIC melanoma characterized by a BRAF V600E or BRAF V600K mutation will