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Matthew E. Nielsen, Bruce J. Trock and Patrick C. Walsh

associated with a significant 3-fold increase in PCSS versus no salvage therapy (HR, 0.32; 95% CI, 0.19–0.54; P < .001). Among men who underwent salvage RT, the median radiation dose was 66.6 Gy and the median time from recurrence to initiating salvage RT

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Eli Rosenbaum, Alan Partin and Mario A. Eisenberger

After local treatment, a substantial proportion of patients with prostate cancer present with rising prostate specific antigen (PSA) serum levels as the only indication of disease activity. Evolving data derived from large databases that were predominantly retrospectively evaluated show that the natural history of these patients is quite variable. Various clinical and pathologic parameters have been shown to predict for the probability of development of distant metastasis, including the surgical Gleason score, time of PSA relapse after primary treatment, and PSA doubling time (PSADT). The PSADT appears to be the most important predictor of development of distant metastasis and prostate cancer-specific mortality. At present, no data support a standard management approach for these patients, and clinical trials pose a major challenge in view of the methodologic complexities involved. Patients and treating physicians should make major efforts to participate in clinical trials in this patient population.

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Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Edward A. Faber Jr, Cristina Gasparetto, Francisco Hernandez-Illizaliturri, Carol Ann Huff, Adetola Kassim, Amrita Y. Krishnan, Michael Liedtke, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Steven P. Treon, Donna Weber, Joachim Yahalom, Furhan Yunus, Dorothy A. Shead and Rashmi Kumar

options for salvage therapy and strategies to mitigate the adverse effects and risks associated with newer regimens for the treatment of MM. Treatment of Progressive or Relapsed Myeloma Salvage therapy is considered for progressive or relapsed MM

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Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Edward A. Faber Jr, Christine Gasparetto, Francisco Hernandez-Ilizaliturri, Carol Ann Huff, Adetola Kassim, Amrita Y. Krishnan, Bruno C. Medeiros, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Steven P. Treon, Guido Tricot, Donna M. Weber, Joachim Yahalom, Furhan Yunus, Rashmi Kumar and Dorothy A. Shead

include the addition of regimens containing novel agents as primary and salvage therapy options; the inclusion of updated summary of response categories and criteria from the sixth international workshop on Waldenström’s Macroglobulinemia; and a section on

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Julian C. Schink and Larry J. Copeland

with ChemoFx and overall survival in primary ovarian cancer. Am J Obstet Gynecol 2010;203: 68.e1–6. Can We Continue to Rely Solely on Clinical Features in Our Selection of Salvage Therapy? Prognostic factors for women with recurrent

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Huntsman Cancer Institute at the University of Utah

Multiple myeloma will account for an estimated 16,570 new cancer cases in the United States in 2006, with an estimated 11,310 deaths. It is not currently considered curable; however, treatment has evolved rapidly because of new drugs such as bortezomib, thalidomide, and lenalidomide. In addition, increased understanding of the bone marrow microenvironment is creating rationale for new combinations and new drug development. Important updates in the 2007 NCCN guidelines include new recommended single-agent and combination regimens for consideration for induction and salvage therapy.

For the most recent version of the guidelines, please visit NCCN.org

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John M. Skibber

Local excision can be a definitive surgical procedure for some early cancers of the rectum, and it is an appealing technique in many ways. It reduces overall surgical trauma and can assure sphincter preservation. It is also associated with low morbidity. However, this technique has a number of limitations also. This article discusses the results of local excision for rectal carcinoma, including histologic features that impact survival and local recurrence-free rates, the importance of careful patient selection, and the potential role of adjuvant and salvage therapies. Technical considerations and alternative therapies are also discussed.

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Keyvan Moghissi

Traditional treatment options for esophageal cancer have centered on the triad of surgery, chemotherapy, and radiotherapy. Although surgery remains the gold standard for operable disease, photodynamic therapy (PDT) is emerging as a valid minimally invasive option for select patients with inoperable disease. Years of experience with PDT for esophageal cancer seem to suggest that it may be particularly useful for treatment of early unresectable lesions, palliation of locally advanced disease, and salvage therapy for stent blockage or local tumor recurrence. Further investigation into the ideal role for PDT, perhaps through a comparative study with other nonsurgical options, may help clarify where it fits in the treatment armamentarium for esophageal cancer.

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The University of Michigan Comprehensive Cancer Center

The incidence of primary malignant brain tumors is increasing, especially in the elderly, and metastatic disease to the central nervous system (CNS) occurs even more frequently (an incidence about 10 times that of primary brain tumors). In fact, estimates are that 20% to 40% of patients with systemic cancer will develop brain metastases. Primary and metastatic brain tumors are heterogeneous, with varied outcomes and management strategies. This marked heterogeneity means that prognostic features and treatment options must be carefully reviewed for each patient. As these guidelines note, the involvement of an interdisciplinary team is key in the appropriate management of these patients. Important updates to the guidelines include the addition of systemic chemotherapy as a salvage therapy treatment option for local recurrence and limited metastatic lesions and its deletion as an option for multiple metastatic lesions.

For the most recent version of the guidelines, please visit NCCN.org

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% reporting a preference for HDT/ASCR consolidation after CHOP+/-R induction. Figure 1 Preferred induction therapy. In the relapsed setting ( Figure 2 ), bendamustine+/-R was the most commonly preferred salvage therapy for oncologists in the